96 TROPICAL MEDICINE AND HYGIENE 



by the lymphatic vessel in which the worm was situated. 

 We know that worms are found in the lymphatics on 

 the peripheral side of the glands. We know that eggs 

 too large to pass through glands are sometimes passed by 

 F. bancrofti. The results, on account of the peculiari- 

 ties of the division of lymphatic vessels, are such as 

 might be expected, and therefore the hypothesis is a 

 logical one. Bahr, and subsequently others, have shown 

 that living worms may be present in the glands, but the 

 embryos do not find their way into the circulation. A 

 worm in the gland tissues may cause hcemorrhage, and 

 always causes fibrosis and round-celled infiltration of the 

 glands, leading to their functional destruction and con- 

 version into fibrous masses. Numerous eosinophile 

 leucocytes may be found in the exudate. 



The frequency of enlarged hard glands in association 

 with elephantiasis, the varying onset, gradual and without 

 acute symptoms, presumably when the discharge of ova 

 is slow and gradual, and with acute symptoms when 

 more rapid, and possibly aided by acute lymphangitis 

 of bacterial origin, affords a plausible explanation of the 

 elephantoid condition. The absence of embryos from 

 the blood would be the result of the blockage of the 

 lymphatics in which the adult lived, or is still living. 

 Their presence in the lymph of the affected part would 

 continue as long as the worm was alive, but as the cases 

 of elephantiasis by the time they are examined are usually 

 of many years' standing, the worms would probably have 

 died. Reinfection, which is the rule when the embryos 

 are in the blood, would not occur when they were shut 

 off from the blood and only found in the lymphatics. 



Treatment. Elephantoid tissue is difficult to keep clean, 

 and, as already mentioned, ulcers are apt to occur in the 

 deep folds. The tissue is of low vitality, and chronic 

 ulceration is common. Any injury or laceration heals 

 slowly. Sloughing and gangrene are not unusual. 

 Cleanliness, and care- to avoid minor injuries, and rest 

 when any acute symptoms supervene, will prevent these 





