Page:Transactions of the Royal Society of Tropical Medicine and Hygiene, volume 1.djvu/194

166 been shown to be coincident with the presence of an adult worm in the thoracic duct.

We must remember that chyluria is not a common disease in tropical countries where filariasis is common. In West Africa, where it has been shown that a high degree of filarial infection exists, I have not seen a single case in eighteen years, and have only heard of one. In Fiji, where a high degree of filarial infection also exists, Finucane states that chyluria is rare, and in other tropical countries the same may be said.

Chyluria occurs in temperate countries, but here also is rare. Osier describes a case of well-marked chyluria in which he was able to make a thorough dissection of the thoracic lymph vessels, which were perfectly normal, and adds that the pathology of the condition is unknown. We are, then, in this position, so far as chyluria is concerned, that it may exist without obstruction of the thoracic duct, and with obstruction of the thoracic duct, but I do not think that until we have more evidence of the presence of an adult worm in the obstruction, we are justified in definitely stating that this is one of the diseases which is due to F. bancrofti.

Another suggestion is that the obstruction of the thoracic duct may be produced by haemorrhage caused by the worm, as evidence has been found of an organised coagulum in the duct. Here, again, this is mere speculation, and, as a matter of fact, it is a very difficult matter to distinguish between the results of organised clot and the fibrosis of inflammatory action. In any case, we should also have to explain why the worm causes haemorrhage in some cases and not in others.

In connection with obstruction of the thoracic duct I should like to show here a case for which I am indebted to the kindness of Dr. Bernstein, as it illustrates the effect of obstruction in a certain position. You will see that it has