HJEMATOZOON INHABITING- HITMAN BLOOD: CIIYLURIA AND OTHER DISEASES. T, T?. LEWIS, M.B., , iBOEfl; DUTY) ATTACH MITARY COMMISSIONEH WITH THE GOVEHXM ' in C A L C IT T T A : VERXMEXT PRIXTIXti. 1872. B. FRIEDLANDER & SOHN Buehhandlung Berlin N.W. 6. 11. Carlatrasee 11. THE LIBRARY OF THE UNIVERSITY OF CALIFORNIA PRESENTED BY PROF. CHARLES A. KOFOID AND MRS. PRUDENCE W. KOFOID 4^ ON A HJEMATOZOON INHABITING HUMAN BLOOD ITS RELATION TO CHYLURIA AND OTHER DISEASES, TIMOTHY RICHARDS LEWIS, M.B., ASSISTANT-SURGEON, H.M. BRITISH FORCES ; (OH SPECIAL DUTY) ATTACHED TO THE SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. CALCUTTA: OFFICE OF THE SUPERINTENDENT OF GOVERNMENT PRINTING. 1872. 19 CONTENTS. Introductory remarks showing that ' Hsematozoa,' strictly so called, had not hitherto been demonstrated to exist in man ... ... 3 Hsematozoa in human blood, when first discovered ... ... 5 Similar worms detected in the urine more than two years previously details of case ... ... ... ... ... 5 Name provisionally adopted for the Hsematozoon : ' Filaria sanguinis hominis' ... ... ... ... ... 7 Particulars concerning the man in whom this Filaria was first detected in the blood ... ... ... ... ... 8 The medical history of a native woman suffering from Chyluria Filariae in the blood ... ... ... ... ... 9 Another case of Chyluria with extreme infection of the blood with Filarise 11 Approximate number of Hsematozoa in the circulation of this person ... 12 Filariae detected in the copious secretion from the eye-lids of the same person ... ... ... ... ... ... 13 The medical history of a European woman whose blood was invaded by Haematozoa ... ... ,.. ... ... 14 Fatal termination of the above case and post-mortem appearances ... 15 Method adopted for the detection of Hsematozoa in the circulation ... 18 Magnifying powers advisable to employ ... ... ... 19 The general aspect of the Haematozoon during life ... ... 20 The general aspect of the worm after death ... ... ... 23 The minute anatomy of the Hsematozoon ... ... ... 24 Its average measurements ... ... ... ... 30 The Hsematozoon, Trichina spiralis, and the Guinea-worm compared ... 30 Kesult of microscopical examination of the kidneys and supra-renal capsules of a person in whose blood Filarise existed ... ... 33 The general aspect and chemical constitution of Chylous urine ... 35 Microscopical examination of Chylous urine Filarise usually abundant... 36 The difficulty sometimes experienced in detecting the Filarise in the urine illustrative case ... ... ... ... ... 37 The salient features of Chyluria ... ... 39 2 . CONTENTS. Page The probable cause and pathology of Chyluria ... ... ... 40 Various abnormal conditions associated with Chyluria . . . ... 42 Hsematozoa in lower animals ... ... ... ... 43 Period during which Hsematozoa may live in the circulation, with illus- trative case ... ... ... ... ... 46 A summary of the principal facts and inferences recorded ... ... 49 WOOD-ENGRAVINGS. Fig, I. Living Hsematozoa observed in a single preparation of blood obtained by pricking (with a needle) the finger of a European woman suffering from Chyluria Magnified 300 diameters ... 14 Fig. II. Hsematozoa as in Fig. I, after death (by the addition of pre- servative media) Magnified 300 diameters ... ... 23 Fig. III. Various appearances presented by a single Hsematozoon, as observed under " and ^V immersion objectives Magnified 600 diameters 26 ON A H^MATOZOON INHABITING HUMAN BLOOD ITS RELATION TO CHYLURIA AND OTHER DISEASES.* FOR many generations writers on medical subjects have maintained that the human blood The belief in the HiSSIoaionfe'S^ during certain diseased conditions is invaded by parasites. The opinion most in favour has been, that these in all probability were in the form of worms ; but, so far as I have been able to ascertain, it has never yet been satisfactorily demonstrated that this condition really existed. That certain limited areas of the circulatory tract may become invaded bv Entozoa has The Disto mata hi- too rto iare S 6 COV to red pasl l n g ^ een known : the portal vein, and the vessels in more or less direct relation with the intestinal canal, are the channels which have usually been thus affected ; but the parasites found in these situations, such as the Distoma haematobium, Com miss * Forming an Appendix to the Eighth Annual Report of the Sanitary iiiis-ioia'i with the Government of India. 4 ON A H^IMATOZOON discovered by Bilharz in 1851, and a few other imper- fectly described distomata, are far too large to pass through any but comparatively capacious blood vessels. The instances on record in which they have been found in vessels beyond these limits are few, and evidently accidental occurrences. None of these, therefore, can, I think, be justly described as l Hgematozoa' in the strict sense of the term. The same remarks apply, with only very slight modifications, to the presence of So likewise are Echi- Echinococci in the blood-vessels, a few young specimens of which, have, on rare occasions, been discovered (by Klencke and others) in the general circu- lation, but then only in vessels of considerable calibre. It has also been inferred that the progeny of some Entozoa must be carried by the blood- Prob ability of some , , . -, i i i parasites having reach- CUlTent, aS otherwise they COUld have ed the tissues in which me e a y ns a o r f e tS- not reached their destination so rapidly in the various distant parts of the body in which they have been found. That the Trichina spiralis, for example, during its earlier migra- tions, may be conveyed in this way, is, although strongly denied, I think not improbable. As their presence in the blood has not, however, been recognized, either in man or in animals, their sojourn in such channels, must, at all events, be of very short duration. But that a condition should exist in which human mlroscop^wSs | Wood should be infested by living human blood. e3 active worms in either an embryo or mature state, to the extent hereafter to be described, INHABITING HUMAN BLOOD. 5 had, I presume, scarcely been surmised a condition in which they are persistently so ubiquitous as to be obtained day after day m numbers, by simply pricking any portion of the body, even to the tips of the fingers and toes of both hands and both feet of one and the same person with a finely pointed needle. On one occasion six excellent specimens were obtained in a single drop of blood, by merely pricking the lobule of the ear. Towards the beginning of July of the present year, whilst examining the blood of a native Date of their dia- suffering from diarrhoea, a patient at the Medical College Hospital under Dr. Clmckerbutty's care, I observed nine minute Nematoid worms in a state of great activity, on a single slide. On drawing the attention of my colleague, Dr. Douglas Cun- ningham, to the preparation, he fully coincided in my opi- nion that they were precisely the same kind as those ob- served by me more than two years previously (in March 1870), as being constantly present in Chylous urine. In a report on the microscopic characters of f t. * choleraic dejecta published at the A synopsis of the first J time, bofti separately and also in the form of an Appendix to the Sixth Report of the Sanitary Commissioner with the Government of India, I had occasion to allude to this condition of the urine in connection with some cells observed in it, which closely corresponded in appearance with cells constantly pre- sent in choleraic discharges, and the opportunity was taken of drawing attention to the Entozoon, which was at the same time figured and described. 6 ON A H^EMATOZOON Por the sake of convenience 'it may be well to refer to this case again. The patient was a deaf and emaciated East Indian, about 25 years of age, under the care of Mr. E. T. Lyons at the General Hospital, and was kept under observation for a period of two months, during which time his urine continued to pre- sent a white, milky appearance, and yellowish- white coagula rapidly formed in the vessel into which it had been voided. When a small portion of the gelatinised sub- stance was teased with needles on a slide, and placed under the microscope, delicate filaments were seen, partly hidden by the fibro-albuminous matter in which they were embedded, and which I at first considered to be scattered filaments of a growing fungus. After being watched for some time, however, they were seen to^coil and uncoil themselves, so that all doubt as to their ; nature was at an end. I had opportunities of showing them on various occasions to several persons ; and having perfectly satisfied myself that their occur- rence was not accidental, nor yet the result of subse- quent development in the urine, after the manner of the Anguillulse which are so well known to develop in vinegar or starch-paste, I did not hesitate to draw attention to them as being the probable cause of the obscure disease known as " Chyluria."* From this period I have paid considerable atten- HOW and where sub- tion to the subject, and I desire to tamed!* c express the obligations I am under to Dr. Ewart, the Surgeon in charge of the Presi- * Subsequent observations in connection with this case will be found referred to further on p. 46. INHABITING HUMAN BLOOD. 