NOTE ON THE PATHOLOGY OF TROPICAL 
< SWELLINGS ' 
By J. W. W. STEPHENS, M.D., Cantab., D.P.H. 
WALTER MYERS LECTURER IN TROPICAL MEDICINE, UNIVERSITY OF LIVERPOOL 
THE patient, the subject of this note, was seen by me in the autumn of 
1903, in the tropical department of the Johnston Laboratory, Liverpool 
University. He was a patient sent by Dr. Fletcher, Degama, Southern 
Nigeria. In his letter, dated, June 1903, Dr. Fletcher says, 'He has for some 
months been suffering from cellulitis, or at least peculiar swellings in his hands, arms, 
feet, and face, i.e., either one or the other ; sometimes only one of these is affected 
at the same time, sometimes two. I know Calabar swellings, but it is not like that ; 
I made several attempts to find a filaria but failed.' The patient informed me that 
he had first noticed the swellings in March, 1903. The swellings he described as 
thickenings, hard in character and not pitting. They occurred mainly on the hands, 
also once below the eyelid. They had occurred on the leg, and then covered an 
extensive area above and below the left knee, and according to his statement only 
one swelling occurred at one time at one place. 
When the patient was seen by me, in answer to my question, he stated that at 
that time he had no swellings on any part of his body, but when his attention was 
called to a slight swelling on the ulnar side of his wrist (left) about as broad as a 
crown piece, he stated that the swelling was of the same nature as the others he had 
suffered from. The swelling was not well marked, it was but slightly raised, some- 
what elastic in consistency, and certainly was not hard, nor was there any redness or 
oedema. A careful inspection of his body revealed nothing further. His temperature 
was not raised. 
A blood examination was made tor parasites with ordinary and thick films. The 
result was negative. In examining for parasites, however, it was observed that there 
was a distinct eosinophilia. Careful counts were then made ot a number of slides, 
with the following results : — 
Leucocytic count (600 counted) — 
Large mononuclear _____ r 
Small mononuclear - - - - 23 
Polynuclear - - - - - - -26 
Eosinophil - - 50 
