Reprinted from the * Veterinarian,' February, 1878.]

y- S

f l e'F' is

Translations from Continental Journals.

DA SILVA LIMA ON ILEMATOZOA.

[ From the French .]

[This memoir originally appeared in the Gazeta Medina
da Bahia for September, 1877 ; the French translation,
from the Portuguese, being afterwards published in the
Archives de Medecitte Navalc for December, 1877. The full
title runs : — “ New phase of the question relating to the
parasitic nature of Chyluria. Discovery of the adult repre-
sentative of the ‘ Filaria of Wucherer.’ Par le Dr. Da Silva
Lima, Medicin de l’Hopital de la Charite de Bahia.” — Eds.]

Those of our readers who have followed the progress of
the discussion which has arisen during these last years, as
much in our country as elsewhere, on the subject of chylous
haematuria will, without doubt, learn with great interest a
very important fact which has come to us from Australia, and
which seems destined to dissolve the problem, so laboriously
studied, of the pathology of this disease.

This fact is nothing less than the discovery of the pro-
genitor or parent worm of the microscopic Filaria? found, for
the first time, by Wucherer, at Bahia, in chylurous urine,
and since then by divers observers in other tropical regions,
not only in the urine, but also in the blood of patients
affected with elephantiasis and certain diseases of the skin.

But, before relating this fact, which comes to us accom-
panied with commentaries and deductions which a discovery
of such value demands, we will here take the liberty of
recalling the principal phases of the study of chyluria con-
sidered as a parasitic affection.

Our distinguished colleague, Doctor Th Yictorino Pereira,
in his inaugural thesis, has very judiciously divided the
history of hmmato-chyluria into four periods: — 1st, Period
of the unknown origin ; 2nd, Flgyptian period ; 3rd,

1

2

TRANSLATION.

Brazilian period ; 4th, Indian period. It is actually necessary
to add (5th) the Australian period.*

In the first, as says our colleague, the hsematuria was
considered as an eliminatory flow of the fat that was not
burnt in consequence of a vice of the haematosis ; in the
second, as due to the parasite of Bilharz; in the third, as
re-asserting itself in consequence of the presence of the
filaria of Wucherer; in the fourth, as a symptom of the in-
fection of the blood by a new hematozoon, this same Filaria
of Wucherer; in the fifth, wc ought to add, it will be re-
garded as one of the symptoms of the helminthiasis occasioned
by the adult representative of these microscopic embryos.

Leaving aside the first epoch of investigation of the
hsemato-chyluria (an epoch of hesitation, of conjectures and
of theories more or less ingenious, that subsequent facts
began to shake and which recent discoveries have deprived
of all the interest and all the importance in which they
rejoiced), wc shall occupy ourselves with those epochs during
which this affection began to be considered under an alto-
gether different aspect — thanks to clinical observation and
to the revelations of the microscope, which came to replace
purely speculative controversies.

In 1851 Bilharz discovered the parasite which now bears
his name ( Bilharzia hamatobia, Cobbold), and the associa-
tion of its presence with the hsemato-chyluria of Egypt ; a
fact confirmed by other observers in this same African region,
and later by Dr. G. Harley in the urine of a patient who
contracted the disease at the Cape of Good Hope.

In August, 1806, our regretted collaborator and friend.
Dr. Wucherer, occupying himself, at the invitation of the
learned Griesinger, to verify here the preceding discovery,
as well of this nematodet as of its eggs, found in the chylous
urine of one of our patients an embryonic nematoid alto-
gether unknown. A few years after, this important fact was
also confirmed in the United States by Salisbury, in the
Antilles by Crevaux, and in India by Lewis.

Here and in these regions the constant presence of this
worm in the milky urine became notorious.

