Page:Transactions of the Royal Society of Tropical Medicine and Hygiene, volume 1.djvu/193

Rh or kink, when it may fold up again and again, with the ever-increasing pressure behind it. But unless this occurred in the thoracic duct, it could not interfere extensively with the general lymphatic circulation.

I show here an illustration of the lymphatics of the lower limb, not, I may say, with any wish to teach the anatomy of the lymphatic system, but simply to illustrate my points, and I am sure you will agree with me that it is very difficult to see how any one worm can produce a complete obstruction of any given lymphatic area.

Chyluria is, however, a disease which is distinctly claimed as being produced by obstruction of the thoracic duct by filaria, and I believe the case upon which this opinion is founded is the classical one of Sir Stephen Mackenzie's, which was published in 1882, upon which I should like to say a few words. I do not wish to take up your time by going into details of this case, but, briefly, it was a case where there was chyluria, with the presence of embryo nocturna in the blood and urine. Subsequently the embryos disappeared from the blood, and the chyluria improved. Then an abscess formed in the upper part of the chest, and, concurrently, there developed a lung affection, which was shown at the post-mortem to be pleurisy and empyema. From this the patient died. At the post-mortem there was marked inflammatory changes at the upper part of the thoracic duct, with occlusion. There was no trace of an adult worm having caused the obstruction. To my mind, on reading the case very carefully, there is no evidence that the obstruction was caused by F. bancrofti, the presence of the embryos merely showing the presence of an adult somewhere, and it is important to note that though the chyluria improved before death, a very marked obstruction was found.

I have been unable to And any case where chyluria has