Read Ebook: Case of Filaria loa by Robertson Douglas Argyll

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The interest connected with the elucidation of the obscure points in the natural history of the worm will, I trust, stimulate those of our profession residing on the West Coast of Africa to undertake the further necessary investigations.

FOOTNOTES

Bajon's 'M?moire pour servir ? l'histoire de Cayenne et de la Guyane,' t. 1er, p. 325, 1777.

Arrachart, 'M?moires, dissertations de Chirurgie, et observations de Chirurgie,' 1805, p. 228.

'Lancet,' vol. i, 1844, p. 309.

Ibid., Nov. 26th, 1859.

'Zoologie m?dicale,' 1859, vol. ii, p. 143.

'Annales d'Oculistique,' 1864, p. 241.

'American Journal of the Med. Sciences,' 1877, vol. lxxiv, p. 113.

'Vera descriptio regni africani, quod tam ab incolis quam Lusitanis Congus appellatur,' Frankfort, 1598.

FURTHER NOTE OF CASE OF FILARIA LOA.

After the removal of the filaria from under the conjunctiva, Miss H? was not troubled with the sensations she associates with the presence of a worm for a period of about six weeks, when again she experienced a burrowing sensation at the back of her left eye. It affected her at intervals, and especially when she was occupying a hot room.

On the 3rd of February she distinctly felt a worm moving about in her left upper eyelid, and came at once to me, but before she arrived this feeling had gone, and I failed to discover any signs of the parasite. She returned on the 6th of February with the statement that not only had she felt the worm moving about in the left lower lid, but that it had also been distinctly seen wriggling under the skin. I saw her three different times that day, but failed to observe anything that might indicate with certainty the presence of a parasite, although she sat in front of a hot fire and had a succession of hot poultices applied, so as to tempt the worm to the surface. On the third visit, as she felt the wriggling of the worm, and as there seemed to be a little fulness at one point in the left lower lid, I decided to cut down at that point and search for the parasite. This I did with Dr. Mackay's assistance, having first of all applied clamp-forceps so as to prevent the worm escaping if it were there. I failed to find any parasite, although I made a careful search, and the patient showed great nerve and steadiness under operation, but I noticed a distinct narrow channel or burrow parallel to the edge of the lid, and crossing about the middle of it, which gave me the impression of being a burrow by which the worm had moved across the lid.

Two days later Miss H? came complaining of a swelling in the right temporal region. This swelling seemed pretty deeply situated, and firm palpation failed to reveal any corded feeling such as might indicate the presence of a worm.

The worm thus removed measured about 30 mm. in length and nearly 1 mm. in thickness. It was firm and transparent like a small piece of fishing-gut. It tapered at either extremity to a blunt point, the tail being rather sharper-pointed than the head. At the distance of about 9 mm. from the caudal end an opening existed in the wall of the parasite, through which protruded a filamentous coil, which subsequent microscopic examination revealed to be the uterine tubes filled with ova in all stages of development up to embryo filariae. Notwithstanding the amount protruded, the interior of the parasite was yet to a great extent occupied by oviduct, the alimentary canal being apparently comparatively small in size. The wall seemed to be chiefly composed of muscular fibre, the transverse striae of which were readily visible at all parts. The semicircular projecting tubercles, which Dr. Manson is inclined to view as serving to facilitate the gliding movements of the parasite by enabling it to get a purchase on surrounding parts, were very numerous towards the caudal end, fewer in number at the centre, and very sparsely distributed at the head extremity. Near the oral end of the worm a small general projection of the wall existed on one side, probably due to a partial rupture produced by injury.

The small piece of the worm I first removed in the course of the operation proved on microscopic examination to be part of the oviduct containing embryo filariae.

I will submit my specimen for more careful and thorough examination and report to Dr. Manson, who is entitled to speak with such authority on this subject.

During the last six months I have at intervals examined blood drawn from Miss H? at various periods of day and night, but have never been able to discover the presence of any filariae.

My patient has several times directed my attention to ill-defined swellings under the skin of the forearms a little above the wrists, over the dorsal surface of the radius, more marked generally in the right arm. The surface of the swellings was not quite uniform, but did not give one the idea of being produced by a coiled-up worm. The swellings measured about half an inch in diameter. They were not painful, but occasioned a feeling of stiffness when the arms were used. The swellings occurred at irregular intervals, and were generally most marked in the mornings. Cold had no influence in dispelling them; on the contrary, the application of cold water on one or two occasions seemed to bring the swellings forward.

My patient informs me that natives of Calabar, and others resident for a time there, are subject to such swellings in the forearms and wrists, to which the natives apply the term "Ndi t?t," or swelling. These swellings she has only suffered from since her return home.

