Chapter XV: Section III: NEMATODA (Round Worms) (3)

Before I proceed to summarise the whole body of facts I must in the next place state that Manson and myself contributed a joint communication to the Medical Society of London on the 25th of March, 1878. In this memoir I especially dealt with the question of priority in connection with the discovery of the adult worm. I then restated that the adult parasite was discovered by Dr Bancroft on December 21st, 1876. The discovery was verified by Dr Lewis on August 7th, 1877, by Dr Silva Araujo October 16th, 1877, and by Dr F. dos Santos November 12th, 1877. I gave these dates unhesitatingly, without, however, in any way prejudicing the question already raised in respect of the identity of the worms found in each case. My own mind was fully made up on that point, and affirmatively so. Dr dos Santos’ find was made in conjunction with Dr J. de Moura in a case of lymphatic abscess of the arm. Clinically viewed, the case published by Dr Araujo must be regarded as unique. Not only were adult and embryonic Filariæ found in the same patient, but, what was far more surprising and interesting, the patient displayed in his own person several of the disorders hitherto found apart; and he was more than once attacked by one or two of the diseases. He experienced a first attack of chyluria three years ago, then attacks of craw-craw commencing a year ago, the latter being attributed to bathing in a particular lagoon. He had a second attack of chyluria six months back, at which time lymph-scrotum appeared, and also scrotal elephantiasis. Dr Bourel-Roncière pronounced this case to be unique, and attributed nearly all the disorders to the presence of Wucherer’s embryonic Filariæ. In a very elaborate analysis of and commentary on Dr da Silva Lima’s second memoir, Dr Bourel-Roncière warmly claims for Wucherer the supreme honor in all these discoveries. A number of affections hitherto regarded as distinct, and all of which appear to be due to the action of Filariæ, are regarded by Dr Bourel-Roncière as mere phases of one and the same disorder. This affection he terms _Wucherer’s helminthiasis_. Dr Manson had indeed arrived independently at a similar conclusion, and I am confident that Wucherer, were he alive, would in this particular aspect of the question be the last to claim priority either to Lewis, to Bancroft, or to Manson.

In this place I may observe that Dr Pedro S. de Magalhães, of Rio de Janeiro, detected free microscopic nematodes in the potable waters of Rio (agua da Carioca), which from their similarity he supposes may have some genetic relation with _Filaria Bancrofti_. In this opinion I cannot share.

As regards the metamorphoses of the embryo, Manson states that for a little while after gaining access to the stomach of the mosquito the embryo undergoes no change (Fig. 40, _a_). In a very few hours changes commence, resulting in wider separation of the outer skin and an appearance of transverse markings on the body within (_b_). In the next stage oral movements occur; the striation becomes more marked, and the outer envelope is cast off (_c_). Then the striated lines disappear and a dotted appearance is substituted (_d_). From this condition the embryo passes to what Manson calls the chrysalis stage, in which nearly all movement is suspended and the large spots gradually disappear (_e_, _f_, _g_, _h_, _i_, _j_, _k_). The tail continues to be flexed and extended at intervals and the oral motions cease. By the close of the third day the embryo becomes much shorter and broader; but the finely pointed tail retains its original dimensions, projecting abruptly from the sausage-shaped body (_m_, _n_). Large cells next appear in the interior of the body, and by a little pressure one may detect indications of a mouth (_o_, _p_, _q_, _r_). At this period the embryo begins to elongate, and at the same time to diminish in width; but the growth takes place chiefly at the oral end of the body. The mouth becomes four-lipped, open, and funnel-shaped, and from it a delicate line can be distinctly traced passing to an opening near the caudal extremity, the tail itself gradually disappearing (_s_, _t_). Speaking of the most advanced stage Manson says:--“A vessel of some sort is seen in the centre running nearly the whole length of the body and opening close to one extremity. This end is slightly tapered down and is crowned with three or perhaps four papillæ, but whether this is the head or tail, and whether the vessel opening near it is the alimentary canal or the vagina, I cannot say.” Now it is quite evident, I think, from Manson’s figures that he has here faithfully represented the head and tail, the former (_u_) to the left, the latter (_v_) to the right. In his _manuscript_ (from which I am now quoting) there is no special reference to these two figures; but it is easy to see that these terminal sections of the body of the advanced embryo closely correspond with the head and tail of the adult worm (_Filaria Bancrofti_). The curved line passing to the left (_u_) evidently indicates the commencement of the partially-formed vagina.

How completely Manson took the initiative in this part of the work is evident even from Lewis’s own later observations. In a paper published in March, 1878, Dr Lewis, writing from Calcutta and speaking of the rôle of the mosquitoes, says:--“I had repeatedly examined, in a cursory fashion, these and other suctorial insects, but had not observed any parasites suggestive of these embryo-hæmatozoa, hence, when, on receipt of a communication from Dr Manson a couple of months ago, a renewed search was made, I was surprised to find that four out of eight mosquitoes, captured at random in one of the servants’ houses, harboured specimens of hæmatozoa to all appearances identical with those found in man in this country. After this, however, several days elapsed before any mosquitoes could be obtained which contained these embryo-nematoids, and the specimens obtained on the next occasion were devoid of the enveloping sheath, which appears to characterise the kind found in man out here, and apparently, according to Dr Manson, in China also.” Further on Lewis also remarks, “When the insect is caught shortly after feeding and the contents of its stomach examined microscopically, the hæmatozoa, if present, will be observed to manifest very active movements, which may possibly continue for several hours on the slide. If the insect be kept for twenty-four hours before examination it is probable that the movements of the parasites will be more sluggish, and their form probably altered owing to irregular contractions and dilatations of their substance--changes which may also occasionally be observed when embryo-hæmatozoa are preserved on a glass slide, and they may sometimes be kept alive thus, if in suitable media, for two or three days. When the insect is not examined till the third day, the contained parasites will probably manifest marked signs of disintegration--and possibly every indication of life will have disappeared from many of the specimens. After the third or fourth day I have not seen any active specimens of these entozoa in the stomach or in any part of the alimentary canal of the mosquito; those which remain have undergone more or less fatty degeneration, and are readily stained with eosin, which, as far as my experience goes, is not the case so long as they are alive and active. After the fourth or fifth day it is very rare that traces of any hæmatozoa-like objects can be detected at all, so that it must be inferred either that they have succumbed to the digestive action of the insect’s stomach or been disposed of along with the excreta.” An important _addendum_ by Lewis records a fortunate incident as follows:--“It was observed that nearly all the mosquitoes captured in one of the servants’ houses contained hæmatozoa, so that the supply of suitable insects in all the stages of their growth became amply sufficient for all requirements. The result of the examinations under these favorable conditions has shown that although the stomach digests a great number of the ingested hæmatozoa, as mentioned above, nevertheless others actually perforate the walls of the insect’s stomach, pass out, and then undergo developmental stages in its thoracic and abdominal tissues.”