It seems proper to recall a circumstance very remarkable

* To this must also be added a Gtk or Chinese period — relating to the
discovery of the larva: and their metamorphoses witnin the stomach of the
mosquito ( Culex mosquito). This has been communicated to Dr. Cobbold
by Dr. Patrick Manson, who is stationed at Amoy, Chiua. See a letter in
The Lancet for January 12th, 1878 (p. 69). — Eds.

f In the French Dr. Lima is made to say “ Ce nematode,” but clearly
the words ought to be “ ce trematode,” as the author refers to Bilharzia.
—Eds.

TRANSLATION.

3

by its singularity, which, at a given moment, if this fact
remains unique till now, has had a considerable influence
on the pathological explanation of the hsemato-chylous
urine. At the moment when Wucherer was seeking for the
Bilharzia hamatobia he found instead of it an unknown
worm * Later on. Dr. Cobbold, studying the embryology of
this fluke-parasite in the urine of a patient who had resided
in Africa, discovered the eggs of a nematoid which contained
embryons perfectly resembling those of Wucherer.

In 1872 Dr. Lewis not only verified at Calcutta the pre-
sence of these nematoids in the embryonal state in the chylous
urine, but, what is more extraordinary, he discovered them
equally in the blood of the patients affected with ehyluria,
diarrhoea, elephantiasis, and even in persons appearing to be
in good health.

He proposed for the designation of this new species of
non-adult helminth the provisional denomination of Filaria
sanguinis hominis. Some time after, 1\ Sousino also dis-
covered the same animalcules in the blood of the hacmaturics
of Egypt.

In 1875 Dr. O’Neill on the West Coast of Africa, and
our studious colleague, Dr. Araujo at Bahia, encountered,
almost at the same time, the same microscopic Filaria, pro-
ceeding from the skin affected with a disease peculiar to
uegroes, which they called “ craw-craw,” and to which
Filaria our compatriot gives the name of Filar lose dermathe -
mica. f llecently a distinguished medical man. Dr. Felicio
dos Santos, encountered the same embryonal nematoid in
the blood of an individual affected with elephantiasis — a
unique fact up to the present time in relation to patients of
this kind, and which since has never been verified at Bahia
in spite of all tentative efforts made to do so.

Such are, in short, the facts relative to the coexistence
of animalcules with hasmato-chyluria, and with other affections
which do not appear to possess in common the least patho-
logical analogy. The Bilharzia associated with ha<maturia
and dysentery in Egypt; the Filaria of Wucherer associated
with the same affection in Egypt, Brazil, the Antilles, the
United States, and India, and, moreover, in this last-named
region and in China associated with the elephantiasis of
the scrotum and with diarrhoea, and with “ craw-craw ” on
the West Coast of Africa.

Let us now see the interpretation of these facts.

* A similar observation has been made by Dr. Sonsino, and commented
on by Sir Joseph Favrer in * The Lancet ’ for August, 1870 (p.284).

t Sec ‘ Arch, de Med. Nav.,’ tom. xxiv, p. 22'J.

4

TRANSLATION.

The presence of the Bilharzia is considered as a cause
of hsematuria and of one form of dysentery in Egypt.

The eggs of this parasite have never, up to the present
time, been found in the urine of the hematurics of Brazil ;
no adult animal has ever been discovered in its seat of pre-
dilection. As much in consequence of the rarity amongst
us of cases of death by chylous hsematuria as by the difficulty
of obtaining the means of making autopsies, Wucherer
made for a long time vain efforts to discover some eggs.
This allows us to presume that this parasite is very rare or
that it is not to be found in our climate. But its coexistence
with our Filaria in Africa in the same individual cannot be
held in doubt, according to the observations of Cobbold and
Sonsino. Up till now it has not been established iu India
that the Bilharzia has been found there.

What role do these parasites or their larvae play in the
pathogeny of the hsemato-chyluria and dysentery in Egypt
and at the Cape ? This still remains to be determined.

Concerning the Filaria of Wucherer, which interests us
more particularly, let us see what have been the principal
opinions put forth up to the present time on its presence in
the chylous urine, the blood, the lymph, &c.

