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Filariasis and Elephantiasis in Fiji

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Filariasis and Elephantiasis in Fiji FILAEIASIS AJN^D ELEPHANTIASIS m FIJI BEING A EEPOET TO THE LONDON SCHOOL OF TEOPICAL MEDICINE. BY P. H. BAHR M.A., M.B., B.C., D.T.M.&H.,Cautab., M.R.C.S.,Eng., L.E.C.P.,Loncl. WITH MANY COLOUEED AND MONOCHEOME PLATES, NUMEEOUS CHAETS AND A MAP. London : WITHERBY & CO. 326 HIGH HOLBORN W.C. 1912, Printed by WITHERBY & CO. at their Printing Press in Middle Row Place London . ... CONTENTS. PAGE List of Appendices . vi. List of Illustrations . vii. Text pp. 1-82 Appendices . pp. 83-190 Bibliography . .. p. 191 LIST OF APPENDICES. PAGE I. Temperature and rainfall in Suva, average for fifteen years 83 II. Variations in number of microfilariae found in consecutive examina- tions of the same persons 83 III. Microfilaria rate at various ages. Males 84 IV. Microfilaria rate at various ages. Females 85 V. Details of circumstances under which adult filariae are discovered 80 VI. Percentage tables, relation of microfilariae to lesions associated with their presence . 88-90 A. Microfilariae present, no signs of disease. B. Microfilariae associated with clinical signs of disease, c. Microfilariae absent, clinical signs of disease present. D. Value of epitrochlear gland in diagnosis. VII. Table to show proportion of those with microfilariae in their blood, withovit clinical signs of filarial disease, to the total number in whom microfilariae were found. .. .. .. .. .. .. .. 90 VIII. The number of microfilariae in the blood, no indication of severity of the lesion. , 91 FIJIAlSiS. IX. Eosinophilia . / 92-114 A. —Microfilariae, no ova of intestinal parasites. B. —Microfilariae, ova of intestinal parasites present, c. —No microfilariae, no ova of intestinal parasites. D. —No microfilariae, ova of intestinal parasites present. E. —Frequency of intestinal parasites in Fijians. F. —Eosinophilia in elephantiasis. G. —Periodicity in eosinophilia in F. bancrofti and F. loa, infections and Chart of F. loa. H. —Eosinophilia in other forms of filarial diseases. I. —Eosinophilia in elephantiasis (a) without microfilariae in blood ; (b) with microfilariae in blood. EUROPEANS. J.—^Europeans born in Colony without microfilariae. K. —Europeans born in Colony with microfilariae. L. —Europeans born in Colony with signs of filariasis, but no micro- filariae. X. Details of cases of orchitis and lymphangitis .. .. .. 115-119 XI. Periodicity (a) Fijians, (b) Indians, (c) Solomon Islanders, (d) Euro- peans. Charts I.-XX 119-131 XII. Temperatures during months in which transmission experiments with various species of mosquito were made . 132 XIII. Development of filariae and measurements at different stages of development . 133-145 (a) In Culex fatigana. (b) In Stegomyia pseudoscutellaria. (c) In Stegomyia fasciata. (d) In Culex jepsoni. XIV. (a) Showing numbers of microfilariae imbibed by individual mosquitoes. 146 (b) Showing that practically all microfilariae ingested develop in the thorax of Stegomyia pseudocutellaris . 147 (c) Showing numbers capable of being transmitted through one mosquito . , . , . 148 vi. Appendices—continued PAGE 149 XV. Measurement of microfilariae in the blood . XVI. Post-mortem on a case of filariasis, microfilariae without periodicity . 149 present in the blood . 1.50-155 XVII. Inequality of distribution of filariasis in Fiji . XVITI. Table of glandular enlargement associated with cases of elephantiasis in different regions of the body . 157-L59 1.59-161 XIX. Details of cases of filarial abscess . XX. Details of cases of hydrocele and enlarged testes .. .. .. .. 161 XXI. Details of cases of fugitive swellings resembling Calabar Swellings . 163 . • . 163 XXII. Details of cases of thrombosis . XXIII. Details of cases of synovitis . 164 XXIV. Investigation on enlarged glands (1) Epitrochlear, (2) Groin glands 165, 166 XXV. Details of case of recurrent orchitis with appearance of microfilariae in tunica vaginalis and chart .. .. .. .. .. .. 170 XXVI. (a) Details of cases of filarial fever, (b) Post-mortem on a Fijian who died after an attack of filarial fever .. .. .. .. 172, 173 XXVII. Details of cases of septic infection following on filarial invasion of the lymphatic glands . 175 XXVIII. Cultures of lymph from elephantoid. tissue . 177 XXIX. Details of cases of filariasis and elephantiasis in Europeans, and of a case of lymphatic oedema in a Fijian . 178 XXX. Details of dissections of tissue in elephantiasis scroti, and post-mortem on such a case . 188 XXXI. Experiments with microfilariae in different sera and solutions ... 182 XXXII. Details of action of various drugs in vivo and charts of four cases . 184 XXXIII. Detailed observations on Stegomyia pseudoscutellaris, its habits and larvae .' 188-190 LIST OF ILLUSTRATIONS. PLATES. 