I may here observe that Sonsino has instituted a comparison between the embryos of this Filaria and those of Anchylostoma, by which it appears that the former measure 0·218 to 0·330 mm. in length, and those of Anchylostoma 0·430 mm. The hæmatozoa are about forty times longer than broad, and the larval anchylostomes only fourteen times longer. The tail of _Filaria_ is conspicuously longer.

In the ‘Lancet’ for June 22nd, 1878, an announcement appeared from the pen of Mr D. H. Gabb, of Hastings, stating that a patient under his care formed the habitat of _Filaria sanguinis hominis_; and in the autumn of the same year a paper which I read to the Linnean Society in the spring was published. In that paper the following summary was offered:

1. _Filaria Bancrofti_ is the sexually-mature state of certain microscopic worms hitherto obtained either directly or indirectly from human blood.

2. The minute hæmatozoa in question--hitherto described as Wucherer’s Filariæ, _Filaria sanguinis hominis_, _Trichina cystica_, _Filariose dermathemaca_, and so forth--are frequently associated with the presence of certain more or less well-marked diseases of warm climates.

3. The diseases referred to include chyluria, intertropical endemic hæmaturia, varix, elephantiasis, lymph scrotum, and lymphoid affections generally, a growth called _helminthoma elastica_, a cutaneous disorder called craw-craw, and also leprosy.

4. It is extremely probable that a large proportion, or at least that certain varieties of these affections are due to morbid changes exclusively resulting from the presence of _Filaria Bancrofti_ or its progeny within the human body.

5. It is certain that the microscopic hæmatozoa may be readily transferred to the stomach of blood-sucking insects, and it has been further demonstrated that the digestive organs of the mosquito form a suitable territory for the further growth and metamorphosis of the larval Filariæ.

6. The character of the changes undergone by the microscopic Filariæ, and the ultimate form assumed by the larvæ whilst still within the body of the intermediate host (_Culex mosquito_), are amply sufficient to establish the genetic relationship as between the embryonal _Filaria sanguinis hominis_, the stomachal Filariæ of the mosquito, and the sexually-mature _Filaria Bancrofti_.

In the month of September, 1878, I received a letter from Dr da Silva Lima announcing the fact that Dr Araujo had verified the existence of the embryos of _Filaria Bancrofti_ in mosquitoes, at Bahia. These mosquitoes had, I understood, attacked a French priest in whose blood Dr Araujo also detected Filariæ. Thus, it fell to the lot of Araujo, through his untiring zeal, to verify in Brazil all the separate discoveries of Bancroft, Manson, and Lewis.

In the October issue of the ‘Pathological Society’s Transactions’ for 1878 Dr Bancroft records numerous cases of filarious disease, and he gives a succinct account of the circumstances connected with his original discovery.

In a clinical lecture published October 12th, 1878, Dr Tilbury Fox seeks to diminish the value of these discoveries, characterising helminthological investigators as merely “recent writers.” Dr Fox denies that Filariæ are a cause of true elephantiasis, but admits the occurrence of “elephantoid inflammation and inflammations due to Filariæ.” Dr Fox’s statement that “Filariæ have not been found in uncomplicated elephantiasis, that is, in disease without chylous exudation,” seems to me to be directly at variance with Manson’s recorded experiences. I hold that Manson has confirmed the truth of Lewis’s views, and that he has thoroughly proved that (to use his own words) “varicose groin glands, lymph scrotum, elephantiasis, and chyluria are pathologically the same disease.” In the first instance I was myself led to conclude that some of the forms of elephantiasis might be due to other causes than obstruction of the lymphatics caused by the presence of Filariæ; but the explanations of Lewis, of Bancroft, and of Manson more especially, have almost entirely removed this doubt. Those who seek to explain away the connection between genuine elephantiasis and Filariæ will do well to study Manson’s last important memoir. He shows that “elephantiasis and allied diseases are much more frequently associated with the parasite than are other morbid conditions.” This fact is brought out very clearly in his table of 670 cases, from which it appears that 58 per cent. of cases of Filaria are associated with elephantoid disease.

When this opposition to Manson’s views is likely to cease (on the part of those who do not happen to have been in any way instrumental to the discoveries in question) it is not easy to say. In a brief communication which appeared in the last number of the ‘Medical Times and Gazette’ for 1878, Dr Manson successfully combats the doubts that have been entertained respecting the rôle of the mosquito. Because Lewis found that canine hæmatozoa were digested, and thus perished in the stomach of mosquitoes, it had been argued that _human_ hæmatozoa must necessarily undergo similar processes, and consequently die. Those who oppose the views of helminthologists in respect of the intermediary host-function of insects on such grounds can have very little general, and still less special knowledge of the phenomena of parasitism. It is the old story. When any new discovery is made, it must always pass through the ordeals of denial and doubt before it can be generally accepted as true; and, as in the case of Jenner’s immortal discovery, there will always remain a certain number of peculiar people who show themselves hostile to every advance in science. Dr Manson may take comfort from this consideration, and rest assured that the value of his discovery is quite unaffected by the opposition referred to.

Since I communicated the results obtained by Manson, Lewis, myself, and others to the Linnean Society, an even more exhaustive summary of the facts has been published by Dr Bourel-Roncière, in the ‘Archives de Médecine Navale.’ The distinguished author does full justice to the writings of English helminthologists, and dwells, with emphasis, upon the finds and interpretations of Lewis, Manson, and Bancroft. Incidentally, also, he comments upon Sir Joseph Fayrer’s early recognition of the etiological identity of hæmato-chyluria and elephantiasis, on other than helminthic grounds. The frequent concurrence of the two affections had especially struck Sir J. Fayrer as pointing to a probable common origin. He had also surmised that the disorders might be due to parasites.

Dr Bourel-Roncière, alike with the caution, precision, and logical reasoning of a cultured _savant_, concludes his elaborate review in the following terms:--“There are the facts. Certainly, many points remain obscure, many problems await a solution, and the last word has not been said on the actual part which the parasite plays in the pathogenesis of the affections above enumerated--its mode of action, the importance of its rôle, the extent of its pathological domain, the habitat of its progenitors, their identity, and so forth. All these questions will only be elucidated by necroscopic researches, which at present remain absolutely wanting.”

“However, notwithstanding the doubts which hover over the future value of these curious discoveries, it is difficult not to recognise their importance in the study of certain tropical diseases--which up to the present time have been attributed to vague and undetermined causes--hæmato-chyluria and elephantoid affections principally. Apart from the interest which attaches to the natural history of the nematoids, they raise, in effect, etiological and prophylactic questions, the extreme importance of which we believe it would be needless to demonstrate. It is greatly to be desired that the researches should be taken up in other parts of the globe, where endemicity and perhaps greater facilities for necroscopic investigation would render them fruitful--Cochin-China, Tahiti, &c. Fresh observations are necessary to confirm the first and to fill up notable gaps. The way has been brilliantly opened by the English and Brazilian physicians. Let our colleagues in the French colonies put their shoulders to the wheel; they have before them a vast field of study to explore.”