Our illustrious collaborator has made known in the Gaz.
Med. de Bahia his important discovery under the modest
title of “ Preliminary Notice on a species of Worm at present
not described still more modestly he formulated in the
following manner his judicious and prudent conclusions : —
“ It would be rash on my part to put forth a conjecture on
the coexistence of these worms of the hsemato-chyluria, and
on the etiological signification which they might have ?
I shall therefore abstain until I have been able to make more
ample investigations, and until I have been permitted to
examine the corpse of a hsematuric, which has not yet been
possible.” ( Gazette Medicale de Bahia, Dec., 1868, p.
99.)

In the four articles that the learned observer pub-
lished the following year we do not find a word on the
etiological signification of these helminths ; he hardly
mentions them ; he admits that he is ignorant of what
manner and in what state of evolution the progenitors of
these animacules penetrate into the human body, how they
arrive in the kidneys, what is the destiny of these embryos
once that they have been expelled with the urine, &c.

Since Wucherer, although many ■works have been pub-
lished either in the form of articles in the journals or in the
form of theses, no important fact has been produced, nor bus

TRANSLATION.

5

opened to the scientific world any vast field of conjec-
tures or of theories. Some have wished to see in the presence
of the worm in the embryonal state in the chylous urine
only a mere coincidence ; others have considered it as the
principal, if not the unique, cause of the disease. Among
these last some supposed that the embryos were really the
cause, others thought that it was only the adult animal
which played this role] they presumed that it existed in
some hidden part of the organization, such as the blood-
vessels, the lymphatics, the kidneys, the bladder, &c.

The discovery of Lewis and the later facts established by
Manson and by other observers who encountered the Filaria
of Wucherer in the blood and in the lymph of patients
affected with elephantiasis of scrotum and with chyluria,
as well as the coexistence of these diseases, not only in the
same countries, but also in the same individual, led to the
conclusion that their parasitical etiology was in common.
There was thus equally established a connexion between
these two diseases and a peculiar eruption in the vesicules
of which O’Neill, in Africa, and Dr. Silva Aranjo, at Bahia,
found the same helminths in patients who were not
affected with chyluria.

Thus, w'ith the presence of the Filaria of Wucherer in
the economy would correspond three distinct pathological
forms, and further, they are determined by the seat of this
animalcule or of its parents. The symptoms are, in certain
cases, chyluria ; in others, elephantiasis, lymphatic varix,
craw-craw, &c.

With regard to this subject opinions vary very much ;
some deny, others hold in doubt, as not being proved, the
verminous nature of chyluria ; there have been found, not-
withstanding, vigorous defenders of the theory of helminths.
Among these defenders we shall cite in the first place our
distinguished colleague Dr. Almeida Conto, who has sustained
this opinion in his thesis concours, and particularly in a
remarkable article published in the Medical Gazette of
Bahia (January and February, 1877).

Such is the state of the question as regards chyluria ob-
served at Brazil and in other intertropical Countries. As to
the relation which exists between this disease and elephan-
tiasis, which for many years have frequently been seen to
coincide in the same individual at Rio de Janeiro, we have
not observed it here. As to that which concerns the Filaria
of Wucherer, so often encountered in the blood of chylurics
and of individuals affected with elephantiasis in India and
in China, it has been proved only twice at Brazil ; the first.

6

TRANSLATION.

in the blood of the papules of a cutaneous eruption ; and
the second, in that of a subject affected with elephan-
tiasis.

It is under these circumstances that the fact that we are
about to relate has come to our knowledge. If it be con-
firmed, it promises peremptorily to decide the question in
favour of those who hold the parasitic etiology of chyluria.

It is Dr. Cobbold, the eminent English helminthologist,
who has first announced, in The Lancet (No. of 14th of last
July), the discovery of the adult Filaria, of which the
embryos have so much preoccupied, during these last years,
the observing medical men of the intertropical countries.

