280 The Philippine Journal of Science 1921 
The third came into the hospital looking like a typical ap- 
pendicitis patient. He also was very ill, having been so for 
one and a half months. The abscess proved to be extraperito- 
neal; it extended both into the iliac fossa and downward into 
the pelvis. Probably it began in the loose tissue about the iliac 
vessels; the fact that the disease began with a rigor and im- 
mediate flexion of the right thigh on the abdomen to an extent 
that is rarely seen in an uncomplicated attack of appendicitis 
lends color to this supposition. This case slowly healed up, 
and the man regained health and strength. His bowels were 
regular and natural at the time of the attack. 
The fourth was a case of perinephric abscess that had been 
neglected and had tracked into the gluteal region. Free inci- 
sions had to be made in both the lumbar and the gluteal regions. 
This patient was also very ill, but with free drainage and care 
he, too, did well. 
Manson’s(28) advice on the subject of these abscesses is sound: 
Deep seated pain in the thorax or abdomen, with inflammatory fever 
followed by hectic, and a diminution in the number of micro-filiarie in, 
or their entire disappearance from the peripheral blood, should, in such 
circumstances, suggest a diagnosis of filarial abscess, and indicate explo- 
ration, and if feasible, active surgical interference. 
Finally we must discuss the onset of this malady and its 
typical temperature. Fig. 2 is a typical temperature chart of 
the disease. Rising rapidly with a rigor, which may occur 
while the man is at work in the fields, cutting wood, or even 
lying in bed, it remains high for from one to three days and 
then descends by lysis,” provided an unopened abscess is not 
left. On the other hand, if the patient be under favorable condi- 
tions and it is possible to abort the attack, the temperature may 
descend very rapidly (fig. 3). . 
In neglected cases and cases that do not run a proper course, 
owing to insufficient drainage or wide inflammatory focus, the 
temperature may assume a septic type (fig. 4). 
In criticism it may be urged that this temperature is the 
result of Plasmodium malariz complicating the filarial attack. 
In reply it may be stated first, that in many of the cases the 
blood was carefully examined for Plasmodium malariz with 
negative results; and, second, that it is quite possible for the 
fever, due to the presence of Filaria bancrofti, and active mala- 
rial attacks to run concurrently, but in such cases both diseases 
are clinically and microscopically distinct; and moreover the 
patient, as I have proved in two instances, has been right in 
