FILARIAL FEVER 83 



tumours which may be mistaken for hernia, as there is 

 definite impulse on coughing. 



When the patient lies down, such tumours diminish 

 slowly in size, but rarely disappear. The tumours may be 

 slightly painful, and often a dragging sensation is com- 

 plained of. They are formed by dilated lymphatics, and. 

 sometimes the sinuous dilated vessels can be in part 

 felt under the skin. The swelling can be followed up 

 the inguinal or femoral canal as the lymphatics pass 

 through these apertures. 



Frequently a second diffuse swelling on the inner 

 aspect of the thigh is also present ; it is usually situated 

 about the lower half of Scarpa's triangle. The swelling 

 is really part of the upper swelling, but as the fascia is 

 less dense in the lower part of Scarpa's triangle, it appears 

 as a separate swelling. On puncture of these swellings 

 with a hypodermic needle, a clear or more or less milky 

 fluid is obtained. The cells in this fluid are lymphocytes, 

 and a few red corpuscles may be present. In some cases 

 filarial embryos and occasionally eggs with the coiled-up 

 embryo will be found abundantly in the fluid, but in old- 

 standing cases none will be seen. 



Bahr has shown that common glands, to be enlarged 

 and to contain living or calcified filaria, are the epi- 

 trochlear, antecubital or Crookshank's gland in front of 

 the elbow. Newham and Wise subsequently found living 

 filariae in these glands in British Guiana. Frequently 

 when living filariae are found in these glands there are no 

 embryos in the blood. It is interesting to recall that 

 Egan, in 1892, called attention to the frequency with 

 which enlargement or inflammation of Crookshank's 

 gland was found in British Guiana, but the relationship 

 to filarial infection was not then recognized. 



When haemorrhages take place into a mass of dilated 

 lymphatics a tumour of considerable size is formed, even 

 if the swelling were previously small. Such a swelling 

 is of sudden onset, may be, if in the groin or inguinal 

 canals, accompanied with severe pain and, frequently 