7 dency General Hospital; to Dr. D. B. Smith, the Officiating Principal of the Medical College; to Dr. Edmonston Charles, Professor of Midwifery at the same College, and to Dr. McConnell, the Professor of Patho- logy, as well as to several others, for the opportunities afforded me for the study of this and of allied conditions of the urine. A slide containing one or more specimens of this Nematode having been forwarded to Probable group of &T%*%Lollon*%e- Professor Parkes, at Netley, he very kindly showed it to Mr. Busk, whose extensive knowledge in this department of science is well known, and the opinion was expressed by him, that, so far as could be judged from the form and size alone, the worm seemed to belong to the Filarida. At this time it was not known to exist in the blood, nor had its minute anatomy been accurately ascertained ; however, I do not anticipate that the information acquired since that time would materially alter Mr. Busk's opinion, so that perhaps the name already applied to the Hsematozoon in the columns of the 'Lancet/ Filaria Sanguinis hominis, may provisionally be adopted. I am indebted for the greater number of the specimens of Chylous urine which I have examined to Dr. Charles, who and Dr. W. J. Palmer, were, I believe, the first to verify the observations which I had published, both having had cases of the disease about the same time towards the end of 1870 or be- ginning of 1871. The fact of Dr. Charles being in B 8 ON A HJEMATOZOON charge of the midwifery wards of the College Hospital, appears to hafl apparently conduced to his being able to aid me so materially, as, among men. strange to say, the patients suffering from Chyluria have, for the most part, been women ; in the last case brought to my notice by him, this con- dition was observed, for the first time, four days after podalic version had been performed. I have now observed the urine in this condition, Dumber of cases of associa ted with more OP less marked hgematuria, in from fifteen to twenty patients, several samples having been obtained from nearly all of them; these microscopic Filar ice have been present on every occasion. Of the persons thus affect- ed, five were ascertained to be of pure European parent- age, but three of them were born in this country; the remainder were either East Indians or Natives, in about equal proportion. I regret that I lost the opportunity of fully ascertain - in g the previous history of the case in concern- ing the patient in i i i TT .n i- 3 whom the Hsemato- which the Hcematozoa were nrst de- zoa were first dis- tected. Having satisfied myself of the identity of the worms previously observed in the urine and now in the blood, by careful comparison of their form, structure and measurement, I returned on the following morning to the Medical College .for this purpose, but to my great disappointment found that the man had been discharged, at his own request, an hour before my arrival. He had, it appears, suffered from diarrhoea for about a fortnight, which had become INHABITING HUMAN BLOOD. 9 greatly aggravated a few days before his admission into hospital; but nothing further could be learnt of the state of his health beyond that he had complained of deafness, especially of one ear.* He had left no address, except that he was a black- smith living in a large bazaar in the neighbourhood ; but as some three or four thousand persons are crowded into this bazaar, a great proportion of whom are smiths in some form or another, those acquainted with the intricate geography of such places in the East will not be surprised to learn that I spent a whole afternoon searching for him in vain. I then enlisted the friendly aid of the Police, but this also proved fruitless. A few days after this occurrence, Dr. D. B. Smith informed me that there was a native A second case of Fi- . / i i rt lariffi in the biood, as- woman in one ot nis wards sunermo: sociatedwith Chyluria. from heematuria, combined with a chylous condition of the urine, and very kindly forwarded a specimen of it on the following morning; this urine, as usual under such circumstances, contained the worms in abundance. I saw the woman on the evening of the same day, and learnt that the complaint from First and second which she was suffering had first made its appearance during the third month of her last pregnancy, but that it had apparently passed off in about five or six weeks. After the birth of this child, which * One of the patients brought to my notice, who had suffered from Chyluria for several months, had been in hospital for another complaint, and had actually left the hospital without having mentioned a word about the condition of his urine. He stated afterwards that he did not like to do so, as it was no great inconvenience to him, and he imagined it was the temporary result of an ' indiscretion/ 10 . ON A HJEMATOZOON was now five months old, the disease came on again : she was unable to suckle her infant, the lacteal secretion being altogether absent.* On pricking her finger with a needle, and dis- tributing a drop of blood over several slides, I found that the Pilarise were present in it also. She remained under observation for a period of about two months, but there was no mark- other symptoms, and ed change in her general condition; her face, however, became swollen on one or two occa- sions, and appeared puffy, as also did the upper and. lower extremities. The urine slightly improved in ap- pearance, and the numbers of the Eilaria3 in it as well as in the blood diminished ; in the latter especially, at all events, the numbers obtainable by pricking the fingers or toes certainly decreased ; and eventually, out of half a dozen or more slides, not more than one or two HaBma- tozoa could be detected : on a few occasions several slides were examined without any being found. The patient, however, could not be persuaded to remain longer in hospital : indeed, all patients thus affected soon get tired of being treated for their com- plaint, as there is seldom any great suffering which the patient can directly connect with this condition, and often no other very well marked symptom, beyond general debility. * A case is recorded by Drs. Mayer and Pearse as having occurred in the Madras Presidency, in which a young East Indian woman had suffered after two pregnancies in this manner; she continued to suckle her children uninterruptedly, but on being advised on the last occasion to discontinue doing so, the urine returned to its na- tural appearance. Brit, and For. Med.-Cbir. Review, Vol. IX, 1852, page 511. INHABITING HUMAN BLOOD. 11 The most remarkable case which has come under my notice, in which the blood was A third case of Filariaj / n . . , . it t in the biood, associated affected in this manner, was that 01 with Chyluria. a patient in one of Dr. Ewart's wards, whom he kindly placed at my disposal for observation and treatment. The man was an East Indian (with more of the habits of the native than of the European), about 22 years of age ; he had been for about five years employed as cook on board one of the light-ships lying at the entrance of the Hooghly, spending only about three months of the year with his family on shore. The prominent symptoms in this case were, extreme and persistent milkiness of the urine, which coagulated with great rapidity after being voided. On being heated the smell given off at first corresponded exactly with that of warm milk, but when the heat was continued for some time, was gradually replaced by the ordinary smell of urine. This condition came on suddenly about two months previous to his admission into the General Hospital. He dates his illness, however, as having commenced other prominent about a year before, for his sight then symptoms. became affected, and there was 'in- flammation' of both eyes, together with a copious discharge of fluid from them. These symptoms have persisted, although he thinks that they have somewhat subsided since the change occurred in his urine. He has well marked 'granular lids,' the mucous membrane of both the upper and lower lids are red and swollen, and the sclerotic conjunctiva injected, the vessels being large and tortuous ; there is also considerable opacity ON A HxEMATOZOON of the cornea. He presents a somewhat emaciated appearance, although his appetite had always continued good, and certainly since his admission into hospital the man has gladly availed himself of the most liberal scale of diet allowed. This is not surprising when the amount of fibro- albuminous matter which is con- Extreme extent of stantly being drained from his system, as evidenced by the state of the urinary secretion, is taken into consideration ; but when to this is added the fact that no matter at what portion of his body the cir- culation is tapped with the point of a needle, numerous active, well-developed Ifematozoa are invariably ob- tained : on one occasion I obtained as many as twelve of these creatures on a single slide. As the drop of blood from which this slide had been prepared sufficed for the preparation of two or three other slides (which, however, between them did not contain more than half a dozen Filaria3), the number infesting his whole body may be imagined. A rough calculation may very readily be made ; the weight of the man is 100ft ; if the Approximate number nit -, i ,- -.', of Hsematozoa present amount oi blood be taken as beinff in the body. on the average ' not less than one- tenth of the weight of the body' (Huxley), and it is assumed that each drop, or grain rather, contains, say, two Hsematozoa, it would be but a reasonable estimate to set down the number as 140,000 ! It must, however, be borne in mind, that the Hsematozoa may be more or less localised to the capillaries and smaller vessels, which INHABITING HUMAN BLOOD. 