Since the above remarks were written I have received several communications from Dr Bancroft, and also others from Drs da Silva Lima, Araujo, Assis Sousa, Paterson, Hall, of Bahia--the two last named being English physicians in practice there. I regret that I can do little more than refer to the writings of these authors in the Bibliography below; but I may observe that Drs Paterson and Hall have ascertained that the proportion of the population of Bahia affected by Filaria is 8-1/2 per cent. Out of 309 persons examined, 26 had hæmatozoa, which is, roughly, one in twelve, or more strictly, 8·666 per cent.

Amongst recent memoirs that by Sir J. Fayrer, read to the Epidemiological Society on the 5th of February, 1879, deserves especial attention. In regard to its significance, I have only space to remark that, much as we may regret the little interest shown by our hospital physicians and surgeons in this subject, it is particularly gratifying to see experienced Indian officers like Sir J. Fayrer, Mr Macnamara, and Dr John Murray, coming forward both to aid and render homage to their junior colleagues in Eastern parts, who are successfully labouring to advance the cause of helminthology and scientific medicine.

In concluding this subject I may observe, that one of the greatest hindrances to the due recognition of the remarkable part played by parasites in the production of human endemics and animal epizoötics arises from the circumstance that no inconsiderable number of minute worms may infest a host without obvious injury. This immunity proves nothing. If, for example, we take the case of _Trichina_ we find that several millions of entozoa may exist in the human, or, at all events, in the animal bearer, without producing any symptom of discomfort. In such cases it is not possible to determine the strict limits of health and disease; nevertheless, were we to double the amount of infection, the imaginary line of demarcation is at once bridged over and the parasites become acknowledged as directly responsible for grave symptoms which may even prove fatal to the bearer. Again, the relative strength and size of the infected host constitute factors that materially limit the power of the parasite for injury. Where the entozoa are of minute size, and where their injurious action is primarily due to the mechanical obstructions they set up, it is clear that the virulence of the helminthiases, or resulting diseased conditions, will mainly depend upon the number of intruders.

Another consideration of the highest value in relation to epidemiology generally, and more especially in regard to the practical question as to the best methods of stamping out parasitic plagues, is that which refers to the life-history of the entozoon itself. It must be obvious that in all cases where the intermediate host can be captured and destroyed, the life-cycle of the parasite can be broken and interrupted, and if thus broken, there is an end to the further propagation of the species. The knowledge that we have acquired by experimental research in this connection has already enabled us to set a limit upon the prevalence of certain well-known disorders, such as Trichinosis, Cestode-tuberculosis, and so forth. In the case of epizoötics, however, which are indirectly due to the action of intermediary hosts that cannot be readily captured or destroyed, then our power of arresting the disease is comparatively limited. In the present case it is probably not necessary either that a dead or living mosquito should be swallowed to insure infection; but it _is_ necessary that the parasitic larvæ should have dwelt within the mosquito in order to arrive at the highest stage of larval growth prior to their re-entrance within the human territory. Undoubtedly, the larvæ are swallowed with potable waters. Perfect filtration before use would certainly check, if in course of time it did not totally extinguish several of the many virulent diseases that now afflict the inhabitants of warm climates.

It is with reluctance that I terminate this article, but in the closing pages of this work (Book II, Section V) I hope to add a few more particulars in reference to Lewis’s latest researches.

