276 The Philippine Journal of Science 1921 
Injury, with the suppuration of consequent hematoma, 
next suggested itself as a possible cause. But.in every case in 
the list injury could be absolutely excluded. 
Infection by the bite of some insect could also be excluded. 
Manson (27) mentions abscess as a manifestation of filarial 
disease, but it is well to realize that this may be the first and 
only manifestation. Systematic examination of the blood of 
the patients who suffered in this way showed every one to be 
suffering from Filaria bancrofti; and, in considering the sub- 
ject of filarial abscess, every doubtful case (that is to say, 
every case in which lymph fever could not be found or a definite 
history obtained of this symptom) has been excluded. Only 
about one in ten abscesses judged to be filarial in origin has been 
excluded owing to this test, and none of these were abscesses of 
the scrotum. 
To turn to the general question of filarial abscess, its inci- 
dence is naturally limited only by the incidence of infection 
with the filarial parasite, and it may occur either as an inci- 
dent in the course of filarial disease or as the first symptom 
and sign of the same. It may occur in any situation where 
there is loose connective tissue, rich in lymphatics, and for this 
' reason the majority of abscesses outside the scrotum are in the 
vicinity of the great vessels, and the abscess does not always 
form in the situation where the inflammatory focus starts. 
In two of the cases in which a filarial abscess was opened over 
the lower end of Hunter’s canal, there was good evidence that 
the inflammatory focus was first situated in Scarpa’s triangle. 
Both the patients themselves and students who saw the cases 
before me are perfectly clear on this point; this evidence is 
important as bearing on the question of pathology. 
Previous observers, on opening such an abscess, have found the | 
dead body of a parent filarial worm, and they have justly sur- 
mised that some at least of these abscesses were the result of 
the death of the parent worm. 
In one of my cases portions of the body of a parent worm 
were found, but in none of the others could anything of the 
kind be found, although a most thorough search was carried 
out. In some, -however, the abscess was of some standing, 
rendering the absence of a dead parent worm insufficient proof. 
On two occasions broth cultures were inoculated without any 
result, and in some there are undoubtedly ordinary pyogenic 
organisms, but these are cases which have been neglected and 
in which the skin is about to slough. 
