19, 3 Maxwell: Filariasis in China 291 
out of the aperture to a distance of 6 inches (15 centimeters) 
and a test tube full of lymph could be collected in a short time. 
The strain on the patient was considerable, and I stopped the 
flow by surrounding the aperture with a purse-string suture 
of the finest horsehair. During the patient’s stay in the hos- 
pital the flow did not recur. 
The second variety follows the opening or bursting of a 
filarial abscess. It may for convenience be called inflammatory. 
Infammatory.—It is not at all uncommon, after the opening 
or bursting of a filarial abscess, for the patient to be troubled 
for some months by a lymph fistula in the site of the opening 
into the lymphatic abscess cavity. This sinus may be several 
centimeters deep, and it often runs down to the region of the 
lymphatics in connection with the large vessels of the limb. 
The usual site for a fistula of this kind is in the popliteal re- 
gion. The abscess cavity closes up, leaving a fine sinus, through 
which lymph gradually trickles. Another favorite situation 
for this kind of fistula is in an elephantiasis scroti, an abscess 
forming in the elephantoid tissue, bursting, and leaving a lym- 
phatic fistula. 
As to treatment, in both regions it is better to do nothing 
in the first case because, given time, the fistula will almost 
certainly heal of itself; and in the second because the probabil- 
ity is that nothing short of removing the elephantiasis scroti 
will be of any avail. In some cases this also heals spontaneously, 
but this rarely occurs. 
Under this class must also be included the ulcers of the leg 
occurring in elephantoid disease of this limb. These also act 
as fistule and are constantly moist with exuding lymph. They 
are very difficult to heal. A case is recalled of a man with 
both legs elephantoid and ulcers on one leg just above the ankle 
(Plate 21). As out-patient and in-patient I worked on him for 
three years, and finally gave up all treatment as hopeless. Al- 
though the ulcers diminished in size, they never showed any 
inclination to heal, and there was too much fibrous change about 
the ulcer to make it possible to do skin grafting with any 
reasonable hope of success. Besides, patients suffering from 
this affliction, although they wished to get their ulcers healed, 
yet confessed that the advent of the ulcer had almost entirely 
freed them from attacks of elephantoid fever. 
The third class comprises those following operations. 
Operative—Temporary postoperative fistule are by no means 
uncommon. Twice in operating on varicose groin glands has 