BIBLIOGRAPHY (No. 23).--_Araujo, A. J. P. da Silva_, “Memoria sobre a Filariose,” &c., Bahia, 1875; see also ‘Arch. de Méd. Nav.,’ 1875 and 1878.--_Bancroft, J._, “Cases of Filarious Disease,” in ‘Pathological Soc. Trans.’ for 1878, vol. xxix, p. 407.--_Bourel-Roncière_, “_Résumé_ of and Commentary upon the writings of Silva Lima, Silva Araujo, and others,” in ‘Arch. de Méd. Nav.’ for March, 1878.--_Idem_, “Pathologie exotique. De l’hématozoaire nématoïde de l’homme et de son importance pathogénique, d’après les travaux Anglais et Bréziliens des dernières années;” _ibid._, for August and Sept., p. 113-134 and p. 192-214, 1878.--_Cobbold, T. S._, “Discovery of the Adult Representative of Microscopic Filariæ,” ‘Lancet,’ July, 1877, p. 70.--_Idem_, ‘On _Filaria Bancrofti_,’ _ibid._ Oct., 1877, p. 495.--_Idem_, “Verification of Hæmatozoal Discoveries in Australia and Egypt,” ‘Brit. Med. Journ.,’ June, 1876.--_Idem_, “Obs. on Hæmatozoa,” ‘Veterinarian,’ October, 1873.--_Idem_, “Remarks on the Ova of another Urinary Parasite (in the paper on ‘Bilharzia’) from Natal,” ‘Brit. Med. Journ.,’ July 27th, 1872, p. 89; see also Bibl. No. 12.--_Idem_, “Entozoa in Relation to the Public Health” (various papers), ‘Med. Times and Gaz.,’ Jan. and Feb., 1871.--_Idem_, ‘Worms’ (l. c., p. 151), 1872.--_Idem_, “Hæmatozoa; Fresh Discoveries by Lewis,” ‘Lancet’ for Feb. 6, 1875.--_Idem_ (brief notice), the ‘Veterinarian,’ p. 209, March, 1875.--_Idem_, “On the Discovery of the Intermediary Host of _Filaria sanguinis hominis_,” ‘Lancet,’ Jan. 12, 1878, p. 69.--_Idem_, “On the question of Priority of Discovery,” Rep. of Med. Soc. of Lond., in ‘Lancet,’ March 30, 1878, p. 465.--_Idem_, ‘Mosquitoes and Filariæ’ (explanatory note), in ‘Brit. Med. Journ.,’ March 16, 1878, p. 366.--_Idem_, “On the Life-history of _Filaria Bancrofti_, as explained by the discoveries of Wucherer, Lewis, Bancroft, Manson, Sonsino, myself, and others,” “Report of the Proceed. of the Linnean Soc.” for March 7, 1878, in ‘Pop. Science Rev.,’ April, 1878; and afterwards published _in extenso_ in ‘Journal Linn. Soc.,’ Oct. 31, 1878.--_Idem_, “On _Filaria Bancrofti_,” in Part iv of a series of papers on the Parasites of Man, in the ‘Midland Naturalist,’ August, 1878.--_Idem_, “On _Filaria sanguinis hominis_,” in a letter to the ‘Lancet,’ July 13, 1878, p. 64.--_Idem_, “Filariæ and Leprosy” (case from Bancroft); ‘Lancet,’ Feb. 1, 1879.--_Corré, A._, “Note sur l’helminthe rencontré dans les urines hémato-chyleuses,” ‘Rev. des Sci. Nat.,’ 1872.--_Cossé_, “Sur l’helminthe rencontré par Wucherer et Crevaux,” &c., ‘Rev. Montpellier,’ tom. i, p. 190.--_Couto, A._, “These de concourso,” Bahia, 1872.--_Crevaux, J._, “De l’hématurie chyleuse, &c.,” 1872; also in ‘L’Union Médicale,’ 1872 (abs. in ‘Brit. Med. Journ.,’ July, 1872, p. 100); also in ‘Arch. de Méd. Nav.,’ 1874; and in ‘Journ. de l’Anat. et de la Physiol.,’ 1875 (see also Silva Lima).--_Davaine, C._, ‘Traité,’ 2nd edit., p. 944; ‘Hæmatozoaires,’ supp., 1877.--_Fayrer, Sir J._, “Filaria sang. hom.,” ‘Lancet,’ March 16, 1878, p. 376.--_Idem_, “Elephantiasis Arabum,” ‘Med. Times and Gaz.,’ Dec. 1, 1877, p. 588; “On the Relation of _Filaria sanguinis hominis_ to the Endemic Diseases of India,” in the ‘Lancet,’ Feb. 8 and 15, and reprinted from the ‘Med. Times and Gazette’ (same date), 1879.--_Gabb, D. H._, letter in ‘Lancet,’ June 22, 1878.--_Leuckart_, l. c., s. 638, 1876.--_Lewis, T. K._, “On a Hæmatozoon in Human Blood,” ‘San. Comm. 8th Rep.,’ Calcutta, 1872; ‘Med. Press,’ 1873, p. 234; ‘Indian Ann. Med. Sci.,’ 1874; ‘Lond. Med. Rec.’ (abs. by myself in vol. i, p. 5), 1873.--_Idem_, “Pathological Significance of Nematode Hæmatozoa,” ‘Tenth Ann. Rep.,’ 1873, Calcutta (reprint), 1874; ‘Ind. Ann.,’ 1875.--_Idem_, “Remarks regarding the Hæmatozoa found in the Stomach of _Culex mosquito_,” ‘Proc. Asiatic Soc. of Bengal,’ March, 1878, p. 89.--_Idem_, “Flagellated Organisms in the Blood of Rats” (being portion of a paper on “The Microscopic Organisms found in the Blood of Man and Animals,” in ‘14th Annual Report of the San. Comm. with the Govt. of India’), in the ‘Quart. Journ. of Micr. Science,’ Jan., 1879.--_Idem_ (published since the present article was written), “The Nematoid Hæmatozoa of Man,” _ibid._, April, 1879.--_Lima, J. F. da Silva_ (with _Crevaux_), ‘Memoria sobre hematuria chylosa ou gordurosa des paizes quentes;’ extrahida da ‘Gazeta Medica da Bahia,’ 1876; repr. in ‘Arch. de Méd. Nav.,’ Dec., 1878 (see also Le Roy de Méricourt).--_Magalhães, Pedro S. de_, “Filarias em estado Embryonario, encontradas n’agua tida como potavel (agua da Carioca),” ‘O Progresso Medico,’ Dezembro, 1877, p. 57.--_Idem_, “Nota sobre os nematoides encontrados no sedimento deposito pela agua (potavel) da Carioca,” ‘O Prog. Med.,’ 1 de Setemb., 1878, p. 577.--_Idem_, “Caso de filariose de Wucherer;” _ibid._, 15 de Setemb., 1878, p. 589.--_Makina, M.D._, “Filaria in Chyluria,” letter in ‘Lancet,’ Feb. 22, 1879, p. 286.--_Manson, P._, “Rep. on Hæmatozoa,” ‘Customs Gazette,’ No. 33, Jan.-March, 1877; see also ‘Med. Times and Gaz.’ for Nov. 10, p. 513, Nov. 17, p. 538, and Nov. 24, p. 563; Dec. 1, p. 589, 1877; also Jan., 1878.--_Idem_, “Additional Cases;” _ibid._, March 2, 9, 23, 1878.--_Idem_, “On _Filaria sanguinis hominis_, and on the Mosquito considered as a Nurse,” ‘Proc. Linn. Soc.,’ March 7, 1878; see also report in ‘Nature,’ March 28, 1878, p. 439.--_Idem_, “On _Filaria sanguinis hominis_, clinically considered in reference to Elephantiasis, Chyluria, and allied Diseases,” ‘Rep. of Med. Soc. of Lond.,’ in ‘Lancet,’ March 30, 1878.--_Idem_, “Further Observations on _Filaria sanguinis hominis_,” “Med. Rep.” for April-Sept., 1877, in ‘Customs Gazette,’ Shanghae, 1878.--_Idem_, “The Development of the _Filaria sanguinis hominis_,” ‘Med. Times and Gaz.’ for Dec. 28, 1878, p. 731.--_Méricourt, A. Le Roy de_, in Appendix to an art. entitled “Nouvelle phase de la question relative à la nature parasitaire de la chylurie. Découverte du représentant adulte de la ‘Filaire de Wucherer,’” par le Dr da Silva Lima, from the ‘Gaz. Med. da Bahia,’ Sept., 1877; see also the ‘Lancet,’ Jan., 1878, p. 22 (editorial notice).--_Moura, J. de_, ‘These de Concourso,’ 1877.--_O’Neill_, “On Craw-craw,” ‘Lancet,’ Feb., 1875.--_Pareira, A. P._, “On Bilharzia and Chyluria,” ‘Gazeta Med. da Bahia,’ No. 9, 1877 (noticed in ‘Lancet,’ Feb. 2, 1878).--_Salisbury, J. H._, “On the Parasitic forms developed in Parent Epithelial Cells of the Urinary and Genital Organs,” ‘Hay’s American Journ.,’ vol. iv, 1868, p. 376.--_Santos, F. dos_, in ‘Gaz. Med. da Bahia,’ March, 1877.--_Sonsino, P._, ‘Richerche,’ &c., 1874; ‘Della Bilharzia,’ &c., 1876; ‘Sugla Ematozoi,’ &c., 1876 (see Bibl. No. 12).--_Idem_, “On the Diagnosis of Embryos of Filaria,” in his paper ‘Sull’ Anchylostoma duodenale;’ ‘Estr. dall Imparziale,’ 1878.--_Sousa, M. de A._, ‘Memoria sobre a Elephantiasis do escroto,’ Bahia, 1878.--_Wucherer, O._, “Noticia Preliminar,” &c., ‘Gaz. Med. da Bahia,’ Dec., 1868.--_Idem_, ‘Sobre Hematuria no Brazil,’ _ibid._, Sept., 1869; see also “Méricourt’s trans. (De l’hématurie intertropicale observée au Brézil),” ‘Arch. de Méd. Nav.,’ p. 141, 1870, and the fuller references quoted in my memoir; ‘Linn. Soc. Journ., Zool.,’ vol. xiv, p. 368.

