19.3 Maxwell: Filariasis in China 289 
to take place. Meanwhile the lymphatics of the occluded area 
are dilated, and lymphatic varix occurs. If the thoracic duct 
is occluded, then the chyle.can only reach the general circulation 
by a retrograde route, and in consequence the abdominal and 
pelvic lymphatics become much dilated. Manson (29) speaks of 
these in the following terms: 
In dissections of such cases the thoracic duct has been found distended 
to the size of a finger, the abdominal and pelvic lymphatics forming an 
enormous varix, perhaps a foot in diameter and many inches in thickness, 
concealing kidneys, bladder, and spermatic cords. In such cases, when one 
of the vessels of the varix is pricked or ruptures, the contents are found 
to be white or pinkish. They are not limpid like ordinary lymph, they 
are chyle, therefore, chyle on its way to enter the circulation by a retro- 
grade compensatory track. 
Lymph scrotum, varicose groin glands, chyluria, and the like 
have as their basis a condition of lymphatic varix, but they are 
not pure lymphatic varices. They will be discussed under sepa- 
rate headings. 
There are, however, cases of pure lymphatic varix that we 
must discuss as such. Occasionally one meets with cutaneous 
lymphatic varix. There are small swellings which, although 
sometimes permanent, are often evanescent. The kind de- 
scribed as “deeply-situated little swellings’ (30) has been seen 
but once. On the other hand, I have sometimes met with 
groups of vesicles on the thigh, which might well fall 
under this category. They may occasionally form the starting 
point of a lymph fistula. The contents of these vesicles accord- 
ing to my experience are always clear fluid. 
The deeper lymphatic varices are rarely seen, owing to the 
utter impossibility of obtaining post-mortems in inland China, 
but on one occasion a lymphatic varix of the spermatic cord 
was encountered when operating for the radical cure of hydro- 
cele. In this case all of the lymphatics of the cord were 
dilated, and there were two or three small cystic dilatations on 
the lymphatic vessels. The contents were clear. No operation 
was performed on these dilated lymphatics, and the case con- 
valesced like an ordinary radical cure. The patient had had 
elephantoid fever, and his blood contained many filarial embryos. 
On another occasion I helped Dr. J. H. Montgomery to operate 
on a school boy, aged 16. In the right inguinal region there was 
a soft, compressible swelling, which enlarged when he stood 
up, and in which there was a marked impulse on coughing; 
on lying down it practically disappeared. The swelling turned 
1810528 