13 would materially modify this estimate, still I know of no fact which warrants any such assumption. The urine also contained numerous Filarioe, but they were by no means so plentiful in this fluid as the con- number in the dition of the blood might have led one to expect. I have seen them far more plentiful in the urinary secretion of a person whose blood did not appear to be infected to anything like the extent to which this man's had been. On several occasions I attempted, but in vain, to detect the Pilarise in the copious slightly milky secretion constantly welling out of the corner Chylous (P) discharge T i i T-IJ from the lachrymal of lllS eVCS, and Which in a Slight and adjoining glands. degree appeared to curdle. I feel convinced, however, that could a sufficient quantity of this secretion be accumulated they would be discovered.* Microscopically the discharge consisted of clear fluid with numerous granular cells, precisely as observed in the urine of persons suffering from Chyluria. Th.e re- action of the fluid was slightly alkaline. Before alluding more minutely to the appearances presented by the Hsematozoon, I will A fourth case of ., Hsematozoa associated refer to one other case for the oppor- with Chyluria. tunity of observing which I am again indebted to the Principal of the Medical College, under * Since this portion was in type the inference above made has proved to have been correct, as 1 have obtained a specimen of the Filnriee in the midst of a shred of flocculent matter, which had been transferred from the inner surface of one of the lower eye-lids on to a glass slide for examination. Its breadth was ^-g^io of an inch and its length -j^", the relative proportion between the latter and the former being, therefore, as 1 to 52. ON A H^MATOZOON whose care the patient was. She was the wife of a police sergeant, 30 to 35 years of age, born in this country, IIG. I x300 Living Haematozoa observed in a single preparation of blood obtained by pricking (with a needle) the finger of a European woman suffering from Chyluria. A few red-blood corpuscles have been introduced to show the relative size of the FilariaB. but of pure European parentage. Towards the end of July last she was admitted into hospital suffering from a chylous condition of the urine, with frequently recur- ring attacks of hsematuria. The disease made its appearance two months after First attack. child-birth, 16 years ago, when she was living a few miles from Calcutta at Hooghly. It continued for six months, and, in her opinion, was cured by taking an infusion of the seed of an aromatic plant used by the natives for flavouring curries called " kahla- jeer a" a species of Nigella (sativa ?). INHABITING HUMAN BLOOD. 15 In the following year she was again confined, but second attack. the symptoms did not return; in 1859, whilst residing at Raj shay e, the disease reappeared. She was then neither pregnant nor nursing. In three and a half months the symptoms subsided, the above- named native remedy having been administered as before. Since this period she had given birth to two more Third attack. children, the last child having been born in 1864 ; but no symptoms of her complaint had appeared until within a few days of her admission into Dr. Smith's ward, when they came on suddenly after a lapse of eight years. During the first three weeks of her stay in hospital no marked alteration in her condi- tion was observed, neither for better nor for worse Hsematozoa were persistently present in her blood, no matter from what portion of her body the fluid was obtained ; they were also present in the urine. Dr. Smith tried muriate of iron, gallic acid, as well Fatal termination. as numerous other remedial agents, mineral and vegetable, not omitting the " kahlajeera" in which she had much faith, but none of them seemed to produce the slightest effect. The proportion of blood in the urine increased, painful diarrhoea set in, with rapid emaciation, and she died about six weeks after her admission. It was with considerable difficulty that permission was obtained to make a post-mortem Post-mortem examin- examination, which had moreover to be so hurriedly .performed that Dr. McConnell, the Professor of Pathology, was unable to give me notice ; but he has most kindly placed at my disposal the careful 16 ON A H^JMATOZOON notes which he made of the appearances presented by the various viscera (fourteen hours after death), a summary of which is here given. The hrain was soft and somewhat anaemic ; other- C9ndition of the wise there was nothing special to be brain and of the , . thoracic viscera. observed in its structure, nor in its ventricles. The right side of the heart contained small semi-decolorised clots, as also did the left auricle, but the ventricle was empty. There was some thickening of the mitral valve, and slight, irregular thickening of the lining membrane of the aorta further than this there seemed to be nothing abnormal. The mucous surface of the trachea and bronchi appeared to be healthy. Scattered throughout the whole of the right lung were numerous specks of what appeared to be softening tubercle, each about the size of a pea ; in addition to which two circumscribed cavities, one of the size of a hen's egg, the other about half that size, were found in the substance of the middle lobe ; each cavity was lined by a distinct "pyogenic membrane" and con- tained thick muco-pus. The left lung contained a few small, irregularly distributed nodules of softening tuberculous matter, and one cavity, the size of a pigeon's egg, filled with muco-pus. The weight of the right lung was 5 ounces and 6 drachms, and that of the left was 8 ounces and 4 drachms. The mucous membrane of the stomach was of a condition of the bright pink colour, not altered in intestine and other t consistence, whereas the mucous sur- face of the duodenum presented a mammilated and congested appearance. The jejunum and ileum in the INHABITING HUMAN BLOOD. 17 upper half were healthy, but in the lower half of the latter the Peyer's patches were prominent, and the surface covered with minute ulcers the glandules infiltrated with a yellowish-white, soft, tubercular-like substance ; the edges of the ulcers thickened and con- taining similar yellowish- white granular matter. The lining membrane of the coecum and ascending colon was of a bright pink colour, and exhibited five or six cir- cular ulcers about the size of half a pea, with raised and opaque white edges. The entire contents of the in- testines consisted only of about a couple of ounces of a pea- soup-like fluid. The mesenteric glands were unaffected. The liver was soft and fatty, otherwise normal in appearance ; no re-action with iodine. The gall-bladder was almost empty, containing only a little tbin ochre- coloured bile. The spleen seemed to be healthy, as did the uterus and ovaries ; the former was small and unimpregnated. The kidneys presented nothing abnor- mal to the naked eye; the right and left weighed respectively 3 ounces 4 drachms, and 3 ounces 6 drachms : these, together with the supra-renal capsules, were placed in spirit and kindly forwarded by Dr. McConnell for my examination, the result of which will be referred to further on (page 33). As in other cases of Chyluria on record, so in this, not the remotest clue is afforded as to the nature, or as to the cause of the disease by the post-mortem appear- ances visible to the naked eye; nor is there any sufficiently-marked lesion to account for the condition of the urine during life, nor for the rapid manner in which the patient ultimately succumbed. 18 ON A HJEMATOZOON In order to detect the Hsematozoon during life, the Method adopted for method adopted by me is as fol- the detection of Heema- i A . /, . lows : A piece of narrow tape is coiled tightly round the end of one of the fingers or toes, so as to produce a little temporary local congestion of the part, but not to such an extent as to cause the slightest pain ; and with a clean, finely-pointed needle the finger is gently pricked half-a-dozen slides and covering glasses having been previously prepared. The drop of blood thus obtained will suffice for several slides, but I find it a good plan to squeeze out only a very small drop, and transfer it altogether to one slide by drawing the edge of the covering glass along the tip of the finger so as to scrape off the ' droplet.' The glass is then carefully pressed on to the slide by a gliding motion, in order to produce as thin a layer of fluid as possible, and to ensure that all the fluid removed is retained beneath the cover, because there is a tendency on the part of the fluid to carry the Hsematozoa towards the edge of the slide, just as is observed to take place in examinations of the urine for ' casts' of the kidney- tubules. The slides are now to be carefully and systematically examined ; a lateral and horizontal stage-movement being very useful for this purpose, as it enables us to make sure that every part of the preparation has been scru- tinized. . It must not be supposed that the Pilariae are to be H*matozoa even detected by taking a mere peep when present not al- . -. -, , -, . , . ways readily detected, through the microscope ; sometimes, certainly, I have observed one, or two even, in the first INHABITING HUMAN BLOOD. 