FILARIASIS AND ELEPHANTIASIS. 295 



than in almost any other section of the Archipelago, the northeast and 

 southwest monsoons bringing rains to a large part of this section. 

 Vegetation is luxuriant, even for the Tropics. This is the greatest hemp 

 district on the Island, the greater part of the land being given over to 

 the cultivation of the abaca plant. Altogether it is difficult to find 

 anywhere in the Islands a prettier or a more prosperous region than this 

 country of the Bicols. 



II. ELEPHANTIASIS. 



This malady is well known among the native population by the name 

 of titibac. Practically the entire laboring class of this section work at 

 some time or other with hemp (abaca), hence it is not surprising that 

 they should attribute the disease to the effect of that plant. There 

 seems to be a diversity of opinion as to the way in which the plant affects 

 the individual. Some believe that elephantiasis is due to the direct 

 action of the sap of the abaca upon the skin, but the more prevalent 

 idea connects the disease with the strain upon the legs incident to hemp 

 stripping and followed by getting the feet wet. Many of the women as 

 well as the men are workers in hemp, but those who have never engaged 

 in work of this kind usually attribute the disease to the strain of 

 working a loom, one of which is found in every home. Another cause 

 of the disease is said to be getting the feet wet during menstruation. 

 The typical history given by the patients, however, is that of a day's 

 hard work at hemp stripping and wading, while still warm, through 

 some stream on their way home. The following day brings on an attack, 

 which in different towns, is variously called sorip, ubag or culibra; 

 during the attack the leg becomes swollen, red, and painful. 4 There is 

 also fever and loss of appetite. With the subsidence of fever and pain, 

 some swelling of the leg persists. In many instances the history of 

 but one such attack can be elicited, while in many cases, especially in 

 the aged, the enlargement seems to have come on gradually without 

 acute symptoms. One patient was observed during such an attack. 

 This was a woman aged 28, a resident of Daraga, Albay Province, who, 

 ten months before, suffered her primary attack, which left the left leg 

 markedly swollen. There was also some swelling and induration of the 

 lower part of the thigh. When seen she had a temperature of 37°. 5 C. 

 (103°. 4 P.), and complained of headache; the left leg and thigh were 

 hot and tense to the touch and tender on pressure; large, scattered 

 erysipelatoid patches were situated over the inner side of both leg and 



4 Probably because of the distribution of the mosquito carriers of filaria, these 

 infections do not seem to be as numerous along the coast as in the higher lands 

 of the interior. A European merchant of Legaspi explained the fact of there 

 being no elephantiasis in that town by the statement that Legaspi was not in 

 the hemp district. One man, living near the coast, attributed his elephantiasis 

 to pulling bejuco (rattan), which necessitated his wading in the water. 



