84 TROPICAL MEDICINE AND HYGIENE 



vomiting. The tumour will feel hard, tense, and tender, 

 and if the blood is coagulated there will be no impulse 

 on coughing. Such a tumour is almost certain to be mis- 

 taken for a strangulated hernia, especially as the patient 

 may be constipated. 



A condition sometimes met with is pain along the cord 

 in the testicle, or in the back, accompanied with fever and 

 frequently vomiting. The fever may be continuous, but 

 more often there are well-marked rigors and short 

 pyrexial attacks not unlike malaria ("Barbados fever"). 

 The febrile paroxysms may occur, like those of malaria, 

 at any time of the day or night. Sometimes during these 

 attacks the testicle is decidedly swollen and very tender. 

 According to Wise these attacks are in some cases due to 

 the presence of adult filaria3 in the lymphatics of the 

 cord. 



Associated with similar symptoms there may be acute 

 oedema of the scrotum, and from the surface there may 

 be a profuse watery discharge, sometimes milky lymph 

 scrotum. In the fluid filarial embryos may be found. In 

 these cases the worms will be higher up than when in the 

 spermatic cord, so that the lymph circulation in the skin 

 is interfered with. 



Deep-seated abscess, in connective tissue, may possibly 

 be due to these worms. Such abscesses may be situated 

 under the scapula, under the deep fascia, in any of the 

 limbs, or in the pelvis. No external cause can be found, 

 and they are not connected with suppurating glands, or 

 with disease of the bone. Wise has found adult filariae in 

 small abscesses in the epididymis and in the cord, and 

 relates a case in which an adult worm was found in the 

 lymphatics in the abdomen, and the right psoas muscle 

 infiltrated with blood containing the embryos, and points 

 out that such a condition could readily lead to the forma- 

 tion of a psoas abscess. He also observed that in a con- 

 siderable proportion of the cases in which the worms 

 were found death was due to septica3mia. In his obser- 

 vations many adults have been found, and he shows that 