19 field examined ; r but this is by no means usual, and their detection often demands considerable patience. Each slide will require about a quarter of an hour before it can be satisfactorily explored ; any one who ima- gines that they can be detected with the same ease as a white-blood corpuscle had better not make the attempt. Several slides may have to be examined, and it A possible cause of mav ^ e necessary to make a fresh this difficulty. puncture, for I have found the Hse- matozoa to be absent in several slides obtained from one finger, but present in all the slides obtained from another at the same time ; whereas on making a fresh puncture in the finger where none had been found at first, it was ascertained that they were equally nu- merous in both. This is possibly accounted for by the little orifice made having become plugged by fat, &c., so that the blood squeezed through had to some extent been filtered, for although this microscopic Filaria can pass through any channel permeable to a red-blood corpuscle, still, when it is considered that the length of the former is nearly fifty times its diameter, the wonder is that they are not more completely prevented from escap- ing through so fine an orifice even when perfectly patent. The search should not be undertaken with too Themagnifyingpow- high a magnifying power, but it |ioy. ad should be sufficiently high to define the outline of a red-blood corpuscle quite distinctly. I have found that a good two-thirds of an inch objective answers the purpose of a searcher admirably; it em- braces a tolerably large area, so that the preparation can be examined in a comparatively short time ; but care 20 ON A H^MATOZOON should be taken to keep the fine-adjustment screw constantly moving, so as to examine the deeper as well as the superficial layer of fluid in each field as it passes under observation. Should anything unusual be observ- ed, the low power must be replaced by a J" or, better, a -J-" objective.* In order to keep the active Hgematozoon under observation for some hours, a camel-hair pencil dipped in a solution of Canada-balsam or mastic in chloroform, should be passed along the edges of the covering glass, so as to prevent evaporation, and the formation of air spaces in the preparation. The appearance presented by the Hsematozoon The general aspect of when first seen among the blood the Heematozoon dur- , . ., ,. . .,, ing life. corpuscles, in the living state, will not readily be forgotten and cannot possibly be mistaken for anything else. The remark made by a young Ben- galee student on my requesting him to look into the microscope and tell me what he saw "He is an incompletely developed snake, evidently very young, though very active" so aptly describes the object as thus witnessed, that I feel sure that any one seeing the * It may seem superfluous to draw attention to the similarity which exists between some vegetable fibres and some of the microscopic * Filarise/ when the latter are not alive; nevertheless a very good objective is frequently required to distinguish them with certainty, as auy one may prove for himself by subjecting the torn fluffy edges of a piece of blotting-paper to microscopic examination. Filaria- like fibrils will frequently be found. A mistake of this kind is referred to by Leuckart as having occurred quite recently. A paper was published announcing the discovery of a filaria-like nematode in the intestines, blood, and tissues of a patient, which was expected to prove as dangerous to life as the Trichina spiralis. These parasites subse- quently proved to be nothing more than vegetable hairs ! ' Die Menschlichen Parasiten,' Vol. II, part 1, p. 151. INHABITING HUMAN BLOOD. 21 Hsematozoon alive will not fail to be struck with the accuracy of the quaint reply. During the first few hours after removal from the body the Filaria is in constant motion, coiling and uncoiling itself unceasingly, lashing the blood corpuscles about in all directions, and insinuating itself between them. It is not at rest for a single moment, and yet on the slide it appears to make but little progress, as it may frequently be watched for an hour in the same field without once giving occasion to shift the stage of the microscope. No sooner has it insinuated its 'head' amongst a group of corpuscles than it is retracted, and probably the next instant the 'tail' will be darted forth and retracted in a similar way. One moment it may appear to possess a long f tail* .Anatomical details -a fourth or more of its entire S. length, which follows it through the fluid like a string, whereas the very next moment not a trace of the * tail' can be seen, even with the highest powers. The same phenomena can be observed to take place at the thicker, cephalic end, but with more difficulty. As usually seen, this presents a blunt or slightly tapering termination, but every now and then a fine point like a fang appears as if darted straight forward out of its substance ; the next instant the creature may -jerk its 'head' on one side, and the c fang* becomes bent and drawn after it like a ribbon (Fig. I, page 14). As seen with a J" objective, these Haematozoa can scarcely be said to present a granular aspect. When only recently withdrawn from the body, they look smooth and almost translucent ; the larger specimens. 22 ON A H^MATOZOON however, frequently present an aggregation of granules towards the junction of the middle with the lower half, as may be seen represented in a few of the specimens delineated (Pig. I). Occasionally also a bright clear spot is observed at the thicker extremity extremely suggestive of an oral aperture ; this likewise is represent- ed in some of the figures in the wood-cuts. They will continue thus active under a covering Duration of their glass, hermetically sealed, for from 6 fLCtivitv to 24 or 30 hours, and if a drop of blood be suspended from the centre of a covering glass and fixed to a ring of wax, thus forming a closed cell, the Haematozoa may live for three days, perhaps longer, but this is the longest period during which I have known them to retain their activity. It must not be inferred that the group of Hsematozoa depicted in this wood-cut (Fig. 1) represents one field of the microscope, but only that the particular specimens were observed on a single slide. The same remark applies to the second group depicted ; except, that two of the figures in it represent Pilarise found in other preparations, obtained from the same individual. In the later periods of their existence the move- ments of the Elarise become much slower, and the plasma of their bodies more and more granular until eventually all signs of activity disappear, and they are seen stretched or slightly curved in the field of the microscope, having lost the snake rather than worm- like appearance, which, from their tenuity and incessant coiling or wriggling movements, they had presented dur- ing life (Pig. II). INHABITING HUMAN BLOOD. 23 If a little spirit, or other preservative agent, such as corrosive sublimate or carbolic acid and glycerine be not added, their outline among the blood corpuscles will become indistinct, and they will degenerate into mere shrivelled strings of a granular appearance, no longer recognisable as Fro. II. X 30 H.EMATOZOA AS IN FlG. I, AFTER DEATH, BY THE ADDITION OF PBESEBVATIVE MEDIA. Nos. 1 to 6. Preserved in weak spirit. (When the Filaria3 are observed in slightly decomposed urine they present the appeal ances here shown also). No. 7. Puckered condi ion, produced by the first addition of pure glycerine. 8. Killed by expos are to the fumes of Osmic acid. Some of the various aspects presented by them af- variety of appear- ^ er death are delineated in the second ances presented by T T -vr i /-ri- TT\ 11 them after death. WOOd-CUt. In No. 1 (Fig. II) the Hramatozoon presents a granular appearance throughout its entire length ; but in No. 2, a hyaline membrane is seen to extend beyond the head extremity, and in 24 ON A H^EMATOZOON No. 3 this transparent membrane appears as if it were a continuation of the tail ; whereas in No. 4 it extends beyond them both. In No. 5 the membrane appears as if slightly wider at the ' tail' end, but is absent at the opposite extremity, and in No. 6 the membrane is bent in the form of a hook. In No. 7 it is seen puckered, on account of the addition of a thick fluid. The meaning of all the different appearances presented by these Filarise, obtained from the same patient, will become evident on perusal of a succeeding paragraph. One of the Hsematozoa in this wood-cut (No. 8) is The results of expos- seen to nave preserved the appearance SVsmga?id he presented during life, it having been instantaneously killed by holding the slide over the fumes of osmic acid by far the best method I know for preserving the specimens. The blood should be quickly but evenly spread over the covering glass, forming as thin a layer as possible ; the cover is then to be quickly inverted (before coagulation sets in) over the mouth of a phial containing a 2 per cent, aqueous solution of this chemical. When the preparation has turned somewhat brown, remove it and place it on a slide, previously charged with a drop of a saturated solution of acetate of potash or soda, when it is ready for mounting, and will keep, I believe, for an indefinite period. To account for the various appearances presented by these Hsematozoa before and after The minute anatomy death, which have been just described and figured, may possibly puzzle others as it certainly puzzled me for over two years, INHABITING HUMAN BLOOD. 