1 Microfilariae in the act of uncoiling in their chorional envelopes . 10 2 Large lymphatic gland from a case of pedunculated groin glands ; vide also Photograph VII. (Coloured) . — . facing 10 3 Section of filaria a in lymphangitis of the forearm . 14 Stegomyia 4 pseudoscutellaris. (Coloured) . facing 18 5 Gulex jepsoni. (Coloured) . facing 18 6 Development of . alimentary canal in the filarial larva . 19 7 Section of thorax of S. pseudoscutellaris two days after feeding on microfilaria- infected blood . 20 8 Section of thorax of S. pseudoscutellaris four days after feeding on microfilaria- infected blood . 20 9 Section of thorax S. pseudoscutellaris ten days after feeding on microfilaria- infected blood . 21 10 Filariae in proboscis on the fifteenth of day development . 22 11 Degenerate and chitinified filaria in mosquito's thorax. 23 12 Infection of Stegomyia pseudoscutellaris, with two broods of filariae . 26 13 Camera lucida drawings of different stages observed in development of the larval filaria in the mosquito . 28 14 Camera lucida drawings of terminal papillae of the larval filaria when fully developed in mosquito . 3x 15 Entrance of filaria into skin of human host . 33 16 Stegomyia pseudoscutellaris in act of sucking . 34 17 Microfilaria showing cell central mass. (Coloured) . facing 36 18 Adult female filaria on section in groin gland . 42 19 Details of a female filaria on section, highly . magnified . 44 20 Enlargement of epitrochlear glands in natives, traced frorn photographs . 45 21 Calcifying filaria in dilated lymphatic trunk . 50 22 Section of calcified filaria in the epitrochlear gland . , . 54 23 Section of female filaria . in an abscess . 55 24 Thickened lymphatic vessel containing dead filariae . 57 vii. Plates— continued. PAGE 25 Fibrotic changes in epitrochlear gland owing to filarial invasion, and section filariae of dead in groin glands. 61 26 Showing dead filaria and embryos in epitrochlear gland and pathological . changes on section . 63 27 Macroscopic section of enlarged groin gland to show contrast between cortex and medulla. (Coloured) . facing 62 28 Changes in mesenteric and lumbar glands from a patient the subject of attacks of filarial fever . 64 29 Dead filaria in epididymis of a Fijian, the subject of frequent attacks of filarial fever. (Coloured) . facing 64 30 Eosinophiles in section of filariated lymphatic gland. (Coloured) . facing 66 31 Epididymis, calcified filaria in vasa eiferentia . 66 32 Uterus of dead filaria and appearance of gland on section: septic infection in filariated . supervening a gland .... 70 33 Section of dead filaria in the tissue of elephantiasis scroti . 75 Filaria 34 immitis on section in superior vena cava of dog .... 76 PHOTOGRAPHS. 1 Microphotograph of sections of Stegomyia pseiidoscuiellaris infected with larval filariae, eighth day. (Hot weather) . 23 2 Microphotograph of sections of Stegomyia pseiidoscutellaris infected with larval filariae, twelfth day. (Hot weather) . 24 3 Microphotograph of section of Stegomyia pseudoscutellaris, eleventh day after infection (August, cool weather) to show slower rate of development observed in the cool months . 24 4 Microphotograph of two filariae leaving the proboscis of mosquito . 32 5 Elephantiasis of both arms, showing lymphatic swellings above the internal condyles . , . 46 • • 6 Elephantiasis of right arm, with disorganization of wrist-joint . 47 7 Pedimculated groin glands and double hydroceles . 48 8 Enlarged masses of glands in the groin . 49 9 Microphotograph of commencement of calcification in a female filaria removed from epitrochlear gland . 52 10 Calcifying female filaria removed from dilated lymphatic (same as PI. XXI.). 52 11 Microphotograph of calcified filaria in efferent lymphatic vessel. (Dr. John Bell, Hong Kong) 53 12 Enlarged microphotograph of the same. (Dr. John Bell) . 53 13 Microphotographs of sheathed and vmsheathed microfilariae in hydrocele fluid 59 14 Case of hydrocele associated with elephantiasis scroti, in which great numbers of calcified filariae were found in hydrocele sac at operation . 59 15 Elephantiasis scroti in which a dead filaria was found at operation . 73 . 74 16 Early case of elephantiasis scroti . 17 Breeding place of Stegomyia pseudoscutellaris, a brackish creek at Loma- 80 Loma . • • vui. — FILARIASI8 AND ELEPHA1NTIA8I8 IN FIJI. The researches detailed below were carried out in the Fiji Islands during the year 1910, and were made possible by a grant of £500, generously placed at the disposal of the London School of Tropical Medicine by Lord Sheffield for trojiical research. The subjects chosen for investigation by the Committee of the Tropical " School were : (1) Elephantiasis and filarial diseases (2) Epidemic and endemic dysentery the two important diseases of the Colony. The author of this Paper was chosen as the representative of the School.
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