It is easy to understand how the embryo filariae may enter the system, although their presence in impure water has not yet been demonstrated. And it is easy to conceive that, having entered the system from the alimentary canal, they may breed and bring forth a large crop of embryo parasites. But the chief difficulty consists in determining how these embryo filariae escape from the bodies of those affected with the disease, and get deposited in the impure water and thus propagate the disease.

PRINTED BY ADLARD AND SON, BARTHOLOMEW CLOSE, E.C., AND 20, HANOVER SQUARE, W.

That night, when Arthur and Nettie, as well as their father and mother were asleep, the Bear and Doll had a chance to make believe come to life, move about, and speak.

"But we won't turn the handles in the bathroom and splash the water now," said the Doll. "It would make such a noise that they'd awaken and we'd be caught. But what can we do?"

"Let's look out the windows," suggested the Plush Bear. So, climbing up first on little stools, and then on chairs, the two toys looked from the hotel windows. They saw many lights sparkling, and out to sea was a tall lighthouse with a gleaming beacon which flickered like a giant lightning bug.

In the morning Arthur and Nettie went down on the sand to play, the little fat boy taking his Plush Bear and Nettie her Rag Doll.

"Oh, what a dandy Teddy Bear!" cried a small, red-haired chap as he ran along the beach to play with Arthur.

"This isn't a Teddy Bear," explained Arthur. "He's a Plush Bear, and he can move his head and his paws and he can growl."

"Let's hear him!" begged the red-haired boy.

So Arthur wound up the spring, and, surely enough, the toy did all those things.

"Oh, he's a dandy!" cried the red-haired lad. "If you let me play with him, I'll let you take my airship that flies."

"We'll take turns playing with them," said Arthur, and then began a happy time for the children. Some little girls came over to play with Nettie, and they had lots of fun on the sand.

After a while Arthur happened to think of what he had said he was going to do--dig a sand cave for his Bear.

"We'll make a big one," he said to the red-haired lad. "We'll dig a big hole."

"With clam shells!" cried the other lad, and, putting aside the Plush Bear and the airship, the two little friends began to make a large hole in the sand. When it was finished the Plush Bear was put down in it, and some sticks were stuck up in front.

"We'll make believe the sticks are the bars of his cage," said Arthur. "We'll pretend he's a circus Bear."

"Oh, yes," agreed the red-haired boy. "That's lots of fun."

So they played with the Plush Bear in the hole of the sand for some time. Then other boys and girls came along, joining in the fun, and pretty soon some children rode past on ponies.

"Oh, I'm going to ask mother if we can't ride on the ponies!" cried Nettie.

"So'm I!" added her brother, and, forgetting all about the Plush Bear in the hole, away they ran to tease for ponies to ride. Mrs. Rowe was sitting on the sand not far from where the children had been playing.

"Yes, Arthur and Nettie, you may ride the ponies," she said. "I'll take you down and tell the man to put you on."

And in the excitement of the pony ride Arthur forgot all about his Plush Bear in the sand cave. The toy was left there all alone, and he did not know what to think.

"I wonder if I dare knock down those sticks they call bars and climb out?" thought the toy. "I don't believe any one is looking." He was just going to do this when along the beach dashed one of the ponies with a little girl on his back. The pony stepped close to the hole where the Plush Bear was, and in another instant the sand caved in, covering Mr. Bruin from sight!

OUT TO SEA

Sand ran down into the eyes of the Plush Bear. Grains of sand tickled his plush toes. Some even got in his plush mouth that he opened when he gave his growls. Other grains of sand trickled between the joints of his paws and his body.

"Oh, dear, this is terrible!" said Mr. Bruin, as he found himself in darkness when the hole into which Arthur had placed him caved in from the feet of the pony. "This is simply terrible!"

But though the Plush Bear, being by himself, was allowed to talk and move about, pretending to come to life, he soon found that it was not wise to open his mouth. The wider he opened it the more sand came in.

"What shall I do?" thought the Plush Bear to himself, not opening his mouth to say anything this time. "How am I ever going to get out of here?"

Well might he ask himself that, for the sand was so closely packed in about him that he could hardly move. Even though the spring inside him was wound up, the Plush Bear could not turn his head nor wave his paws. As for growling, he knew better than to try that.

"Well, something must be done!" thought the Plush Bear. "If I stay in this sand hole too long I'll smother! I wonder why Arthur doesn't come and take me out? He always said he was fond of me!"

But Arthur, the fat boy, was just then having a glorious ride on a pony, and Nettie, his sister, was also having a ride. For the time being the children had forgotten about their toys. Nettie had left her Rag Doll and Arthur his Plush Bear. But the Rag Doll was not buried in the sand.

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