25 although I was constantly in the habit of examining specimens ; but, until their existence in the blood had been discovered, by far the greater number of them had been dead, or nearly so, before they came under observation. Having observed that the appearance usually presented by the Haematozoa, when recently withdrawn from the circulation, differed considerably from what was observed after or shortly before death, it was determined to watch these changes from beginning to end, and to note them as they occurred. With this pbject in view, a specimen which appeared to be well develpped, was selected out of several found on a quite recently prepared slide, a carefully corrected immersion J" object-glass was employed, and the examination conti- nued for eight consecutive hours. At first the movements of the Haematozoon were The existence of so rapid that little could be detected transverse striae de- in addition to what had been quite as distinctly seen with J" glass, except that in certain positions assumed by the worm, and in certain lights, extremely fine transverse striae were observed quite distinctly. The existence of these striae had, on several occasions, been more than suspected under the lower power ("), but they could not be satisfactorily demon- strated. No attempt has been made to represent those fine markings in the wood-cuts as seen by such a, com- paratively, low power as this, for it would only tend to mislead ; to cut lines in wood only -23-7 oir of an inch apart (which is about the distance between the markings), when simply magnified 300 diameters, would be impos- sible; and even in the engraving which represents the 26 ON A H^MATOZOON object as magnified by twice this power, the distinctness of these markings is considerably exaggerated (Fig III) . 802 II W g ft " E* w p l! g o As the movements of the Eilaria became a little The whip-like ante- slower, it was seen that the striae rior and posterior pro- longations: were not on its outer coat, but con- fined to the body of the worm, and that the tail, which INHABITING HUMAN BLOOD. 27 almost always under the J" objective looked like a lash, was not so in reality, but that, every now and then, it could be seen flapping against the corpuscles like a fin sometimes vertically, sometimes horizontally, and then becoming folded upon itself like a ribbon (Fig. Ill, 1), a condition which I had already observed and figured two-and-a-half years ago without knowing what it was. Precisely similar phenomena were observed to occur at the opposite terminal extremity (Pig. Ill, 2). It w r as, however, only after the lapse of fully five hours' careful watching, the activity The explanation of . , ..-.- . . , the appearances pre- oi the lisematozoon having consider- sented by the filaments. ably subsided, that the real nature of what appeared to be the rapid protrusion and retrac- tion of the delicate membrane at the oral and caudal terminations, was discovered. An unusually long tail was seen to be trailing after the * body' of the Eilaria for several seconds, and whilst thus being dragged, fortu- nately, it remained exactly in focus, when suddenly the ribbon-like-folds were straightened by the darting of the pointed extremity of the worm into the very tip of this hyaline filament (Pig. HI, 2). Scarcely had this taken place than the tail was again retracted and the ribbon-like appendage became evident once more ; where- upon the ribbon-like filament at the other extremity was suddenly straightened in a similar manner and the ' head' rapidly projected into the very tip. The Haematozoon may, therefore, be said to be enveloped in an extremely delicate tube, closed at both 28 ON A H^EMATOZOON ends, within which it is capable of elongating or short- ening itself. This tube, like the sarcolemma of muscu- lar fibres, is without any visible structure, is perfectly transparent, and, but for the difference between it and the fluid in which it is immersed in its power of refract- ing light, which allows of its margins or folds being brought into view, it could not be demonstrated. The fact of its being thus enclosed seems to show probability of the that in the present stage of its exist- blood being the 'home' ., ,-, , / j i TTI of the Fiiaria in the ence, the ' home of this Filaria is in present stage of its development. t ke blood ; it has no visible means of perforating the tissues ; moreover, although constantly observed to be in a state of great activity, it does not seem to manifest any special tendency to migration, and is apparently dependent on the current of the blood for its transference from place to place; its movements, therefore, within this enveloping tube, appear to be as limited as those of any other animal enclosed within a sac. As has been already stated, a short chain of aggregated molecules, probably repre- Further anatomical , . ,-, -, , . , details suggestive of senting the rudiments of an mtes- the existence of an oral t di- tinal canal, is frequently seen towards the centre (Fig. Ill, 1), but the rest of the entire length is at first uninterruptedly clear, although not transparent. But during the time the details described in the preceding paragraphs were observed, and they became more and more evident as the activity of the Haematozoon diminished, the appear- INHABITING HUMAN BLOOD. 2!) ance throughout became granular or rather molecular. A bright spot also became very evident at the terminal point of the anterior portion, which, as already remarked, is extremely suggestive of an oral aperture, and imme- diately below this a somewhat elongated vacuole. From this downwards, until about the junction of the middle with the lower third, or perhaps a little nearer the middle, a more or less clearly differentiated oesophagus (?) became likewise discernible, and appeared to have a coecal termination, but beyond this, until the caudal extremity was reached, the continuation of the digestive tract was less clearly defined (Fig. Ill, 3).* It then became too dark to continue the observa-' tion, and by the next morning the Filaria had become uniformly molecular, all appearances suggestive of internal organs having vanished, although it still con- tinued to noil itself languidly amongst the blood corpuscles. Such is the minute anatomy of the Hsematozoon as far as I have been able to make it out. What has here been recorded has now been repeatedly observed, and may be observed by any one possessing a good " or T V" immersion lens, and a microscope provided with good arrangements for illumination. The simple detec- tion, however, of the Haematozoa, when present in the blood, is simply a question of patience, and not dependent * For the care with which these wood-cuts have been executed, I am much indebted to II. H. Locke. Esq., Principal of the Government School of Art, under whose superintendence they were engraved. 30 ON A H^EMATOZOON on any special perfection in the magnifying powers employed. The average diameter of the Hsematozoon, as usu- ally found, is, as already stated, about that of a red-blood corpuscle, and its average length about 46 times that of its great- est width ; that is to say, its greatest transverse diameter is about -gyVo- f an i nc h an d &s length about T Vth of an inch. These are about the measurements most frequently met with, but I have occasionally seen specimens not more than half this size. The largest specimen which I have measured was found to be slightly over T ^Voth of an inch in width and about -^th of an inch in length, whereas the smallest was only -oVo-th of an inch in width and T i--th of an inch in length : the relative proportion between the length and the greatest width being as 1 to 45 in the largest and 1 to 56 in the smallest ; the width, therefore, gaining somewhat in proportion to the length as the total di- mensions increase. Prom what has been above stated concerning the power of extension and contraction possessed by the Ha3matozoon, it will be perceived that these measure- ments are subject to variations during life; and, as death may occur when the Filaria may happen to be in either of these conditions, the relative proportion between the length and the breadth may then also be found to vary somewhat. INHABITING HUMAN BLOOD. 31 In order to prevent misconception, it may perhaps be well to compare these measure, m?to^ e on. e tSTru,h ments with those of two well-knowu spiralis and the , Guinea-worm. Nematode helminths which are occa- sionally found in the tissues of the human body, viz., the Muscle-trichina and the Guinea-worm, or rather its contained embryos. Both of these parasites present a certain degree of likeness to the Filaria described in this paper. The first named is found in the muscular tissue ; the second in the cellular tissue ; and the third in the blood. All three present transverse markings, more or less evident in the Guinea-worm embryo they are particularly distinct ; but beyond these features the similarity between them appears to cease. They differ from each other in size, in form, and in the relative proportions of length to breadth setting aside altogether the great difference which exists be- tween their minute internal organisation. As to size and form the Hsematozoon approximates more closely to the Filaria medinensis Differences of size r Guinea-worm embryo, than to the p larval stage of the Trichina spiralis, though much smaller than either, especially in breadth. The average length of samples of the former which I possess is iV n( l ^ an *&<&, and the breadth T oW', so that the breadth to the length is as 1 to 31 : whereas the specimens of Trichina with which these comparisons were made averaged T V^ f an * ac h *- length and T 7 th in width ; so that they are only 28 times the length of 32 ON A H^EMATOZOON their greatest transvefse diameter. It will be remem- bered that these proportions in the case of the Haemato- zoon have been referred to as being on the average 1 to 46. A still greater dissimilarity between these helminths _. x than the disparity in size and relative Different aspects pre- ' J proportions, is the totally different tions of all tliree. j i i j i i aspect presented by their anterior and posterior extremities ; this is sufficiently evident without referring to the minute structural anatomy of the parts. The cephalic end of the Trichina is almost pointed and its caudal termination blunt; whereas, although the anterior extremity of the two Pilarise agrees in the matter of being somewhat rounded and the posterior end in both comes to a very fine point, nevertheless^ the relative proportion between the tail of the one and that of the other is sufficiently great to present a marked difference the tail of the Dracunculus being nearly ^rd, wheTeas that of the Hsematozoon is not, at the utmost, more than -Jth of the entire length, Of course this is exclusive of the hyaline tube within which the latter is enclosed. Possibly when live young Dracunculi shall have been as carefully examined and described as the lifeless specimens have been by Mr. Busk and Dr. Bastian, the similarity between the Filariae will become more evident.