19, 3 Maxwell: Filariasis in China 821 
disease among women is the cause. If the growth becomes 
large, the breast should be amputated. These tumors are 
occasionally very large and have been known to descend as far 
as the knees. One on record weighed 21 pounds (9.5 kilo- 
grams) .(36) 
Cases of hypertrophy of the breast may reach a huge size and 
are found in China, but so far I have seen none to which filarial 
infection could be assigned as a cause. 
ELEPHANTIASIS OF LIMITED SKIN AREAS 
Elephantiasis of limited skin areas are also rare, but not so 
rare as the kind just discussed. I have several times seen flat 
elephantoid areas on the thighs, but have never seen any suffi- 
ciently serious to justify operation. 
Localized pedunculated tumors have been reported from other 
localities. Corney, (11) of Fiji, Daniels, (12) and Silcock (40) 
have described cases of this kind. Daniels met with his cases 
in Fiji and Demerara, and Silcock’s patient was an East Indian. 
The tumors are easily removed by operation. 
THE EFFECT OF FILARIAL INFECTION ON THE COURSE OF OTHER 
DISEASES 
A few observations have been made on the effect of filarial 
infection on the course of other diseases. Surgical wounds in 
the subjects of filarial disease heal very well, unless they happen 
- to be in an elephantoid area and have been allowed to become 
septic, in which case they heal very badly. One case, a man who 
had been clawed by a tiger, who came into my hands very badly 
torn and whose blood was swarming with filaria, healed well. 
Ordinary operation wounds heal by first intention quite as well 
as in other subjects. Broken bones also unite without any 
trouble. Operations for cataract follow a normal course. 
Of the medical diseases, malaria and filariasis are not antago- 
nistic, and they have been frequently seen combined in the same 
subject. Enlarged malarial spleen and elephantiasis not infre- 
quently coexist in a patient. ae 
Typhoid fever is not influenced in its course by filariasis. 
Three times I have seen them coexist, without the fever being 
in the least modified. 
Lung diseases are unfavorably modified by the presence of 
filariasis, especially pneumonia. Twice I have seen patients, 
the subjects of filarial disease, removed in a dying condition by 
their friends; one case died in the hospital, and two or three 
181052——5 