_Filaria Loa_, Guyot.--Although further examinations of this worm will probably result in placing it in some other genus than _Filaria_, yet it is by no means clear that Diesing was right in placing it with the genus _Dracunculus_. I therefore abandon the nomenclature adopted in my previous treatise. According to the surgeon, Guyot, who made seven separate voyages to the coast of Angola, these worms cannot be confounded with the Dracunculus. They are quite white, and relatively much thicker than guinea-worms. Under the title of _Filaria oculi_ Moquin-Tandon has spoken of certain small nematodes as “not uncommon in the negroes of the Angola coast;” and he gives other localities where it occurs. The worms are identical with those described by Guyot as dwelling beneath the conjunctivæ of negroes at Congo and in the Gaboon region generally. The parasite is rather more than an inch and a quarter in length, being pointed at one end and blunt at the other. It is termed _Loa_ by the natives, who state that after a period of several years the worm voluntarily quits the organ. The disease is thus naturally cured. This parasite enjoys a tolerably wide geographical distribution, as it has been observed by Clot Bey in a negress who had come from the town of Monpox, situated on the banks of the River Magdalena; by Sigaud, who saw one in the eye of a negress in Brazil; by Blot, at Martinique, who saw two in a negress originally from Guinea; by Bajon, who met with one in a little negro girl who had come from Guadeloupe; by Mongin, who found one in a negress who had been living in the Island of San Domingo; and by Lestrille, who removed one from beneath the conjunctiva of a negro who came from Gaboon.

BIBLIOGRAPHY (No. 24). _Davaine_, l. c., p. 839.--_Guyon_, ‘Gaz. Méd. de Paris,’ p. 106, 1841, and in ‘Micr. Journ. and Struct. Record,’ p. 40, 1842, and in ‘Dublin Journ.,’ vol. xxv, p. 455, 1839.--_Idem_, ‘Compt. Rendus,’ tom. lix, p. 743, 1865.--_Guyot_, in ‘Mém. par Arrachait,’ p. 228, 1805.--_Küchenmeister_, l. c., s. 322.--_Lestrille_, in Gervais and Van Beneden’s ‘Zool. Med.,’ 1859, also quoted by Davaine, l. c., 2nd edit., p. 840.--_Leuckart_, l. c., s. 619.--_Moquin-Tandon, A._, ‘Zool. Med.,’ Hulme’s edit., p. 363, 1861.

_Filaria lentis_, Diesing.--This is a doubtful species. The worm was first discovered by Nordmann, in a case of lenticular cataract under the care of Von Gräfe, and it was afterwards found by Jüngken in a similar case, as recorded by Sichel. There is also the instance described by Gescheidt, in which Von Ammon operated, and from which brief descriptions of the worm have generally been taken. In this case there were three worms, two measuring about 1/6″ and the third 1/15″ in length. In Jüngken’s case (exhibited by Quadri, of Naples, at Brussels) the worm was more than 3/4″ long. In another case, reported by M. Fano, the worm was somewhat less than 1/4″ long. There is no certain evidence that any of these various worms had developed sexual organs in their interior. It is true that the reproductive organs were described in two of the worms observed by Gescheidt; but after a due consideration of all the facts I fear we must conclude that all the worms in question were sexually-immature and wandering nematodes, possibly referable to Gurlt’s _Filaria lacrymalis_, as Küchenmeister long ago suggested.

BIBLIOGRAPHY (No. 25).--_Cobbold_, ‘Entozoa,’ p. 332.--_Davaine_, l. c., p. 821 _et seq._--_Diesing_, ‘Syst. Helm.,’ p. 625.--_Fano_, ‘Traité des Malad. des Yeux,’ tom. ii, p. 498; and in ‘Rec. de Méd. Vét.,’ p. 140, 1869; quoted by Davaine, p. 831.--_Gescheidt_, Ammon’s ‘Zeitsch.,’ 1833, s. 435.--_Leuckart_, l. c., Bd. ii, s. 622.--_Nordmann_, l. c., Bibl. No. 2, s. 7, 1832.--_Sichel_, ‘Iconogr. Ophth.,’ p. 707, 1859.

_Filaria labialis_, Pane.--This is a filiform cylindrical worm measuring an inch and a quarter in length. The mouth is armed with four papillæ arranged in the form of a cross. The tail of the female is blunt, the vaginal outlet being placed at a very short distance from its extremity, and a little above or in front of the anus. This parasite was found by a medical student at Naples. It occupied the cavity of a pustule in the upper lip, giving rise to considerable irritation. Only the male worm is at present known.

BIBLIOGRAPHY (No. 26).--_Davaine_, l. c., edit. ii, Synopsis, p. 107.--_Leuckart_, l. c. (with a fig.), Bd. ii, s. 616.--_Pane_, “Nota di un elminte nematoide,” in ‘Annali dell’ Acad. degli aspiranti Naturalisti,’ Napoli, ser. 3, vol. iv, 1864.

_Filaria hominis oris_, Leidy.--In the fifth volume of the ‘Proceedings of the Philadelphia Academy of Natural Sciences’ (1850, p. 117) Dr Leidy furnishes the following description of this worm as gathered from the examination of a simple specimen preserved in alcohol, and labelled as having been “obtained from the mouth of a child.” Body white, opaque, thread-like; mouth round, simple; posterior extremity obtuse, furnished with a short, curved, epidermal hooklet, 1/500″ in length, by 1/2000″ in diameter at base. Dr Leidy offers some speculations as to its origin, but from whatever source the worm was obtained by the bearer, it seems to be an immature form. Its length is five inches and seven lines.

_Filaria_ (_Nematoideum_) _trachealis_, Bristowe and Rainey.--This is another very doubtful worm. It was originally described in the ‘Pathological Society’s Transactions’ for 1855. It evidently represents only a juvenile stage of growth of some species of round worm. Rainey discovered a considerable number of these worms in the trachea and larynx of a person who died from a disease affecting the lower extremities. Individually the parasites measured about the 1/50″ in length.

_Strongylus_ (_Filaria_) _bronchialis_, Rudolphi.--This is a small nematode. The male measures rather more than half an inch, whilst the female is upwards of an inch in length. The caudal appendage of the male is furnished with a bilobed, membranous, half-bell-shaped bursa. This surrounds the cloacal outlet, the latter concealing a double spiculum. The tail of the female is sharply pointed, the anal orifice being placed a little in front or above. The body is filiform, of a pale yellow color. It is about 1/50″ broad in the male, and 1/35″ in the female. The mode of reproduction is viviparous.

The original specimens were discovered by Treutler in Germany, during the winter of 1791, in the bronchial glands of an emaciated subject, whilst those sent to Diesing for description were discovered by Dr Fortsitz at Klausenberg, in Transylvania, in the lungs of a boy six years old. Diesing and Weinland suggested the identity of _Filaria bronchialis_ and _Strongylus longevaginatus_, whilst Küchenmeister went further, and pronounced them to be one and the same species.

BIBLIOGRAPHY (No. 27).--_Cobbold_, ‘Entoz.,’ p. 357.--_Davaine_, ‘Synops.,’ l. c., ‘Synopsis’ cix.--_Küchenmeister_, l. c., Eng. edit., p. 381.--_Leuckart_, l. c., s. 618.--_Treutler, F. A._, “De vermibus filiformibus (_Hamularia lymphatica_) in glandulis conglobatis bronchiorum repertis,” in ‘Obs. Pathol. Anat.,’ 1793.--_Wedl._, ‘Die im Menschen vorkommenden Helminthen’ (quoted by Leuckart), Wien, 1862, s. 22.

