19, 3 Maxwell: Filariasis in China 271 
strain, as seen in the case of the burden bearers of this dis- 
trict; but overfeeding is a still more potent cause. During 
four years I frequently had, as one of my burden bearers, a 
man whose blood swarmed with filariz. Sometimes he used to 
visit an island where the people were most hospitable and fish 
was plentiful; as often as he visited this place, this man got 
an attack, apparently through overfeeding. Cold and wet do. 
not seem to be very potent causes in bringing on an attack. 
As to treatment, there is no need to order the patient to bed, 
for he is feeling too ill to wish to be anywhere else. When an 
attack is well under way, there is no form of treatment that 
will stop it; but if the case be seen before the fever has started, 
it may be partially or wholly aborted by a sharp purgative and 
a stiff dose of quinine. Three or four “Livingstone rousers” 
and 15 grains of quinine in acid are a good prescription, and 
the fever has been cut short by this method in a remarkable way. 
If there is a manifest accompanying lymphangitis, this should 
be suitably treated. Phenacetin sometimes gives relief to the 
headache and diminishes the fever, but its action in this respect 
is not at all certain. It may be said, generally, that once 
the fever is established, expectant treatment is the only course 
open to the medical man. 
There is but little practical difficulty in the diagnosis of 
elephantoid fever..As a rule, there is some accompanying 
lymphangitis; and even if there is none, generally the native 
is quite able to distinguish between it and malarial fever. On 
one occasion a man walked into the consulting room and told 
me that he was suffering from both filarial fever and malarial 
fever. He was quite right, his malarial attack taking place at 
the time he foretold it, the quartan parasite being easily found, 
and two attacks of filarial fever occurring during his fortnight 
in the hospital. This case had no manifest accompanying lym- 
phangitis. 
LYMPHANGITIS 
In the great majority of forms of filarial disease, lymphangitis 
is present at one time or another. If the affected lymphatics 
are on the surface, the characteristic red streak on the skin 
and the tender cordlike swelling of the lymphatics are very 
manifest almost at the commencement of the attack. Often, 
even before the commencement of the fever, the lymphatic glands 
of the implicated region are a little swollen and tender. If the 
attack is at all severe, the inflammation will spread to the sur- 
rounding parts, the skin of which will become tense and shiny. 
