PATHOLOGY 



1601 



e.g., Young found six females and one male in such a bundle — and 

 they may be discovered behind a valve or in a dilated sinus. A 

 single female worm may, however, be found lying in a dilated 

 lymphatic, the draining gland being probably blocked by the 

 aborted ova. The irritation caused by the worms may lead to a 

 permanent blocking of a main lymph channel, which will persist 

 even after the irritating worms have died and disappeared, as has 

 been observed by Mackenzie; or, again, the thoracic duct may be 

 found dilated in part of its course, but quite patent throughout, 

 though associated with enormous varicose glands and vessels and a 

 complete absence of worms, which simply means that the parasites 

 having caused the lesions have died and disappeared. 



Low and Bahr have shown that the worms lead to great fibrosis 

 in the glands, and that lymphocytes are collected in clusters between 

 the strands of this tissue. This fibrosis is associated with an 

 excessive number of eosinophile cells in the glandular substance. 



In chylous extravasations the blocking of the thoracic duct leads 

 to engorgement of the renal, the lumbar, and the pelvic lymphatic 

 channels with lymph, as well as that of engorgement and dilatation 

 of the lacteal vessels themselves. 



If the lymphatic vessels of the bladder or other parts of the 

 urinary tract rupture as a consequence of this pressure, the result 

 will be chyluria, and if, as often happens, some bloodvessels also 

 rupture, there will be hsemato-chyluria. Wise states that in chyluria 

 the milky opacity is due to a large amount of proteid, and not to 

 fat, and this observation has been confirmed by Low, who in one 

 case found the lacteals normal, and showed that the milky fluid 

 was lymph proceeding from dilated lymphatics in the kidneys, 

 ureter, and bladder. If the abdominal lymphatics rupture, there 

 will be chylous ascites; if those of the tunica vaginalis, there will 

 be chylocele. 



If, on the other hand, the obstruction is posterior to the junction 

 of the lacteals with the receptaculum chyli, then ordinary ascites, 

 hydrocele, and varicose lymphatics of the scrotum (lymph scrotum), 

 of the leg, and varicose groin glands, will result. More rarely the 

 lymphatics of the arm may be affected in the same manner. 



The lowered resistance of the tissues engorged with lymph 

 renders them specially liable to inflammation, which may at times 

 go on to abscess-formation, and which, if often repeated, will end 

 in elephantiasis. 



Manson believes that elephantiasis arises by a damage to the 

 female worm, causing her to produce immature embryos, which lie 

 coiled up in the egg-shell, instead of stretching it considerably. 

 The immature egg is 50 in length by 34 /x in breadth, while the 

 fully-developed Microfilaria is 250 to 300 /x in length by 5 to 8 /x 

 in breadth; therefore it is not difficult to imagine that a lymphatic, 

 along which the slim Microfilaria passes with ease, might be quite 

 blocked by the immature egg, and that if sufficient channels in the 

 skin or in the lymphatic glands were blocked, lymph stasis would 



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