306 PILARIS AND THEIR ALLIES 



from blood and tissues of elephantiasis cases. Others, however, 

 have found the blood quite sterile. It is worth noting in this 

 connection that the number of cases of elephantiasis or other 

 filarial diseases in which microfilariae are not present in the blood 

 is considerably greater than those in which the larval parasites 

 are present. This is usually explained by assuming that the 

 parent filarise have died or that the larvae cannot reach the blood 

 on account of a blocking of the lymph channels by fibrous growths. 

 Cruickshank and Wright, for instance, in 130 cases of elephantiasis 

 in Cochin, found only 12 with microfilariae in the blood. The 

 observations recorded above are certainly significant and may 

 revolutionize our ideas in regard to filarial diseases. However, 

 even if some of the " filarial diseases " were found to be due to 

 bacteria, the filariae might still be incriminated as carriers of 

 the bacteria, and therefore as an indirect cause of the diseases. 

 Treatment and Prevention. — So far there is no widely-ac- 

 cepted treatment by which the parent filariae, and with theni._the 

 inicrofilariae, can ha destroyed. The number of the lar_v8e_js 

 reduced, however, by injections of thymol, ichthyol and other 

 drugs, and such injections might prove to be a useful preventive 

 measu re. McNaughton has recently reported five cases of 

 filarial infection successfully treated by injections of salvarsan; 

 one case was of ten years' standing. Usually the only course 

 of the physician is to relieve as far as possible the abnormal 

 conditions associated with the presence of the worms. Such 

 relief, of course, varies greatly with the diverse pathological 

 conditions which may arise. Varicose glands and vessels, un- 

 less causing great discomfort, are usually left alone, since they 

 are lymph channels substituted for the normal ones in the body 

 which have been blocked, and it is therefore dangerous to inter- 

 fere with them. In cases of elephantoid fever the only treat- 

 ment is such as would tend to relieve the pain in the swellings 

 and the fever, and perhaps in severe cases the pricking of the 

 swollen part to allow the exudation of the collecting lymph. 

 In chyluria the treatment consists in rest and in making the 

 pelvic regions as comfortable as possible to prevent pressure 

 which would tend to burst the lymphatics and force the lymph 

 into the kidneys or bladder. Elephantiasis, the commonest 

 expression of filarial disease, is seldom completely recovered 

 from. Formerly the only treatment was temporary reduction 



