A feature of chyluria is its tendency to disappear and reappear so that when treating such a case one should be conservative in considering the treatment as effecting a cure.
It is difficult to understand why chyluria should be common in India and China while almost unknown in the filarial infections of the Pacific islands.
In treating a case of chyluria one should enjoin rest in bed, laxatives and a restriction of fluids and fats. Patients subject to the condition should refrain from active exercise and other conditions which might cause fatigue. Drugs are of little value.
Filarial Orchitis and Hydrocele
The condition rather resembles an attack of epididymitis. As a result of recurring attacks hydrocele develops. The fluid may be lymphous or chylous in appearance and upon microscopical examination may show filarial embryos. These filarial hydroceles seemed to be the most common manifestations of the disease as observed in the Philippines. These hydroceles or chyloceles do not become very large but may require tapping.
Elephantiasis
As the result of recurring attacks of lymphangitis the tissues of the affected part show the effects of lymphatic obstruction by an hypertrophy of the skin and subcutaneous tissues. It would seem that the combination of lymphatic obstruction and bacterial infection is necessary for the production of elephantiasis. The skin of a part affected with elephantiasis is rough and the hair scanty. In addition to the lymphoedema of the part there is a great increase in the connective tissue.
On account of the lymphatic stasis incision into the blubbery tissue causes the outpouring of much lymph.
Elephantiasis of the lower extremities is by far the most common situation, giving us probably 90% of such affections. In Fiji elephantiasis of the upper extremities is quite common.