TREATMENT 99 



The operations on the limbs when the bulk is excessive 

 are not very satisfactory. Ligature of the femoral artery 

 was at one time practised, but was very liable to be 

 followed by gangrene, and the results were most unsatis- 

 factory. It is no longer practised. 



Removal of longitudinal wedges of skin and sub- 

 cutaneous tissue is fairly satisfactory as regards appear- 

 ance, and the drain of lymph from the incised surfaces 

 aids in the diminution of the bulk. As regards utility 

 there is as a rule no benefit. Castellani advocates the 

 combination of this method with the use of fibrolysin, 

 but it is too early to form any opinion as to the final 

 results of his operation. 



In the opinion of the author most of these operations 

 are, as regards final results, disappointing. 



Attempts at producing an anastomosis between the 

 dilated lymphatics and a large vein have not been 

 successful. 



The establishment of passages in the subcutaneous 

 tissue by the insertion of long silk ligatures, so that 

 drainage may take place from one lymphatic system into 

 another, is more promising, but so far little or no 

 permanent advantage has resulted. 



Tumours formed by varicose lymphatics are best left 

 alone. Death has in several instances followed their 

 removal or incision, as an acute general sepsis has 

 resulted. No such results have followed excision of the 

 enlarged antecubital glands. 



Treatment of the complications of filariasis due to 

 Filaria bancrofti must be conducted on general principles. 

 There is no specific treatment of the condition itself. 

 The worms cannot be killed, and it would be of doubtful 

 value to do so. It has been noticed that in the course of 

 treatment (of trypanosomiasis) of persons with filariae by 

 injections of atoxyl or tartar emetic the embryos have 

 disappeared permanently from the blood without any bad 

 effects. Further observations show that the effect is on 

 the embryos only, and there is no advantage in destroying 

 these as the adults are unaffected. 