* * Since this paragraph was in type, I have, however, had ample opportunity of satisfying myself on this matter hy the examination of numerous young Dracunculi in all stages of development obtained from a patient admitted into the General Hospital under the care of Dr. Coull Mackenzie, suffering from Guinea-worm, but I find that there is even less resemblance between the Filarise during life than was suggested by lifeless specimens. INHABITING HUMAN BLOOD. The comparisons just instituted between the three helminths referred to will, perhaps, be more clearly understood by throwing these details into a tabulated form* : Average breadth. Average leugth. Relative proportion of breadth to length. ASPKCT PRESENTED BY Relative length of tail to total length. Head. Tall. Trichina (of muscle) Too *' 1 to 28 Pointed Blunt... , Dracunculus(einbryo) looo rf' 1 to 31 Rounded Acutely pointed. 1 to 3* Human Haematozoon 3~5oo" ft* 1 to 46 Ditto ... Ditto 1 to 8 The part which the Hsematozoon appears to take in the production of disease will become still more evident when the condition of the kidneys and supra- renal capsules, referred to in a previous paragraph (page 17) as having been obtained from a patient who died of Chyluria, has been described. To the naked eye none of these organs presented any marked deviation from the normal standard, except that the kidneys were more than usually lobulated, and, that on section several of the pyramids, espe- cially near their apices, presented a smooth, tallowy appearance, suggest- ive of amyloid disease. No approach to the characteristic iodine re-action could, however, Tallo appearance * The measurements here introduced of the young Trichinae and Dracunculi do not materially differ from those generally given. For the sake of uniformity, however, it was considered advisable to measure all three with the same micrometer- scale. 3-1 ON A H^EMATOZOON be obtained ; but when longitudinal sections were sub- jected to microscopic examination, numerous translucent oil-like tubules of a somewhat varicose appearance could be observed running alongside the uriniferous tubes as if the lymphatics or minute blood vessels of the part had become plugged. These sections when placed in boiling ether, and afterwards subjected to pro- longed maceration in it, did not appear to be materially affected by the process the translucent oil-like tubules being quite as evident as before. No other morbid changes could be detected as having taken place in either the The kidneys and tubular or cortical tissue of the Hcematozoa. , . , , . . kidneys, but in every fragment, no matter from what part of the kidneys removed, numer- ous microscopic Pilarise were invariably obtained, if the tissue had been properly teased, precisely analogous to those which had been detected in the blood and in the urine during life. Teased fragments of the supra- renal capsules yielded similar specimens. On slitting open any portion of the renal artery, from its entrance into the kidney as far inwards as I was able to follow its ramifications, and gently scraping its inner surface with a scalpel, numerous Haematozoa could always be obtained. The renal vein when similarly examined also yielded specimens of the Filariae, but they did not seem to be so numerous in it. The vessels themselves did not appear to be diseased, and such of the branches as could be seen with the naked eye did not strike me as being INHABITING HUMAN BLOOD. 35 abnormally large. But whether the microscopic ramifi- cations and the capillaries were distended or otherwise (in the absence of properly injected preparations of the organs) could not well be ascertained. Having traced the course of the Hsematozoon from the blood through its channel into the urine, the peculiar appearances presented by this secretion will now be very briefly considered. The chemical constitution of chylous or milky-urine The general appear- is SO Well knOWH that it IS not ance presented by _ chyious urine. s ary to do more than refer to the principal features which it presents. It is, as the term applied to it conveys, more or less perfectly white, has a faint odour of milk, which is heightened by warmth ; and, like that secretion, may be passed through several layers of filtering paper without materially modi- fying its colour. Usually it is of low specific gravity from 1006 to 1018 and manifests a slightly acid re-ac- tion to test paper. As a rule, the more it approaches the appearance of milk, the more readily and firmly does coagulation take place. "When the presence of blood is a prominent feature in it, curdling takes place still more perfectly, but the early addition of solutions of ammonia, sulphate of soda, or nitrate of potash retards, if it does not completely prevent this change ; frequently, however, the process has already commenced before the escape of the fluid from the bladder. The elaborate analyses which have from time to time its chemical consti- ^ en made of tlie urin ^ in this condi- tion, as well as such simple analyses as I have been able to conduct, have not tended to show 36 ON A HJEMATOZOOtf that there is any organic or inorganic substance in the secretion, but what already exists in the nutritive fluids of the body, or that any new chemical combination has been called into existence. With regard to the alleged presence of sugar in this kind of urine, my attempts to detect it have been entirely negative. In short, the urine appears merely to deviate from r in what way it dif- the healthy standard in so far that fers chemically from . healthy urine. it contains an abnormal amount of fatty and nbro-albuminous material, with, perhaps, a diminution in the percentage of urea; in connection with this, however, I may add that in the cases noted which presented a low specific gravity (1006 1010) the quantity voided had been considerable, from 60 to 70 ounces in the course of the 24 hours. On no occasion have I been able to detect * casts' of renal tubules in urine of this nature, even in cases where previous attacks of the malady had occurred. When subjected to microscopic examination, this Microscopic examina- kind of urine presents a finely mole- tion of chylous urine; -, i j i cular appearance ; when recent, how- ever, scarcely any distinct oil-globules, such as are con- stantly observed in milk, are present ; but when acetic acid is added, followed by a little warm ether, this 6 molecular base' becomes replaced by large globules of fat, which may be seen to form whilst the re-agents are being applied. In the meshes of the coagulated substance numerous granular cells are seen, apparently identical with those of chyle, lymph, or the white cells of the blood ; and, generally, a sprinkling, more or less marked, of red-blood corpuscles. INHABITING HUMAN BLOOD. 37 Besides these, if the shred of coagulum on the The detection of slide has been properly teased/ the the Filari sometimes , .1 i ,1 j very difficult; Manse, described in the preceding pages, will also be usually found. As before stated, in not a single case which has come under my notice have they been absent. However, they may not be present in every sample of Chylous urine examined, or rather I should say, the numbers present may be so few as to elude detection. With regard to the size of the Pilarise which are Dimensions of the m ^t with in the urine, it may be observed that they present the same measurements as those met with in the blood ; some of the largest as well as some of the smallest examples have been 'found in this secretion. The importance of bearing in mind the difficulty A case illustrative that ^ sometimes experienced in dis- of the difficulty some- xi. t-it ' AI i times experienced in covering the Jjilaria in the urine also, detecting Filariro in may possibly be more strongly im- pressed by the narration of an illustrative case, which will, moreover, serve to draw attention to other impor- tant matters bearing on . the question of infection with Hsematozoa : A European, age 38, formerly in the army, was kindly sent to me by Dr. McConnell, with a note stating that the man was amongst his out-patients and had been suffering, and was even suffering a little still, from Chyluria. The medical history which I gathered from the man was, briefly told, as follows : Has suffered more or less constantly for five years from what he believes to be c chronic dysentery.' This came on during his 38 ON A H^MATOZOON residence in Mysore. Eight months after the advent of the intestinal affection, he observed that the urine passed towards the middle of the day was white, but was not so in the early morning. His hearing and sight became affected about the same time, and have remained imper- fect since, although there is nothing to be observed wrong about either set of organs. The urine at the time he paid me a visit did not Mode of preserving seem to be Particularly affected, mere- a little cloudy, but was albumin- ous. A little carbolic acid solution having been added to it, it was set aside in a conical vessel, and subsequently the sediment removed by means of a pipette for microscopic examination. This is usually the method adopted by me in cases when the fluid does not coagulate, or when, after coagulation has taken place, it has become liquified. Slide after slide was examined in vain, still I felt so convinced that, as there had been Eventual result of nu- merous examinations. a distinct history of Chyluria, and as the urine was still albuminous, but contained no e casts, 5 the original cause had not entirely disappeared. Eventually after searching for about four hours, three excellent specimens of the Filarise were obtained, one of which I forthwith despatched to Dr. McConnell. A week afterwards the patient returned, but I failed to detect a single worm in the specimen of urine which was obtained on this occasion. He came a third time, after an interval of about another week, when Mlariae were detected in the sediment without much delay. INHABITING HUMAN BLOOD. 