MORBID ANATOMY 



Young to be composed of dilated lymphatic tissue. Inflammatory 

 masses adherent to the skin in various parts of the body have been 

 found to contain the adult worm. 



In lymphatic varix or varicose lymphatic glands the obvious 

 lesions may, and generally do, form part of a much larger dilatation 

 of the pelvic and lumbar lymph vessels and glands. The vessels 

 are found enormously dilated with thickened walls, while the 

 glands are riddled with dilated channels. At first the appearance 

 of the gland may not be much altered, and on section it may show 

 the appearance of a sieve riddled with holes, but in more advanced 

 cases all appearance of a lymphatic gland disappears, and it is 

 transformed into a large sac divided by fibrous tissue, septated into 

 numerous compartments. 



In chylous extravasations the thoracic duct may or may not be 

 found impervious, but in any case the lacteals, the lumbar, pelvic, 

 pudendal, and crural lymph vessels will be found enormously 

 dilated, and the lumbar lymph glands converted into septated sacs. 

 The site of the ruptured lymphatics is, however, by no means easy 

 i o find. 



In elephantiasis the lymphatic vessels will be found dilated and 

 thickened, and in early cases a round-celled infiltration may be 

 seen in the connective tissue of the part ; but in later cases this has 

 led to a hypertrophy of the connective tissues of the skin and the 

 fasciae, including those around the muscles, the vessels, and nerves, 

 while all the tissues are sodden with retained lymph. The muscles 

 of the affected regions are found to be in a state of fatty degeneration ; 

 the bones may be thickened and covered with osteophytes, or more 

 rarely atrophied, and still more rarely invaded by caseous abscesses. 



Microscopically the epidermis may be normal, or thickened with 

 atrophied or elongated papillae; the sweat glands and hair follicles 

 may or may not be degenerate. 



In cutting into the tissue of a region affected with elephantiasis 

 ' the skin may be noted to be thickened, and below it there will be 

 found dense fibrous trabeculae, with the spaces filled with yellow, 

 oily, fatty substance, which exudes lymph, while the vessels and 

 nerves will be found much increased in size. 



THE CLINICAL DESCRIPTION. 



General Remarks. — The clinical description of the various 

 lesions will be arranged under the headings Filarial Fever, Filarial 

 Lymphangitis, Orchitis, Lymphangiectasis, Phlebectasis, Varicose 

 Lymphatic Glands, Chylous Effusions, and Elephantiasis of various 

 parts of the body — e.g., scrotum, leg, etc.--- and, finally, a few 

 remarks will be made with regard to rarer lesions. As regards 

 general treatment, salvarsan, neosalvarsan and galyl have been recom- 

 mended and tartar emetic might be tried, but no good results have so 

 far been obtained in our experience. Prevention is to be based on 

 antimosquito measures as described in the chapter on malaria, p. 1202. 



