19,3 Maxwell: Filariasis in China 319 
It must be remembered that an abscess in the leg may be the 
first sign of filarial disease, and it is not infrequent for abscesses 
to form in the already elephantoid leg; these may give much 
trouble, owing to their tendency to form lymph fistule. In 
like manner they are prone to become the seat of intractable 
ulcers, which, however, act as lymph fistule and so save their 
owners a number of attacks of elephantoid fever. 
Before treatment, one should determine how much inconve- 
nience the patient really suffers. In many cases it is not much, 
and it is as well in such cases to do nothing. If a leg is badly 
ulcerated in addition, it may be amputated, but this should rarely 
be done. I have had to advise it in only one instance, where the 
limb was deformed and ulcerated. Ligature of the femoral 
artery has been practiced; but, besides being useless, it may be 
followed by gangrene, and is therefore unjustifiable. Elec- 
trolysis has also been used, but it is of no use whatever. Aseptic 
puncture during the acute attacks of erysipelatoid inflammation 
has been performed with good results, but the benefit is only 
temporary; unless done with great care and antiseptic precau- 
tions, it may be followed by ulceration or a lymph fistula. 
The main treatment is prophylactic, and the part should be 
carefully kept from injuries, such as wounds, insect bites, and 
scratches by thorns. If possible, the patient should give up work 
that involves wading in water, with bare legs exposed to the sun. 
If ulceration is already present, it should be prevented from 
spreading over a large area by antiseptic dressing. 
In some cases a spell in bed with the limb slightly raised and 
the use of an elastic bandage will greatly lessen the size of the 
limb. In other cases the constant use of an elastic bandage 
helps the patient. : 
In serious surgical treatment, there are several operations 
that have been tried and abandoned. 
Decortication of the limb with subsequent Thiersch grafting 
has been performed. Although in some instances the huge 
wound so formed has been induced to heal, the surface broke 
down again, and intractable ulceration and contracture followed, 
necessitating the removal of the limb. } 
Longitudinal strips of skin have been dissected off the fascia, 
but here again the procedure proved of doubtful value, and 
often it was a matter of great difficulty to get the wound to heal. 
There are two operations, however, that have ‘been attended 
with a great measure of success in nonfilarial cases, and they 
probably will be of value in selected filarial cases. One is the 