_Eustrongylus gigas_, Diesing.--This is by far the largest nematode known to science, the male sometimes measuring a foot in length and the female more than three feet, whilst the breadth of the body reaches half an inch at the thickest part. Though fortunately very rare in man, this worm is known to occur in a great variety of animals, especially in weasels. According to Weinland and Jackson, it is particularly abundant in the kidney of the North American mink (_Mustela vison_), destroying the substance of the organ, the walls of which become the seat of calcareous deposit. It has been found in the dog, wolf, puma, glutton, raccoon, coati, otter, seal, ox, and horse.

The body of the adult worm is cylindrical, more or less red in color, and somewhat thicker behind than in front. The head is broadly obtuse, the mouth being supplied with six small, wart-like papillæ, two of which correspond with the commencement of the two lateral lines of the body. These lines are also distinguishable from other six longitudinal lines traversing the body from end to end by the presence of very minute papillæ which are less closely arranged towards the centre (Leuckart). The tail of the male shows a simple, thick, cup-shaped bursa, which is destitute of rays, and partly conceals the simple spiculum. The tail of the female is blunt and pierced by the centrally placed anal opening. The vulva is situated near the head in the ventral line. The eggs are stout and oval, measuring 1/300″ in length by about 1/550″ in breadth.

As regards development the recent researches of Schneider have shown that certain kinds of fish play the part of intermediary bearer. Balbiani preserved the ova in water for more than a year without their hatching, and all his attempts to rear the larvæ in the intestines of the dog by direct experiment failed. Similar feeding experiments upon fishes and reptiles also failed. The embryo, when removed from the egg, measures 1/104″ in length. It is vermiform, having a pointed head and simple mouth. Balbiani describes the buccal cavity as containing a protractile stylet. Notwithstanding the negative results obtained by Balbiani’s experiments on fishes, Schneider (from anatomical data, which Leuckart confirms) has placed it almost beyond question that the worm hitherto known as _Filaria cystica_ is the sexually-immature _Eustrongylus gigas_. This worm is found encysted beneath the peritoneal membrane in _Galaxias scriba_ and _Synbranchus laticaudatus_. It is worthy of remark that the genus Galaxias comes nearer to the Salmonidæ than to the pike family, whilst the Synbranchi are tropical oceanic fishes. Probably the sexually-immature worm occurs in other fishes, especially the Salmonidæ.

Remarkably fine examples of the adult worm may be seen in the Hunterian Collection, Lincoln’s Inn, and in the Museum of the Royal Veterinary College. The human example is undoubtedly genuine. The dissections in the Hunterian Collection of specimens were made by me in 1865. Objection has been taken to my description of the œsophagus as “spiral.” In Sheldon’s specimen it is certainly twisted upon itself, precisely in the manner in which Davaine has also figured it (‘Traité,’ fig. 68); but I cannot here give further anatomical particulars. Drelincourt found two worms sexually united in the kidney. When once the parasites have gained access to this organ, rapid destruction of the glandular substance follows. Ultimately the kidney is reduced to the condition of a mere cyst or bag, which, besides the worms, contains a quantity of sanguineo-purulent matter. Frequently only one worm is present, but oftener two or three. In the kidney of a puma D’Azara’s friend, Noseda, found no less than six worms, whilst Klein obtained eight from the kidney of a wolf.

BIBLIOGRAPHY (No. 28).--_Azara, F. de_, ‘The Natural History of the Quadrupeds of Paraguay,’ trans. from the Spanish by W. P. Hunter; Valpy’s edit., p. 43, 1837; Black’s, 1838; French edit., p. 313, 1801.--_Albers_, ‘Beitr. z. Anat. &c.,’ Bd. i, s. 115.--_Aubinais_, ‘Revue Méd.,’ 1846, p. 284.--_Balbiani_, “Recherches,” &c., ‘Compt. Rend.,’ 1869, p. 1091; ‘Rec. de Méd Vét.,’ 1870, p. 5.--_Bickford_, “Spec. of _Str. gigas_ found in the Kidney of a Dog,” the ‘Veterinarian,’ 1859, p. 312.--_Blainville_, ‘Dict. des Sci. Nat.,’ tab. 29.--_Blanchard_, ‘Ann. des Sci. Nat.,’ 1849, p. 186.--_Idem_, in ‘Cuvier’s Règne Animal’ (Masson’s edit.), ‘Les Intestinaux,’ p. 57, pl. 27.--_Blasius_, ‘Obs., &c.’ (with fig. of Lumbricus in renibus hominis), 1674, p. 125.--_Bobe-Moreau_, in ‘Journ. de Méd.,’ tom. xlvii.--_Boerhaave_, ‘Aphorism.,’ 1728.--_Bremser_ (l. c., Bibl. 2), s. 223.--_Chabert_, ‘Traité des maladies verm. dans les Animaux,’ 1782.--_Chiaje_, ‘Comp. d. Elmintogr. umana,’ p. 106.--_Clamorgan, J. de_, ‘La Chasse de Loup,’ 1583 (quoted by Davaine, the worms being described as “serpents et bêtes fort venemeuses”).--_Cobbold_, ‘Entoz.,’ p. 358.--_Idem_, ‘Catalogue of Entozoa in the Museum of the Roy. Coll. of Surg.,’ “Descr. of preps. Nos. 19-25,” p. 3, 1866.--_Idem_, “Parasites of Man,” ‘Midland Naturalist,’ Dec., 1878.--_Collet-Meygret_, “Mém. sur un ver trouvé dans le rein d’un Chien,” in ‘Journ. de Physique,’ &c., 1802.--_Cuvier_, see _Blanchard_ (supra).--_Idem_, ‘Voyage en Sicile,’ and in ‘Ann. des Sci. Nat.,’ tom. xi.--_Davaine, C._, ‘Traité,’ l. c., deuxième edit., p. 271 _et seq._ (with full lit. refs. at p. 290).--_Diesing_, l. c., vol. ii, p. 325.--_Dujardin_, l. c., p. 113.--_Frank, F._, “Ein Spulwürm in der Urinblase eines Hundes,” ‘Hufeland’s Journ.,’ Bd. xviii, s. 112.--_Jackson_, ‘Catalogue of the Boston Museum,’ 1847, p. 317.--_Klein, T. K._, “Anatomical Description of Worms found in the Kidneys of Wolves,” ‘Phil. Trans.,’ 1729-30, p. 269.--_Küchenmeister_, l. c., Eng. edit., p. 376.--_Leblanc_ (rep. by Rayer and Bouley), in ‘Bull. de l’Acad. de Méd.,’ 1850, p. 640; in ‘Rec. de Méd. Vét.,’ 1862, p. 800; and quoted by Davaine.--_Leuckart_, l. c., Bd. ii, s. 353-401, 1876.--_Moublet_, “Mém. sur les vers sortis des reins et de l’urethre d’un enfant,” ‘Journ. de Méd-Chir. et Pharm.,’ 1758, pp. 244 and 337.--_Otto_ (Anat.), in ‘Mag. d. Gesellsch. naturf.,’ 1814.--_Owen_, art. “Entozoa,” in Todd’s ‘Cyclop.’--_Rayer_, ‘Traité des maladies des reins,’ 1841.--_Rayger_, ‘Sur un serpent qui sortit du corps d’un homme après sa mort’ (quoted by Davaine, l. c., p. 272), 1675.--_Schneider_, ‘Monographie der Nematoden,’ 1866, s. 50.--_Idem_ (mit Peters), quoted by Leuckart, l. c., s. 382.--_Stratton_, in ‘Edin. Med. and Surg. Journ.,’ p. 261, 1843.

