l602 



THE FILARIASES 



occur, and, as a result, the connective tissue would become inflamed 

 and hypertrophied, which, together with the excess of lymph, 

 would increase the size of the part. Manson bases this theory on 

 his observation of eggs escaping from the ruptured vesicles of a 

 lymph scrotum. Bahr is of the opinion that tropical elephantiasis 

 can best be explained by the blockage of the lymphatic channels 

 of the diseased area by the frequent and long-continued invasion of 

 the adult FilaricB. He finds that the Microfilariae may not reach 

 the blood, but die in the gland or organ in which they are lying. 

 He also finds that the periodical discharge of these Microfilarice 

 may be a factor in the production of lymphangitis, orchitis, and 

 funiculitis, and that the parent -worm may die after these inflam- 

 matory attacks. 



It is believed that the smooth elephantiasis (elephantiasis glabra), 

 in which the skin is smooth, is due to blocking of the channels in 

 the groin glands, and rough elephantiasis (elephantiasis verrucosa), 

 in which the skin is very nodular, is due to blocking of the small 

 skin capillaries, but we are not acquainted with definite proofs of 

 this theory. 



The Blood. — ^The blood in fllariasis does not exhibit anaemia unless 

 there is hsemato-chyluria or diarrhoea; the number of leucocytes is 

 normal, but there may be leucocytosis during the attacks of fever. 

 The eosinophiles are at times increased. 



Morbid Anatomy.— The morbid anatomy naturally varies with the 

 variety of the pathological lesion produced. 



In lymphangitis the lymphatic vessels will be found enlarged and 

 inflamed, and abscesses of varying size may at times be found con- 

 taining the dead worms, which are apt to become calcified by the 

 deposition of lamellar plates of calcium carbonate in the interior 

 of the worm. The calcified worms were first described by Wise as 

 small yellow bodies, with the shape and structure of FilaricB, which 

 he found in the pelvis of the kidney. Bahr states that at a later 

 stage the calcareous deposit may be gradually absorbed until only 

 minute yellow spicules are left. The calcified (and also the living) 

 worms are surrounded by eosinophile cells in large numbers. Bahr 

 has found filarial abscesses to be of common occurrence amongst 

 the Fijians in the substance of the gastrocnemius, the popliteal space, 

 the groin, and in the quadriceps extensor in the leg, and over the 

 internal condyle, in the axilla, in the latissimus dorsi and serratus 

 magnus muscles in the arm In these abscesses the dead worm was 

 found associated with Staphylococcus pyogenes aureus and Strepto- 

 coccus pyogenes. 



With regard to the lymphatic vessel, Bahr is of the opinion that 

 the worm, both during its lifetime as well as after its death, exerts 

 an influence on the vessel wall, leading to proliferation of the endo- 

 thelium and to an invasion of the vessel wall with fibrous tissue. 

 In this manner the tymphatic becomes thickened, but shows also 

 numerous cyst-like dilatations in which the dead worms maybe found. 



The fugitive swellings found in filariasis have been proved by 



