Case of Filaria Loa

Part 1

CASE OF FILARIA LOA.

BY D. ARGYLL ROBERTSON, M.D., F.R.C.S.ED., OCULIST TO H.M. THE QUEEN IN SCOTLAND; PRESIDENT OF THE OPHTHALMOLOGICAL SOCIETY OF THE UNITED KINGDOM; LECTURER ON DISEASES OF THE EYE IN THE UNIVERSITY OF EDINBURGH, ETC.

Reprinted from the ‘Transactions of the Ophthalmological Society.’

LONDON: PRINTED BY ADLARD AND SON, BARTHOLOMEW CLOSE, E.C., AND 20, HANOVER SQUARE, W. 1895.

Illustrates Dr. Argyll Robertson’s paper on Filaria loa.

MALE FILARIA LOA.

FIG. 1.—The whole worm. Portions of the testicles and alimentary canal protruding through a rupture of the wall of the parasite.

FIG. 2.—The head of the worm.

FIG. 3.—The curved tail of the worm with its papillæ.

FIG. 4.—The ruptured part of the worm with protruding alimentary canal and testes.]

Communication read at the Meeting of the Ophthalmological Society on October 18th, 1894.

Case of Filaria loa, in which the parasite was removed from under the conjunctiva.

By D. ARGYLL ROBERTSON.

(With Plate VI.)

On the 29th of June last I was consulted by Miss J. H⸺ on account of what she termed the presence of a worm in her eye.

She is a slightly anæmic, prematurely grey-haired, but otherwise healthy-looking lady, thirty-two years of age. She has resided at Old Calabar on the West Coast of Africa at intervals, for nearly eight years altogether. She twice had to return home on account of debility following severe intermittent fever. During her last visit to Old Calabar, which extended to about eighteen months, she suffered almost the whole time from chronic dysentery followed by severe remittent fever, which necessitated her return to this country last January in a very weak state of health.

She stated that the worm was first observed by her in February of this year, immediately after her return home. It frequented both eyes, but showed a preference for the left one, sometimes coursing over the surface of the eye under the conjunctiva, sometimes wriggling under the skin of the eyelids—causing a tickling, irritating sensation, but not real pain. It had latterly restricted its visits entirely to the left eye. On account of the remittent fever from which she was still suffering, her bedroom, when she first came home, was kept well heated, and until she recovered from the fever she noticed that the worm was particularly lively, occasionally causing the eye to become bloodshot, and the eyelids to swell and blacken slightly. As long as she was confined to warm rooms the worm was almost constantly moving about in the neighbourhood of the eye, causing such irritation as to prevent reading or work of any kind. This irritation with accompanying injection always passed off in the course of the day, and never resulted in severe inflammation.

She thus found that the worm was sensitive to cold, coming to the surface when the temperature was high, and disappearing to deeper parts when she was exposed to cold. As soon as she had recovered strength so far as to be able to go out of doors the visits of the worm to the eye became fewer, perhaps a week or longer occurring between them. It usually put in an appearance when she was near a cosy fire or in bed. Its last disappearance was for two months, during July and August, and as she at that time passed a worm per rectum she thought she had thus got rid of it. During these two months she was mostly in the open air, but as soon as, in September, the rooms began to be heated, it again came to the surface.

When I first saw Miss H—, in June, I very thoroughly examined the eye, but failed to observe any trace of the parasite, unless perhaps the appearance of a minute bluish vesicle at the extreme outer angle of the conjunctival cul-de-sac corresponded to one of the extremities of the worm, but the vesicle, though watched for a time, did not alter in position or appearance. I gave her strict injunctions to return at any time whenever she felt the worm on the move.

I saw her twice at the eye wards of the Royal Infirmary about the beginning of July, but on these occasions careful inspection was again negative in its results.

On the 12th of September, however, she again came to the Infirmary, stating that she had felt the worm moving about in the left eye that forenoon, and to prevent it leaving the surface she had kept the eye well covered with a warm cloth till she made her way to the Infirmary. On this occasion, after examining the eye for a minute or two, I observed the worm moving in a tortuous, wriggling manner under the conjunctiva, the surface of which became slightly elevated as it moved along.

It passed with a pretty quick movement over the surface of the sclerotic at the distance of about 5 mm. from the outer margin of the cornea. It glided from the upper outer towards the lower outer part of the globe. There was increased lachrymation and slightly increased injection of the conjunctiva,—just such an appearance as would result from a particle of dust in the eye.

I at once placed my finger on the surface of the globe in such a manner as to prevent the parasite passing backwards until the conjunctiva was pretty well anæsthetised by the application of cocaine. I then got my friend Dr. Maddox, who was present, to apply his finger while the necessary preparations were hastily made for an operation.

She was placed on a couch and the speculum applied, when the pressure of the finger having been removed the wriggling movements of the worm were resumed, as briskly as before the application of the cocaine. I now grasped with a pair of toothed fixing forceps a good fold of conjunctiva over the centre of the wriggling worm, taking care to include in the fold all structures superficial to the sclerotic. I next made with a pair of scissors an incision through the conjunctiva a little nearer the cornea, in such a manner as to lift up a small flap of conjunctiva, and after a little careful separation of the tissues found one extremity of the worm, which I seized with a pair of iris forceps. On now relaxing the fixing forceps the parasite came away readily. No irritation or inflammation followed the operation.

The worm presented the appearance of a piece of fishing-gut, being round, firm, transparent, and colourless. It wriggled slightly for a few minutes after removal while held in the forceps, but on being placed in a solution of boracic acid, so as to prevent it becoming dry, it seemed completely to lose its vitality. It measured 25 mm. in length and barely half a millimetre in breadth. It terminated rather abruptly at one extremity, scarcely tapering at all, but at the other it gradually tapered to a pretty sharply curved fine point. Twisted round the worm, and apparently attached to it near its centre, was a much finer, less firm, transparent filamentous body, which I at first thought might possibly prove to be a second young filaria, or even the male filaria, but which on further careful microscopical examination appears to be the alimentary canal of the worm protruded through an opening in its musculo-cutaneous wall, caused by the forcible grasping of the parasite with the forceps.

The worm after removal was, on the suggestion of Dr. Muir, Pathologist to the Infirmary, placed in a mixture of equal parts of glycerine and methylated spirits, but the cork of the bottle in which the mixture was put had retained some of the blue colouring matter (methyl violet) of a solution previously in the bottle, and thus the preservative mixture became faintly blue-tinted. The parasite absorbed the colouring matter slightly, but the filamentous body projecting from it absorbed it more freely, becoming markedly blue-tinted. After remaining in the solution between three and four weeks the parasite was carefully mounted as a microscopic preparation in glycerine jelly by Mr. Simpson, assistant keeper of the University Anatomical Museum.

It is not my intention to attempt an account of the natural history of the parasite, as I propose to submit the specimen to some special authority in that department.

I have had some sketches of it made by a competent artist, and these, as well as the preparation itself under the microscope, I have pleasure in exhibiting to you.

Part 2

It appears to me not improbable that this specimen may be found to supply what has hitherto been a missing link, namely, the male animal.

Since writing this I have had the opportunity of submitting the specimen to Dr. Munson, who at once recognised it as the male worm, and has undertaken to make a careful microscopical examination and description of it.

“Report by DR. MANSON on the structure of the Filaria loa, from an examination of the specimen removed in the foregoing case, as well as of the specimen of the same parasite exhibited at a meeting of the Society on January 31st, 1895. The latter filaria was removed from the eyelid of a patient by Dr. J. R. Logan, Liverpool.—

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