19, 3 Maxwell: Filariasis in China 303 
infection. When compared with the figures given for general 
incidence, it must be admitted that the filarial disease, barring the 
elephantoid form, does not seem to be especially prone to give 
rise to hydrocele. 
CHYLOUS DIARRHEA 
Chylous diarrheea is extremely rare, and I have never seen a 
case. As the lymphatic varix must extend in some cases into 
the wall of the bowel, it is by no means an unexplainable trouble. 
As such cases are only a curiosity, they need not detain us fur- 
ther. 
We have now to discuss the forms characterized by the pro- 
duction of more or less solid cedema in the parts affected, in 
addition to the lymphatic dilatation that characterizes all the 
affections that I have grouped under this section. 
Not so very long ago it was necessary to enter into elaborate 
reasons which would justify the placing of the diseases char- 
acterized by solid oedema among the filarial diseases at all. 
Happily, with the advance of knowledge, this is no longer 
necessary ; still, it is well to bear in mind the main reasons that 
justify this classification. It is true that not all cases of ele- 
phantiasis are connected with filarial disease and that, while 
the most common cause, it is not the only one. In the East and 
in Europe cases occur that have nothing to do with filarial 
disease and yet are as pronounced cases of elephantiasis as one 
could wish to meet; but, on the whole, it may be fairly stated 
that the elephantiasis of China is due to filarial disease, for the 
following reasons: 
a. The distribution of filarial disease and elephantiasis are the same. 
Generally speaking, where there is no filaria, there is practically 
no elephantiasis, and vice versa. After a period of work in the 
coast belt of Fukien, I moved inland to a place well outside the belt. 
Here filariasis was absent, and the few cases of elephantiasis of 
the leg that came to me were either frankly due to other causes or 
were cases that had originated in the coast belt. 
b. Every gradation between lymph scrotum—which is clearly a filarial 
disease—and elephantiasis scroti can be observed. . 
ce. Both lymph scrotum and elephantiasis scroti are lymphatic varices. 
d. The type of fever observed in undoubted filarial cases and elephan- 
tiasis cases is precisely the same. 
e. The removal of a lymph scrotum or varicose groin glands—both 
manifestly filarial diseases—may be followed by the development 
of a form of elephantoid disease, either elephantiasis of scrotum 
or leg. 
f. Acknowledged filarial disease and elephantiasis may and often do 
occur in the same subject. 
