The first cases reported by an English surgeon were by Dr. Loney, a naval surgeon, occurring in two Kroomen, whom he saw while cruising on the West Coast of Africa during 1841-2. In both he succeeded in extracting the parasite.[3]
Another case was observed by Dr. Mitchell at Trinidad in the person of a young negress, in whom the worm appeared at long and uncertain intervals for four or five years before he had the opportunity of seeing it. At length in 1845 Dr. Mitchell saw the worm twisted like the letter S lying motionless under the conjunctiva, midway between the edge of the cornea and the inner canthus. Extraction of the worm was deferred to enable six or seven of his medical brethren to observe so unusual an appearance, with the result that when they assembled the following morning the parasite had removed itself to deeper parts.[4]
A case is also recorded by Gervais and van Beneden,[5] in which M. Lestrille succeeded in 1854 in extracting a filaria from a negress, and Dr. Guyon once more, at a meeting of the French Academy of Sciences in 1864, exhibited another filaria, which had been removed by a French naval surgeon from a negro of the Gaboon. The filaria was of unusual size, measuring fifteen centimetres. Its length was such that the whole of it could not be seen at one time below the conjunctiva, part always remaining embedded in the deeper parts of the orbit.[6]
Dr. Morton[7] reports a case occurring in a negress residing at Gaboon in West Africa, in which a native woman succeeded in extracting the parasite. The worm, preserved in gin, had been sent to him by a missionary, the Rev. Dr. Nassau, in the district, who informed him that although he had been very many years in that country, and had often heard of the parasite, this was the first specimen he had been able to secure. The missionary himself appeared to be also affected with filaria, which, however, did not appear on the eye, but could, he said, occasionally be felt under the skin of the fingers, and once in the skin of the lower eyelid, from which position he attempted himself to remove it with scalpel and forceps, but he did not succeed, the worm wriggling away across his cheek. The worm that was sent to Dr. Morton measured 16 mm., but was in too badly preserved a state to permit of accurate examination.
Lastly, in Dr. Davidson’s work on hygiene and diseases of warm climates (p. 962) Dr. Manson, who writes the article on filaria, reports the case of a negro who had been affected with Filaria loa, and in whose blood he afterwards found the Filaria diurna, and raises the question whether the Filaria loa may not turn out to be the female parental form of the Filaria diurna.
I am afraid we must confess that we are as yet very ignorant of many points connected with the life history of the Filaria loa. With the adult female parasite we have a limited acquaintance, but till now we are ignorant of the appearance of the male worm. The larvæ have been observed in the interior of the adult, but what their further course is, what transmigration may occur, ere they reappear as fully formed filariæ under the conjunctiva has yet to be discovered. The only observation that bears at all upon this question is that made by Dr. Manson and reported in Dr. Davidson’s work, that in one case of Filaria loa, the Filaria diurna was afterwards found in the blood. With the view of ascertaining whether the Filaria diurna was present in the blood of my patient Miss H⸺, and also with the view of getting a report as to her general medical condition, I got my friend Dr. Alexander Bruce to undertake the examination.
It must, however, be borne in mind that in her case the filaria removed proves to be a male, and, unless she were affected with the female parasite as well, no embryos could be expected in the blood.
Report by Dr. Alexander Bruce, October 16th, 1894.—“Miss H⸺, missionary to Old Calabar, went there at the age of twenty-two, has been out there ten years altogether; first was out for two years, then furloughed for one year on account of an attack of intermittent fever which turned her hair grey, but was not otherwise very severe in type. Then she was out for four years and home for one year on furlough. Then was out for seventeen months, invalided home in January, 1894, for remittent fever, gastritis, and a form of dysentery and great anæmia. The remittent fever began in December, 1893, with delirium at beginning, and fever which rose daily to 102° and 103° F. She was sent to sea in ten days, and on the way home the temperature on one occasion rose to 107°; this was reduced by ice-pack. Improvement was slow, being retarded by the gastritis and dysentery, and the tendency to pyrexia did not abate till the end of June. The gastritis was indicated by intense pain (agony, she called it) in swallowing anything, whether solid or fluid. The bowels now move only once daily or less frequently, and the motions are accompanied by small flakes of mucus (formerly by blood). There was always great mental depression during the attacks of dysentery.
“The arms became, since June, stiff and swollen, especially on awakening from sleep (whether at night or during the day), and the hands felt ‘numb,’ ‘dead,’ ‘as if asleep,’ or ‘as if they didn’t belong to her.’