39 Several preparations of the blood were also examin- ed, but the Hcematozoa were not detected in this fluid. Were, however, a couple of ounces of the blood examined (coagulation being prevented by the addition of a neutral salt), instead .of a couple of drops, doubtless the sediment would contain plenty of the Filaria3, seeing that a few must have actually passed out of it through the kidneys, as we have already seen that they are not localised in these organs, the latter simply acting as one of the channels through which they may escape out of the circulation. The phenomena associated with Chyluria are so well known that it is not deemed necessarv The salient features * of chyiuria:- ^o gj ve more than the salient fea- tures of the malady, more especially such, as are exemplified in the cases referred to in this paper ; which, in the main, correspond very closely with the cases that have been from time to time recorded by others, In the first place it is to be noted that the malady is decidedly localised as to its origin. Originates in certain * countries; j^ s f ar as j have been able to as- certain, the only cases on record have occurred in persons who have at some period of their lives inhabited the East or West Indies, some parts of Africa, Bermuda, Brazil or the Mauritius ; so that all writers agree, no matter to what particular cause the disease has been referred, that it is intimately related to a tropical cli- mate. Simple removal, however, from such climate has not sufficed to prevent a recurrence of the disease in England or in other parts of Europe. ON A. It^EMATOfcQON Secondly, it is noticeable, that the : disease, as ma- uddenness of attack. nifested the milky appeajfcftcd ; o I)0fiijrm>20 booid OilJtl imne^ comes on very suddenly ^ o theiifirpf , Dbxifc on succeeding occasion^ to iflQcal ;cause j distributed^ oral torn w:jl r: ." >nb$eiioe @f casts of thfe urine,; organic g^j v,G albuminoid elements present. .floiMuoiio ;* s ! ) pj . ,}nttirr.8 orfi from E$ *i'i;; gn ,.{i!}WK 7iij3iooq89 ow , (Hitnm a 'iq ^m^wswwmte^ rafe tl)c w^^i?isM^8^^i^,^fat^ 4-jTfi TIPA AT* P"VTT*PTYV1 rl/^Q Liiu itiuu ui CA.LI oiiiii/w^o. . . s - omii oj omi) moi! JTOOC! be fttf iff Bft Wfeiscertained that the of iM # btfiffl^^f *^ft: ^tet in one particular ^^' INHABITING HUMAN BLOOD. 11 giving rise r to' rupttire4-Wr, as is w^ltknWa, tMitvalls of these channels are extremely delicate, those of the lymphatic system bemj especially so. The resulting phenomena, such as tlie>es6ape of the nutritive fluid and of the Filarioe eonta&iM^ittiin'tte coated ^^h^inel into 'the.excretoiy duefe bblotigiag' teithe -pafrt, appeafe to me to he so simple a proceflui?^ Jbtpabreto^jdibvtQ'- on UH mechanism \voulcl be .quit^'iostt^ettftifoito e#jj[)iri gogaBiIo omog oi oi/li ?>fijHoj iri jjljjii oil) m 'io t 7am r jol oil) It would seem, therefore, of the f ^rjffi^; is nieml^i ^n^o^g IjSXflWfeiiq? the oxitQiu-e of this Filaisja ^jtrg^^ve channels of the ' Bte UfiUi9^aJ -HIT . ,i)f> kb^g earxoeob !w jtii ji&ai orfi rfoUvr moil fljodqarje other ^^W*"" 1 ^ bo^tob^u&t&rttttectt^t other circuhistance8"miglitt^ just as various .udkstwwEtihg causes, of tumours, produce the exusdatioii ei the body from, ; .the abdominal axilla, the thigh and other parts, such as are constantly being reported in medical journals. Nevertheless, cases occurring ia ,waYm countries, or in persons who -had formerly resided in. them, appear to indicate that the disease is not dependent on such mechanical or patholo- gical, causes, as these. 42 ON A H^EMATOZOON The same remarks apply to the etiology of the various other phenomena enumerated Cause of various con- may not^e^s seated as the more or less frequent concom- itants of Chyluria, without much modification for even should actual rupture not take place, local congestions may be induced or very trifling fissures, which might yet be sufficient to interfere with the functions of delicate organs, or it may be, as in the case of the eye or ear, that the mischief may be chiefly due to some changes induced in the refractive media of the former, or in the fluid in contact with the nerve filaments in the latter. The intestinal affection, if in reality connected with the entrance or exit of these Pilarise, The intestinal affec- tion, &c. ; deserves special attention. The only known symptom from which the man in whose blood this helminth was first discovered, was severe diarrhoea ; the commencement of the illness of another man is dated from a similar attack, which developed itself into what is described as " chronic dysentery," on which the usual medicines appear to have had no influence, for during the last five years the disease came and went without reference to medical treatment the chylous condition of the urine having been equally irregular in its appear- ance and disappearance. It will be remembered that the intestinal affection commenced eight months before the urinary symptoms appeared; moreover, in the woman whose autopsy has been recorded on a previous page, c tubercular-like ' ulcers were found in the intestines, as also in the lungs. All these occurrences, especially INHABITING HUMAN FLOOD. 43 when taken in connection with what is known to occur in connection with the migration of several parasites, are too prominently associated with the history of the cases in which these Ha3matozoa were detected to permit of the subject being passed over without comment. With reference to the 'granular-lid' condition of one of the patients affected with Some forms of 'granu- x Hsematozoa, it has been demonstrated since the earlier pages of this paper was in type, that, not only had congestion resulted from the presence of the Filarioe, but actual rupture and escape of one of them at least occurred, either through the channel of the lachrymal or of a Meibomian gland (see foot-note, page 13)." Although feeling convinced that Chyluria and other morbid phenomena are induced bv The recurring at- * the presence of these microscopic Pilarise in the circulation, still, unless it can be shown that they may have a prolonged existence in this con- dition, it will be difficult to reconcile this opinion with the fact that the malady so frequently recurs in the same individual. It seems unlikely that the same per- son should become re-infected with Hsematozoa several times, and especially that re-infection should occur after years of residence in England, where probably this par- ticular Filaria is not indigenous. Not having been able to watch the progress of isolated cases for a sufficientlv Ion"* Hsematozoa in lower * dogs, & C . period to judge whether or not all the Haematozoa in the system escape during a single attack of Chyluria (the period of their existence in the a& ON A' BJEMATOZOON stage in w v hich tlicy are found in" the blood 'hating ex; pired), nor having suceeeded in prolonging their exist* ,enc& by r ; artificial " Cultivation, in serum, moist sand or saliva,, bey nd-a period of three days, it will be necessary for me to refer .briefly to a x few of 'the recorded irii Mances* -of llEemiatozoa occurring in loweii .animals, so as" to fill up the gap in the: bhain 'of ^evidence as far as possible. ' , EoiiDjiiosi among the:record^d particulars eoncerning are ^tliosd of CMiM. Grube and r Delalbd^ presented in their Mdmoire" td jte . :Erencli lAcadeniy of ? Sdietf&fc* These geritlcmen, daringa peridd of qine y ears, :made observations on !.'.;20 -dogs li&u wliose blood on an average 55,000 microscopic worms u{erfe The diameter ;of tliese^wi^ /some- f ai f ed:-])l(idd;CJOaq3uscle; the length, M not giFeiv)ini this: ^0|nmtiiiicatiori, but I find this >xeMroi'>tdI iajlaae t l6H)e early ilw^Mrhe^ of the (18^8) as bcing>^botit ^^th ol jEthaiiothe :;Jmifaaai( Shese dogs were tmder ob&ervationi :;. fcar'i JperMds! varying from -se^eraiL indhths to iive;::years;,; during; which the state of the blood Temained^ ^unchanged. ; Fdstjrnbrteni examinations appear to Jiave Jjaeii coM"uotpd, j Mth t great -care at all sea&onsfof ith:e year, "butum one !o<3caslon only were what the authors deemed to be th^l^ pir^iit-wDrjms 5 discovered. Six of these, were found tp be lodged in a large ,'fecentlvrformejd cl-otinl.the right ventricle four [being females and twjobaales; ilChe ^ize of these was by * ' Meiuoire stir \u vi-r iilaire qui "vif 'claiiB 'le sang du"cliH-n" ei u'fu INHABITING HUMAN .BLOOD. 