304 Proceedings of Royal Society of Edinburgh . [sess. 
hypertrophy of the integument and areolar tissue, chiefly of the 
extremities and genital organs ; occasionally by swelling of the 
lymphatic glands, enlargement and dilatation of the lymphatics, 
and in some cases by the co-existence of chyluria, and the presence 
in the blood of certain nematoid haematozoa ; together with various 
symptoms indicative of a morbid or depraved state of nutrition. 
Geographical Distribution . — Although elephantiasis may be 
occasionally seen in all parts of the world, it is endemic in cir- 
cumscribed areas, in tropical and sub-tropical countries ; in these 
areas of distribution it is not uniformly present, but is almost 
always limited to well-defined foci. In India, the disease is 
frequently met with along the littoral of Lower Bengal, in 
Pondicherry, and at a few other points on the Coromandel coast. 
It is especially frequent in the district of Tanjore, but most, of all 
on the Malabar coast (principally in Travancore and Cochin). 
It occurs at Ramghar, Chota-Nagpore, Sirgooja, and in the district of 
Tirhoot. In Ceylon the headquarters of the disease are on the 
coast, especially between Colombo and Matura. In the East Indies 
the places most severely affected are Sumatra, Banka, the Nicobars, 
and Philippines. In Further India it is met with in Penang and 
Cochin-China. In China elephantiasis is principally seen on the 
southern and south-eastern coast districts, especially at Canton, 
Amoy, Shushan, and Shanghai. Some of the worst regions of 
endemic elephantiasis are to be found in the Polynesian Archipelago, 
e.p., the northern part of New Caledonia, the Tonga and Fiji 
groups, the Samoa group, Wallace Island, the Society Islands, 
especially Tahiti, and Raiatea, and the Gambier group. Elephan- 
tiasis is less frequently seen in the Marquesas and Hawaiian islands. 
In equatorial and sub-tropical Africa and the adjoining islands, 
elephantiasis is very common, especially in Reunion, Mauritius, 
Seychelles, Madagascar, Nossi-Be, the Mozambique and Zanzibar 
coasts, the coasts of Senegambia and Liberia, and the Guinea 
coast as far as the equator. Further inland elephantiasis is met 
with in the Cameroons, in Bornu, and Sego ; and a few cases occur 
in Tunis, Algiers, and Egypt, not far from the sea coast, and in 
the swampy valleys of the interior of Abyssinia. Throughout the 
whole of the upper Nile valley and the adjacent districts isolated 
cases only are met with, save in the Bari and Madi districts, where 
