274 The Philippine Journal of Science 1921 
fected region (and very often a leg ulcer may serve the pur- 
pose), no attacks of filarial fever or erysipelatoid inflammation 
will occur as a rule, so long as drainage is kept up. Heal the 
ulcer or close the fistula, and the attacks recommence. This 
lends some weight to the view that these filarial inflammatory 
attacks are due to a poison that is generated in the body itself 
and not introduced from the outside into tissues that are merely 
weakened by the presence of the parasite or into an area of 
lymph stasis. . 
-It is very easy to say that all these attacks are set up by 
small wounds, scratches, insect bites, and the like, but the 
evidence on this matter is far from satisfactory. Careful ex- 
amination has often been made for a point of local infection; 
but, although sometimes points that might serve can be found, 
it is difficult to satisfy oneself that such was the actual point 
of infection. 
Treatment consists of rest in bed and elevation of the af- 
fected part. In the case of the leg, wrapping it in a continuous 
cold-water dressing gives great relief in some cases. The 
bowels should be kept well open, and quinine and iron should 
be given internally. One of the marked features is the linger- 
ing character of some of these cases. An attack may last only 
a few days; on the other hand, it may drag on for a fortnight 
or three weeks. Not infrequently second and even third at- 
tacks may supervene while the patient is in bed recovering 
from the first. 
DERMATITIS AND CELLULITIS 
The section on dermatitis and cellulitis need only be dealt 
with shortly, as it concerns a more acute form of the inflam- 
mation seen in erysipelatoid inflammation or lymphangitis. 
Clinically it is just like an ordinary cellulitis, only much more 
amenable to treatment. For this reason it is not necessary to be 
in a Marry to incise, as many cases will yield to the treatment 
described in the last section. An additional reason for being 
cautious is that wounds made under these circumstances heal 
very slowly. A simple incision in a case of this kind may take 
seven months to heal. On the other hand, if it is clear that 
there is imminent danger of extensive sloughing, then free 
incision should be made at once, as the effects of extensive 
sloughing are most disastrous. As an illustration may be ad- 
duced the case of a man who came under care in the last stage 
of this trouble. He was greatly emaciated; he had had cel- 
lulitis in the lower part of both thighs, with the result that 