He says that the brilliant discoveries of Lewis, continued
in Egypt by Sonsino, and by Welch and others in England,
have been verified by the observations of l)r. Bancroft
in Australia. lie has found in the sexually mature state
the form at least of one of the species of microscopic
hematozoa.

Already, Dr. Cobbold had found, in 1876, in some blood
sent from Australia, in capillary tubes, from a kannaturic, a
nematoid egg. This fact almost certified the existence, in the
human body, of an adult worm. Dr. Roberts, of Manchester,
who had sent these tubes to Dr. Cobbold, had already verified,
in the blood that they contained, a microscopic heinatozoon,
discovered in Australia by Bancroft. This doctor (Bancroft),
at the instigation of Dr. Cobbold, actively continued his
investigations; they resulted in the communication of the
following new facts, addressed to Dr. Cobbold, and dated
from Brisbane, Queensland, April 20th, 1877.

“ I have with great ardour followed up the research foi
the parent parasite, and I am happy to tell you that I have
found five specimens of worm, which I hope to send to you
as soon as 1 shall have a safe opportunity. I reckon about
twenty cases of this parasitic disease, which, I believe,
explain the chyluria, a certain form of hsematuria, a foim of
spontaneous lymphatic abscess, a particular soft vanx of the
groin, a hydrocele containing a fibrinous liquid, another
with a chylous appearance, also some forms of varicocele and

orchitis. All this I have verified.

“ In the colony there are found no cases of elephantiasis
of the legs or of the scrotum; but, by the description of
these affections in the memoir on the diseases of the skin,
and of other diseases of India by Fox, Farquahar, and
Carter, and by Dr. Roberts’s article on these last named i m
a book on the affections of the urinary passages, I thin, k that
the parasitic nature of these diseases will be establishe .

TRANSLATION.

7

“The worm is, more or less, of the thickness of a hair,
and from three to four inches in length.

“ The Filariaj described by Carter came forth in prodi-
gious numbers by openings placed towards the centre of the
body.

“ My first specimen was found, Dec. 21st, 1876, in a
lymphatic abscess of the arm. It was dead. I obtained four
other living individuals from a hydrocele of the spermatic
cord ; they found themselves stopped at the orifice of a
special trochar that I employ for puncture. I preserved
them alive during one day ; I had much trouble to separate
them from each other. When the worm was plunged in
pure water it stretched itself and then remained perfectly
still. In this state it was readily extracted from hydroceles,
with a great trochar, from the patients known to be attacked
with Filaria.

“ I will soon send you more details about my cases and
the worms.”

“ Such is,” says Dr. Cobbold, in finishing his article,
“ the report rendered of these discoveries that Dr Bancroft
gives us, and according to the brief description which he
traces of the parasite 1 propose to give to this adult nema-
toid the name of Filaria Bancrofti .”

He adds that he shares the opinion of the Drs. Bancroft,
Lewis, Sonsino, Fayrer, and others, who think that a con-
siderable group of morbid states, of which the manner of
origin is yet very obscure, proceeds from the injurious influ-
ence of the microscopic Filaria!.

The discovery of Dr. Bancroft has an incontestable
importance, whether one arrives or not at being able to
demonstrate with certitude that the nematoid, of which the
author of the preceding article has given a name so advan-
tageously known in the scientific world, is the progenitor of
all the microscopic Filariae found concurrently with the
symptoms of chyluria and of other enumerated morbid
states. These animals in the embryonic state have not, in
truth, a very great resemblance to each other, according to
the descriptions given by the observers of divers countries ;
nevertheless we expect with confidence the demonstration of
their perfect specific identity, and particularly of their com-
mon and legitimate affiliation with the adult w'orm which has
just been discovered in Australia.

