300 1'HALEN AND NICHOLS. 



VI. RELATIONSHIP OF FILAKIA TO ELEPHANTIASIS. 



J'j'imt, at a recent meeting of the London Society of Tropical Medicine, 

 presented a paper in which the theory of filarial infection as the essential 

 cause of elephantoid disease was brought into question. He gave it as 

 his opinion that a majority, if not all the cases of elephantiasis, in the 

 Tropics as in temperate regions, are due to an ordinary streptococcic 

 lymphangitis, aggravated by lack of attention, and he brings forward a 

 formidable arra3 r of evidence in support of his position. To be sure, the 

 arguments in support of the relationship between the Microfilaria ban- 

 crofti and elephantoid disease are few in number: namely, that the 

 Filaria bancrofti is a parasite of the lymphatic vessels, and elephantiasis 

 is a disease of the same vessels, and also that the geographical distribution 

 of elephantiasis and filariasis coincide. Our own investigations add their 

 mite of evidence to the generally accepted view that elephantoid disease 

 is directly due to filarial infection. Although our examinations for 

 filariasis have not been very numerous, nevertheless they indicate a 

 higher percentage of infection for the Bieol provinces than has been 

 shown for any other part of the Islands, with jDrobably the exception of 

 the Davao district in Mindanao, and in no other portion of the Archi- 

 pelago has elephantiasis been encountered in any like degree. Other 

 writers have also observed that the subjects of elephantiasis showed a 

 lesser percentage of filarial infection than the general population. Sir 

 Patrick Manson speaks of finding but one filarial infection among four- 

 teen subjects of elephantiasis, and twenty among seventy-four persons 

 not so affected, all the specimens coming from the same locality. He 

 explains this phenomenon by the view that the production of elephantoid 

 disease results from some injury to the adult filaria, causing her to 

 evacuate her eggs instead of the living embryos into the lymphatic 

 vessels. The eggs, being of much greater diameter than the embryo, can 

 not pass through the lymphatics, but obstruct them instead. Then, 

 either because of the death of the adult worm, or of the clogged condition 

 of the lymphatics, filarial embryos are no longer able to get into the 

 circulation. 



VII. TREATMENT AND PROPHYLAXIS. 



The household remedies of a people are always of interest to the 

 physician. The popular remedy for acute attacks of the lymphangitis 

 is the leaf of an indigenous plant which the natives call anonang (Cordia 

 blancoi Vid.). This is first bruised and mixed with salt and then ap- 

 plied to the affected parts. Azafran (Curcuma long a Linn.), the juice 

 of the root of a local plant, is also commonly used as a local application. 

 Multiple parallel incisions through the skin are also employed for 

 the relief of the swelling, a penknife being used for the operation. 

 The only treatment of elephantiasis observed by us was that of a 



