992 The Philippine Journal of Science 1921 
the operation wound healed by first intention, except for a fine 
aperture at the lower end of the scar, which continued to run 
lymph for from a fortnight to three weeks. In the end, how- 
ever, these fistule heal satisfactorily, and they may safely be 
let alone. 
But it is sometimes otherwise with the fistule that may be 
left after operations for elephantiasis scroti. Occasionally the 
elephantoid change extends high up on the skin of the abdomen. 
In this case, particularly if the patient is well on in years, it 
is better to leave some of this diseased skin rather than make 
a huge operation wound. But this carries with it its own pen- 
alty, as it becomes necessary ‘to operate through diseased tis- 
sues, which are notoriously difficult to heal. Then a fistulous 
opening is apt to occur in the region of the root of the penis. 
Twice this has occurred in my own patients: in the one case 
the fistula healed spontaneously, in the other case it was still 
open a year after the operation. 
VARICOSE GROIN GLANDS 
Where, in the course of the lymphatic varix, lymphatic glands 
occur, these participate in the general dilatation. In marked 
cases, on removal from the body, they may appear on section 
like a sponge. In other cases, especially where there have been 
many attacks of elephantoid fever with inflammation of the 
glands, they may be indurated, and there may be a great in- 
crease in the fibrous tissue forming the framework of the gland. © 
Of these varicose glands by far the most important are those 
found in the groins of patients suffering from filarial disease. 
These groin swellings may be found alone, or in association 
with other forms of filarial disease, notably with lymph scrotum, 
elephantiasis of leg or scrotum, chyluria, or chylous dropsy of 
the tunica vaginalis. 
In a not inconsiderable number of cases the patient is quite 
unaware of their presence until they are discovered by the 
medical man. They are often quite painless and give no 
trouble whatever. In other cases the patient’s attention is called 
to them by dragging or aching pains in the groin. The swellings 
vary much in size, from a slight enlargement to masses the size 
of a man’s fist. In many cases the glands are discrete, but in the 
majority the lymphatics running into the gland are also dilated, 
and the whole forms a mass. All of the groin glands may form 
a large, ill-defined, matted swelling, inguinal and femoral glands 
being alike involved. One side only may be the seat of these 
swellings, but very frequently both sides are affected. In many 