The more extended and minute works which the Drs.
Cobbold and Bancroft promise us will, perhaps, disperse in
great part, if not totally, the doubts which still exist in the
minds of some medical men as to the veritable origin and

8

TRANSLATION.

the nature of the hsemato-chyluria, and of the affections
which offer, as a common bond with them, the presence of
the same helminth in the urine, the lymph, and the blood.

Appendix. — By Mons. A. Le Roy de Mericourt, Medecin
en Chef de la Marine et des Colonies ; Officier de la Legion
d’Honneur.

Our excellent confrere and friend, Dr. Silva Lima, devotes
the close of his article to an expression of the regret that he
feels at the oblivion in which the learned English helmintho-
logist has left the venerated name of Dr. Wucherer, when he
(Dr. Cobbold) quotes in his memoir the indefatigable observer
whose labours have contributed to the elucidation of this
question. The name of Wucherer deserves, however, to
figure in the first rank in the chronological order of investi-
gators. Dr. Cobbold had already previously associated with
this subject the names of Leuckart, Vix, Bastian, Heller
Lewis, and Salisbury {Med. Jlecord, No. 1, p. 6). This
neglect, certainly involuntary, on the part of the English
helminthologist (in the article in The Lancet of last July
14th) is repaired in a new article from the same savant , on
the Filaria Baticrofti, inserted in the same periodical, No.
3, of Oct. 6th, 1877. Doctor Da Silva Lima will have
Avelcomed, with a lively satisfaction, this new and legitimate
homage paid to the memory of Wucherer. Here, moreover,
is the substance of Dr. Cobbold’s last article, which will
complete the communication of our distinguished contem-
porary of Bahia.

Last 28th August, Dr. Cobbold received from Dr. Bancroft
three tubes containing some adult female Filarise, preserved
in glycerine, and a fourth containing some embryos and
the eggs. The microscopical examination allows the follow-
ing characters to be given to this species : — Filaria Bancrofts
(Cobbold) , body capillary, smooth, of a uniform volume. The
head furnished with a simply circular mouth, denuded of
papillae ; neck straight, about a third ot the thickness of the
body. Tail of the female simple, suddenly narrowing. The
reproductive orifice is situated very near the head, the anus
close to the extremity of the tail. Length of the female
three and a half inches ; thickness, -gV of an inch. Embryos
from to xiT" in length ; eggs, —oW' bY tbVo "•

The female worm only has been found.*

In giving the name of Dr. Bancroft to this sexually

* By a slip of the pen this passage stands “ Le male du ver seul a etc
trouve.” It should have been “ La femelle,” &c. — Eds.

TRANSLATION.

9

mature worm Dr. Cobbold wished to recall at once the
origin and the date of the discovery (Brisbane, Dec. 21st,
187(>). This appellation ought in no wrise to diminish the
merit of Lewis, who first gave to the immature worm the
name of Filaria sanguinis hominis . Drs. Salisbury and
Cobbold had previously found the embryos still enclosed in
the chorion, which should be the young of the Filaria Ban-
crofti ; but it was reserved to Lewis to discover the hsemato-
zoal character of the young of this worm and to find them in
the blood. If the relation of origin established by Dr. Cobbold
between the embryo and the Filaria Bancroft i should come
to be verified, it would be absurd to call the adult worm
Trichina cystica ; however, Salisbury has given this name to
the parasite found in the urine. In conclusion, the adult
Filaria sanguinis hominis (Lewis) and the Filaria Ban-
crofti (Cobbold) are evidently no other than the same
species under two denominations. Cobbold goes farther, he
expresses the opinion that all the different larval forms sepa-
rately described by Salisbury, Lewis, Sonsino, Wucherer,
Crevaux and Corre, Da Silva Lima, Bancroft and himself,
must be referred to one and the same species. If the
denomination given by Lewis is adopted to designate the
adult worm in preference to that of Filaria Bancrofti,
Cobbold does not make any objection.

A. Le Roy db Mkricourt.

Glasgow

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