19, 8 Maxwell: Filariasis in China 293 
cases the swelling is much smaller on one side than on the 
other. ; 
The skin over these swellings is natural. In the case of 
the smaller swellings it is nonadherent, but if there has been in- 
flammation about the glands, it may be difficult on operation 
to free it from the mass. The swellings themselves may be said 
to be adherent to the underlying fascia. A hypodermic syringe 
draws off lymph from these swellings, either clear or chylous, 
according to whether or not the varix is in connection with the 
chylous lymphatics. This fluid very often contains filarial 
embryos. 
As to their diagnosis, it has been said that it is a common 
mistake to confuse these with herniz. I have seen some two or 
three hundred cases, but have never seen one in which the 
slightest doubt on this head arose in my mind; and, with proper 
care in the examination of the swellings, this mistake should not 
occur. As there is often some other manifestation of filarial 
disease present, this may assist in diagnosis, if there is doubt. 
Masses of tubercular or lymphadenomatous glands might, if 
sufficient care be not taken, be mistaken for them, but there 
is one valuable positive sign that should greatly help: when 
the patient lies down with the buttocks raised, the tumors grad- 
ually get smaller, a condition that may be hastened by pressure 
with the hand; if the patient now stands up, the tumors 
gradually fill and become prominent. There is no impulse to 
speak of over these swellings. Manson(31) adds a hint that is 
a very wise one: 
Chronic swellings about the groin, cords, testes, and scrotum, in patients 
from the tropics should always be regarded as being possibly filarial. 
Azema(1) has made the statement that these various glands 
may spontaneously disappear at or about the age of 40. It is 
difficult to see why this should be the case. I have never seen 
one spontaneously disappear, nor have I been able to get satis- 
factory evidence of this taking place. Certainly they generally 
do not, and many cases are seen after this period. Once I saw 
them appear for the first time in a woman of 64. She had 
come for dragging pains in the groins, accompanied by slight 
hematuria, for which no cause could be discovered. The hema- 
turia ceased on the day of admission, leaving a urine in which 
nothing wrong could be discovered. Four months later she 
returned with markedly varicose groin glands, her blood full 
of the embryos, and it was clear that here was the explanation 
