gives rise to pronounced anæmia, with depression of spirits, and feelings of weakness and debility, and thus tends to incapacitate the patient for active, vigorous life.
Exciting causes of chyluria.— Chyluria is very liable to occur, either for the first time or as a relapse, in pregnancy or after childbirth; the disturbance of the pelvic lymphatics in pregnancy and the muscular efforts attending labour apparently causing rupture of pelvic lymphatics previously rendered varicose by filarial obstruction of the thoracic duct. In men, running, leaping, and violent efforts generally are sometimes assigned as its cause; usually the exciting cause is not discoverable.
Treatment.— The treatment of chyluria should be conducted on the same lines as the treatment of inaccessible varix elsewhere; that is to say, by resting and elevating the affected part, and thereby diminishing as far as possible the hydrostatic pressure in the distended vessels. Many forms of medicinal treatment have been advocated. Because during treatment with some drug a chyluria has subsided, curative properties are apt to be attributed to the drug. The best results are got by sending fhe patient to bed, elevating the pelvis, restricting the amount of food and fluid especially fatty food gentle purgation, and absolute rest. It will be found that a day or two of treatment on these lines is often followed by temporary, perhaps prolonged, cessation of the chyluria. The drugs which have been particularly lauded in the treatment of this disease are gallic acid in large doses, benzoic acid in large doses, glycerin, the tincture of the perchloride of iron, decoction of mangrove bark, chromic acid, quinine, salicylate of soda, ichthyol, and Nigella sativa. I do not believe that these substances have any influence whatever in stopping the lymphorrhagia. Neither do I believe that thymol, recommended by Lawrie, or methylene blue, recommended by American writers, has any effect either on the filaria or on the disease it gives rise to; since their first recommendation both drugs have been tried, but in other hands-have failed.
