19 , 3 
Maxwell: Filariasis in China 
299 
under provocation, such as is afforded by an attack of elephantoid 
fever, and in the intervals the urine is perfectly normal. It is 
important to bear this in mind, as the practitioner in a filarial 
region is sure, sooner or later, to meet with patients who complain 
of having passed bloody urine, in whom the urine is normal at 
time of consultation ; in such cases the explanation is that they 
have had an attack of chyluria of sanguineous hue and, on 
questioning these patients carefully, the point may be elicited that 
they had an attack of fever at the time. In what have been called 
the intermittent cases the attack lasts a day or two at the longest. 
The cases that have been called permanent are not truly so, 
for with rare exceptions the chyluria does not continue per- 
manent through life ; but it may last weeks or months at a time, 
then intermit, and at an uncertain and variable time reappear. 
It must be remembered that the disappearance of the milky 
nature of the urine is not proof that the fistula is closed, as the 
urine may still contain proof of the lymphatic connection in the 
presence of albumen, lymph corpuscles, and a gelatinous clot. 
Rarely, retention of urine from clot formation is the first sign 
of chyluria ; and although it is true that in most cases this re- 
tention passes away spontaneously in the course of a few hours 
by the passage of the offending clots, yet their occurrence gives 
the patient much pain and inconvenience. 
The general health of the subject of this disease is, on the 
whole, fairly good ; but if the drain of chyle is 'severe, the patient 
may become anaemic, depressed, and melancholic. 
The patient generally notices the color of the urine himself; 
but if its milky nature is not marked, the doctor may be the first 
to discover it in the course of a routine examination of his pa- 
tient. The urine may be markedly milky, or pinkish, or red, 
and this color may vary widely in the course of a single day. 
It may pass from milkiness to limpidity in a couple of hours. 
The nature of the food taken also makes a great difference in 
the appearance of the urine, as will be noted in more detail when 
we come to speak of treatment. 
What are the characters of chylous urine? As to odor, this 
may be best described as heavy and urinous. This urine 
decomposes very rapidly in hot climates. Whether decomposi- 
tion would take place with the same rapidity in a cold climate 
is open to doubt, but I have no data on this point. It is said that 
the quantity of urine passed is in excess of the normal ; but the 
quantity of urine passed, especially in a hot climate, depends so 