_Dochmius duodenalis_, Leuckart.--Much time might be occupied and wasted over the nomenclature of this parasite. In my previous treatise, and for reasons there stated, I placed it under the genus _Sclerostoma_. On rather slender grounds Dubini formed the genus _Anchylostoma_ for its reception, but Von Siebold thought that, on account of the absence of symmetry in the arrangement of the so-called dental organs, Dubini’s genus might very well be allowed to remain. Bilharz, Diesing, Küchenmeister, Wucherer, and others have retained the genus as either _Anchylostoma_ or _Anchylostomum_. Schneider keeps it amongst the _Strongyli_; but after all that has been said and written there can, I think, be no doubt that if Dujardin’s genus _Dochmius_ is to be retained at all, Dubini’s worm must be placed in it. The comparisons instituted by Leuckart afford sufficient proof of the intimate alliance as between _Anchylostoma_ and _Dochmius_. Professor Molin thought to meet the difficulty by calling the worm _Dochmius anchylostomum_, but the specific term, _duodenale_, should certainly be retained.

This worm was discovered by Dubini at Milan, and though at first thought rare, it is now known to be tolerably common throughout Northern Italy. The worm has also been recently found by Dr Kundrata at Vienna, in an Austrian subject. According to Pruner, Bilharz, and Griesinger, it is abundant in Egypt. Griesinger believed that about one fourth of the people of that country suffered from anæmic chlorosis, solely in consequence of the presence of this worm in the small intestines. From Wucherer’s observations especially, we know that Dubini’s worm is not limited to the localities above mentioned, for it occurs in the western tropics, in Brazil, and even in the Comoro Islands.

The worm may be described as a small nematode, the males measuring 3/8″ or rather more, whilst the females extend to very nearly 1/2″ (12 mm.). The head is pointed and tapering, and bent forward, having the mouth directed towards the ventral aspect. The oral opening is armed with four asymmetrically disposed, unequally-sized, horny, conical, converging teeth. The neck is continuous with the cylindrical body, which is 1/80″ in thickness. The body terminates in a straight cone-shaped, or rather sharply-pointed tail in the female, the caudal extremity of the male ending in a partially inflexed, blunt point. In the male there is a cup-shaped, bilobed bursa, the membranes of which are supported by eleven chitinous rays, ten being simple, whilst the median, or odd one, is bifurcated at the summit. The mode of reproduction is viviparous. Adult males and females occur in the proportion of one of the former to three of the latter.

As above mentioned, it was Griesinger who first pointed out the clinical importance of this entozoon. He first explained the manner in which the worm produces anæmia, the persons attacked losing blood as if they were being bitten by innumerable small leeches. Like the rest of their kindred, these worms are veritable blood-suckers. In the first instance the views of Griesinger met with opposition, but they have since received abundant confirmation. Whilst Küchenmeister’s ‘Manual’ furnishes an excellent account of the disorder as known in Europe, we are chiefly indebted to Wucherer for what is known of the disorder in Brazil. The experiences recorded in the ‘Deutsches Archiv für Klinische Medicin’ for Sept. 27th, 1872 (s. 379-400), were amongst the last that appeared from the pen of that gifted and amiable physician. As little or no notice of his writings appears to have been taken by professional men in this country, I depart somewhat from the design of this work when I venture to abstract a few of the clinical particulars which he has supplied. Their importance in relation to sanitary science is obvious, inasmuch as these parasites are introduced into the human body by drinking impure water, or, at least, water which either contains the free larvæ of the worm, or the intermediary bearers that harbor the larvæ.

It should be borne in mind that Dubini’s original discovery was made at Milan in 1838, whilst Griesinger’s recognition of the worm as a cause of the Egyptian chlorosis resulted from a post-mortem examination made on the 17th of April, 1851.