15 ii -means microscopic, bckig.firoift 5 to 7 inehes in length (14 to 20 centimetres)*-, and from ,'.ih to ^tli of an inch transversely. Schneider questions whether these were Hie parent-worms of the iriicrdseopic Eilarioe ;f others state that they had simply: found their way to the heart from the Intestines .by accident, because this nbservatkm of MM. Grube and Delatbnd, although pub- lished about t \vonty years, has never - been ;eoriurmed. Leuekart. who, however, expresses no opinion on this- particular subject, refers to these observations as an illustration of the fact that, with the excteptioa of the Trichina spiralis, not a single rieinatode has been observ- od to ini'eet its own 'bearer' the Ikematozon of dogs as well 'as of frogs/ klever having been observed to develop mto'matiwo'li.diidntJto as long as they remained in the, blood.; B oil) im\ ftoeM riL it;iv?- Qj/JiOTl?} !>L;o:.) In a highly interesting paper read, by Dr. Cobbold before the Linneau Socjetv in 18G7,. it is more .than 1 , ! ,, ^ r 1.1 ATliT hinted at, that the , Hsematozoa referrecj. f , to bv MM. ', , , .. , , , ra^TT to(i->iiniiT K- c : Grube ami Delafon^l were the brood .of c Spitpptera . -: -n oaoiiJ .j^ml I,.- 1 ' sanguinolenta , so commonlv found m T the heart of doi? . - ^t ;:..: V t>mm OiTOT MifT OYJJilj Cluna. . ' it){ivJ'i joi joa . IOO,SQJJ;L In a foot note it is stated that Dr. Lamprey had foiv hould ina T ns.iiY? e ^ro l he a great matter if Professor" A itkcn would n.-exaiuiiu^ oj ^ . Per^dW^Wil ineJ -h \^ 8 on Hettfuutl.ology ' from onelialf to three-fourths of an jn<'h.' - r \ t ^MBgfiPffldS WaLSoiT,' -ista r . ?. 'id ,V/DP I ,o t * Menschlichen Parasiteii', Vol. II, Part 1, p. 102. Journal of Link l{ Sdt.^' Zoology.' Vol.-I\. 46 ON A H^MATOZOON the specimens, especially as to the minute structure of the contained embryos, if there be any, and publish the result. As regards the blood and heart of dogs in India, out of nearly 200 dogs examined by Dogs in Bengal not ^ ^^ ~ . affected with Heema- Dr. D. D.- Cunningham and myself, in connection with various experi- ments, in no instance were any such helminths detected, so that the canine Eilarise of Prance and China would appear not to be found in Bengal. Dr. G. E. Dobson has drawn my attention to a description of mature Filarise found by M. Joly in the heart of a seal ; the female worm is stated to have been stuffed throughout its entire length with ova and embryos ; the latter measured T V^ n to -j'^th of an inch in length and Ty ' 6 - - th in breadth, but the author does not consider that they could circulate with the blood through the capillary vessels.* Such, in a few words, is the present state of our knowledge of the principal Hsematozoa affecting lower animals ; and from these records alone would our in- ferences have had to be made in regard to the particu- lar question as to the possible duration of the Human Hsematozoon, were it not for a rather strange coinci- dence. The foregoing account had just been transcribed rue Fiiariee detected from my notes, when I had occasion ' tSly to visit the Government Printing existed more than years previously. Establishment, where, to my utter surprise, I saw, busily putting into type a portion of the * Ami. Mag. Nat. Hist., 1858, p. 400. INHABITING HUMAN BLOOD. 4? foregoing pages, the very man in whose urine these Filarise were first detected more than two and half years ago ! Being rather below the average in intelli- gence, he had not the remotest idea to what the manu- script referred. * At my request he called upon me in the afternoon, and I learnt from him then, that his urine had been perfectly healthy ever since he left the hospital, about April 1870, it certainly looks healthy now, and is quite free from albumenf. I prepared seven slides from blood obtained by pricking the middle finger of one hand, and three slides from the same finger of the other hand. On seeing me do this, the man enquired why I had made so many preparations, as on a former occasion I had only taken one slide; a circumstance, by the way, which I had quite forgotten ; certainly I had not discovered Hsematozoa. This little incident also conveys its lesson ; had I taken a dozen slides on the first occasion instead of one, the date of the detection of the Pilaria in the blood would probably have been simultaneous with their detection in the urine. In the first four or five preparations examined nothing could be observed; in the two next taken up, one belonging to each hand, Hsematozoa were detected, very active, but in no way differing from the excellent live specimens which I had obtained in his urine long ago, and in no way differing from the * See page 56. f On referring to my notes of this case, I find that, at the time when he left the Hospital, the albumen had disappeared from his urine, and that Filari could no longer be detected in it. 48 ON A H^MATOZOON Pilarise since detected in the urine and blood of so many persons. The measurements of two specimens were taken on the following morning after their activity had subsided ; one was T Vth of an inch in length by TT '~th in breadth, and the other -^'th by 7r \? 5 tli. Here is, therefore, definite information more satis- The prolonged exist- factory than that to be obtained by ence of Hsematozoa . . fo^recurrenc a Sfthe ins titutmg comparisons between the malady - Haematozoa of man and of animals, that, not only may those found in man live for a period of more than 2J years, for certain, but that there is no evidence that they have any tendency to develop beyond a certain stage so long as they remain in the circulation. For aught we know to the contrary, these Filariae may live for many years, and thus, at any moment, no matter how long after a previous attack, nor in what country the person may reside, he may be surprised by the sudden accession of Chyluria or any other obscure disease, such as will readily be understood by the physician when he becomes aware of the state of the blood. If after the first brood of young Filarise, there be no provision for other broods to follow, then every attack would be a step towards permanent recovery, but of this I know nothing at present, although some of the cases recorded appear to warrant such an inference. Nor have I any definite knowledge as to how the blood originally becomes infected ; to hint that it is possible if not probable that the Filaria may eventually be traced to the tank either to its water or its fish, is the utmost that can be done. INHABITING HUMAN BLOOD. 49 Many other interesting questions suggest them- selves as matters for future enquiry ; such for example as to whether the foetus in utero is infected by the mother's blood : cases have been recorded which seem to favour such a supposition ; such instances, however, may have been due to the particular localities in which the persons resided parents and children having for generations been subject alike to the same influences. On one occasion, I attempted to solve this question, but the mother, who herself was very averse to having her finger pricked, peremptorily refused to submit the child to a similar trivial operation. This paper having considerably exceeded the limits A summary of the originally intended, it may be that Sfer c ences recorded. 11 the leading facts referred to have become obscured by the digressions that have been necessarily made, so that, before concluding, a short summary of the observations and of the inferences which have been deduced therefrom may be advan- tageous : (1). The blood of persons who have lived in a tropical country is occasionally invaded by living microscopic Pilarise, hitherto not identified with, any known species, which may continue in the system for months or years without any marked evil consequences being observed ; but which may, on the contrary, give rise to serious disease, and ultimately be the cause of death : (2). The phenomena which may be induced by tho blood being thus affected are probably due to the me- 50 ON A HJEMATOZOON INHABITING HUMAN BLOOD. clianical interruption offered (by the accidental aggre- gation, perhaps, of the Hsematozoa), to the flow of the nutritive fluids of the body in various channels, giving rise to the obstruction of the current within them, or to rupture of their extremely delicate walls, and thus causing the contents of the lacteals, lymphatics or capil- laries, to escape into the most convenient excretory channel. Such escaped fluid, as has been demonstrated in the case of the urinary and lachrymal or Meibomian secretion, may be the means of carrying some of the Filariae with it out of the circulation. These occur- rences are liable to return after long intervals so long in fact as the Pilariae continue to dwell in the blood : (3). As a rule, a Chylous condition of the urine is only one of the symptoms of this state of the circula- tion, although it appears to be the most characteristic symptom which we are at present aware of : (4). And, lastly, it appears probable that some of the hitherto inexplicable phenomena, by which certain tropical diseases are characterised, may eventually be traced to the same, or to an allied condition. The importance of a careful microscopical examin- ation' of the blood of persons suffering from obscure diseases, in tropical countries especially, is therefore more than ever evident, and opens up a new and most im- portant field of enquiry referring as it does to a hither- to unknown diseased condition Calcutta, October 1872. RETURN CIRCULATION DEPARTMENT 5786 TO* 202 Main Library LOAN PERIOD 1 HOME USE 2 3 4 5 6 ALL BOOKS MAY BE RECALLED AFTER 7 DAYS Renewals and Recharges may be made 4 days prior to the due date. Books may be Renewed by calling 642-3405. DUE AS STAMPED BELOW OCTlR UNIVERSITY OF CALIFORNIA, BERKELEY FORM NO. DD6 BERKELEY, CA 94720 C. BERKELEY LIBRARIES OX A HLEMATOZOON INHABITING HUMAN BLOOD: ITS DELATION TO CHTLURIA AND OTHER DISEASES, BY T. R, LEWIS, M.B., ASSISTANT-SURGEON-, H.5I. BRITISH FORCES; i> UTY) ATTACHED TO THE SANITARY COMillSSIO^ER WITH THE GOVEH^Or CALCUTTA: OFFICE OF THE SUPERINTENDENT OF GOVERNMENT PRINTIN 1872.