In the journal above mentioned, Wucherer records his own discoveries as follows (‘Ueber die Anchylostomunkrankheit,’ &c.):--“Although Griesinger with well-founded confidence gave an account of his ‘find’ and its significance, yet it remained for a long time unnoticed and unutilised, till at length a case led me to corroborate it. During my many years’ residence in Brazil, especially during the first year, I had very frequent opportunities for witnessing the tropical chlorosis, but seldom to treat it, as it is one of those diseases for which Brazilians seek no medical assistance. Its treatment falls to the lot of the _curiosos_, _curadeiros_ (quacks), who employ the fresh pulp of a species of fig as a remedial agent with the best results. On the 13th of December, 1865, I was called to the Benedictine monastery in Bahia to see a slave of the _order_ suffering from _hypoæmia_. The patient was about thirty years of age, married, a strongly built mulatto. He was a field laborer on the Ingua plantation of the order, who exhibited in a conspicuous degree all the symptoms that occur in hypoæmia except the diarrhœa. He was well nourished, but strikingly pale, his whole face, but especially the eyelids, being œdematously swollen, as also were the feet, legs, and hands. The hands and feet were very cold. His appearance betrayed the most horrible anguish or low despondency. With difficulty only could he raise himself, being obliged to lie down again immediately on account of his weakness. Auscultation revealed a diminished respiratory murmur, and bronchial expiration in both lungs. The pulse was very rapid and small, the patient complaining of pain in the region of the heart. He had frequent palpitation when he moved, and he complained of pain in other parts of the body. His abdomen was much distended by gases, but not sensitive to pressure from without, except in the region of the stomach. The urine was clear, its specific gravity 1007 to 1023-1/2°. Under great difficulties he resided for several months after his marriage at Inhatâ. Earlier he had been on the estates of the order at Rio de S. Francisco. He there suffered for a long time from intermittent fever, but at Inhatâ he entirely recovered. At Inhatâ the slaves frequently suffered from hypoæmia, but in S. Francisco not at all. He appears not to have made any misuse of brandy. The slaves of the order were well cared for, and supplied with good and wholesome nourishing food. The patient had already, for a long period, treated himself with steel wine, yet was continually getting worse and worse. He had not taken the pulp of the fig. As I was unaware he had suddenly become so ill, they hastily despatched a message to the town. There was no good to be expected from the further employment of iron, and the patient was in such a condition that from the very first I despaired of his recovery. I immediately prescribed the pulp of the Gammeleira (_Ficus doliaria_), but it could not be easily obtained. Considering that the Gammeleira would have a drastic effect, I therefore prescribed two grammes of elaterium, to be divided into eight doses, of which he should take one every three hours.” Dissatisfied with this advice, however, Dr Wucherer goes on to say that on reaching home he carefully looked up the literature of the subject. “In a ‘Geologico-Medical Report’ by Professor Hirch, recorded in the ninety-sixth volume of ‘Schmidt’s Jahrbucher,’ I found how Griesinger had recognised the _Anchylostoma_ as the cause of the Egyptian chlorosis, which was clearly identical with our _hypoæmia_. He had employed this commended anthelmintic. I resolved the more to prescribe the pulp of the Gammeleira when I found it described as a worm-expelling remedy in Martin’s ‘Systema Materiæ Vegetabilis Braziliensis.’ The next morning, however, when I arrived at the monastery I learnt that my patient died about two hours after a slight evacuation. Only after much resistance would they permit the _sectio cadaveris_. I merely opened the abdomen, and was surprised to find everything as Griesinger had described. During the next season, through the courtesy of my colleagues attached to the General Infirmary at Bahia, especially of Drs Silva Lima, Faria, and Caldos, I was enabled to open more than twenty bodies of anæmically deceased individuals. All were selected as miserably poor in condition, but only five were bodies of persons in whom hypoæmia was diagnosed, and in these there were a great number of Anchylostomes in the small intestine. The intestines of the other bodies contained either none, one, or a few.” Dr Wucherer next states that he compared the characters presented by his entozoa with those given by Dubini, Diesing, and Von Siebold, and found a perfect agreement throughout. He sent several examples to Griesinger, who also established their identity, and communicated the results of his investigations accordingly (‘Archiv für Heilkunde,’ 1866, s. 387. See also Leuckart, ‘Die Mensch. Par.,’ Bd ii, s. 411). Dr Wucherer also forwarded a number of specimens to Dr Weber, who published a brief account of them with excellent figures (‘Path. Soc. Trans.,’ vol. xviii, 1867, p. 274). As mentioned in the text of his memoir (s. 394), Dr Wucherer also transmitted some strongyloids to myself. “The publication of my observations,” adds Dr Wucherer (‘Gazeta Medica da Bahia,’ 1866, p. 27 _et seq._), “had a result in that Dr J. R. de Moura, of Thersepolis, in the province of Rio de Janeiro, sought for Anchylostomes in the bodies of tropical anæmics (_Hypöæmikern_). He at once found these parasites, as stated in the same journal (for 1866, p. 132). As occurred to myself, he saw no enduring results from the application of the remedies which appeared to be called for, whilst he well knew that unprofessional persons (Nichtärzte) succeeded in obtaining marked results by the exhibition of the pulp of the Gammeleira (_Ficus doliaria_). The anthelmintic action of this remedy was also unknown to him.” Dr Wucherer then records how his discovery of these entozoa was announced by Dr Jobini to the Rio academy, and how Dr Moura’s observations were subsequently communicated, adding remarks upon the interesting discussion that followed. The general opinion was that the _Anchylostomata_ were _not_ the primary and necessary cause of this tropical anæmia, but rather a co-operating agent in its production. Against this view Dr Wucherer afterwards very properly protested (‘Gazeta,’ Jan. 15th, 1868). In the mean time, says our author, “Dr le Roy de Méricourt, prompted by my first communication, had invited the physicians of the French colony to seek for Anchylostomes. Drs Monestier and Grenet, at Mayotta (one of the Comoro Isles, which lies about 12° S. lat. to the north-east of Madagascar), ascertained the presence of entozoa in hypoæmics. Dr Grenet sent the duodenum and a portion of the jejunum of an hypoæmic corpse to Le Roy de Méricourt, who compared the Anchylostomes with Davaine’s description, and recognised them as examples of _A. duodenale_.”

“In the year 1868 Dr Rion Kérangel found Anchylostomes in the bodies of hypoæmics in Cayenne. Thus, the occurrence of Anchylostomes in hypoæmics has been authenticated by Pruner, Bilharz, and Griesinger, in Egypt; by myself, Dr Moura, Dr Tourinho, and other physicians, in Brazil; by Monestier and Grenet, in the Comoros; and by Rion Kérangel in Cayenne. It thus also appears, from the wide separation of these several localities, that the Anchylostomes, if duly sought for, will be found in many other countries.”

These details given by Wucherer are so precise and instructive that I could not have further abridged them without injustice to his record. The bearing of the foregoing facts in relation to the question as to how we may hope to arrest the fatal action of many of these nematodes is sufficiently obvious. That strongyles and their allies prove highly destructive to man and beast is as well established as any other recognised conclusion in medical science; nevertheless, there are those who still doubt the power of these nematodes in relation to the production of fatal epidemics. I shall deal with the sanitary bearings of the subject hereafter. In conclusion, I may mention that Dr da Silva Lima has forwarded specimens of _Anchylostomum_ to the Hunterian Museum, where they may be seen.

BIBLIOGRAPHY (No. 29).--_Bilharz_, ‘Zeitschr. f. wiss. Zool.,’ Bd. iv, s. 55.--_Cobbold_, ‘Entozoa,’ p. 361.--_Idem_ “Remarks on Recent Contributions to our Knowledge of the Parasitic Nematoids, especially in reference to the Wasting Diseases they produce in Man and Animals,” the ‘Veterinarian,’ Jan., 1876, p. 1.--_Davaine_, l. c., pp. 118 and 931.--_Diesing_ “Revis. der Nematoden,” ‘Sitzb. d. m.-naturw. cl. d. k. Akad.,’ 1860, s. 716.--_Dubini_, ‘Entozoografia,’ &c., 1849.--_Griesinger_ (quoted above), see also ‘Arch. f. Phys. Heilk.,’ 1854.--_Küchenmeister_, l. c., Eng. edit., p. 383.--_Leuckart_, l. c., ss. 410-455.--_Molin_, ‘Il sottordine degli Acroffali,’ p. 61 (quoted by Leuckart).--_Siebold_, ‘Zeitsch. f. wiss. Zool.,’ 1852, s. 55.--_Sonsino, P._, _L’Anchilostoma duodenale_ in ‘relazione coll’ Anemia progressiva perniciosa,’ Egitto, 1877.--_Idem_, ‘Sull.’ _Anch. duod._, 1878 (see also Bibliog. No. 27, both reprinted from ‘Imparziale.’)--_Weber, H._, l. c., 1867.--_Wucherer_ (quoted above), 1872.

_Dracunculus medinensis_, Cobbold.--This parasite is popularly known as the guinea-worm, or Medina-worm. Probably Lister was the first writer who distinctly spoke of it as the Dracunculus, 1690, the same title being applied to it by Kaempfer, 1694. Be that as it may, Gmelin, long afterwards, placed the parasite in the genus _Filaria_, at the same time adopting the specific title _medinensis_. This had been previously employed by Linneus, who, however, regarded the worm as belonging to the genus _Gordius_. It being clear from the distinctive characters of the entozoon that it was desirable to separate it from the Filariæ, and that no better generic name could be devised than _Dracunculus_, I thought it right to combine Lister’s and Gmelin’s nomenclature as above, 1864. Leuckart pursued a similar course, crediting Linneus with the titles.