19, 3 
Maxwell: Filariasis in China 
273 
is by no means slight, yet there are very important differences 
to be noted. Foremost among these is the practically non- 
contagious nature of this disease. In earlier practice it was 
feared that Chinese students might carry infection from such 
cases to operation cases, but it was soon found that this danger 
was a negligible quantity, as cases may lie alongside newly 
operated cases without any harm occurring. In spite of this, 
however, it is not an advisable thing, as it is quite possible 
for a filarial subject to get ordinary erysipelas, and the distinc- 
tion is not always easy. 
The rash, too, is far more diffused and, as a rule, it has no 
clearly marked, raised border. Argument from the constitu- 
tional symptoms cannot be used, as these vary within wide 
limits. It is not at all uncommon to see several of these af- 
fections of filarial origin present at the same time in one and 
the same patient, thus preventing any definite deductions from 
constitutional symptoms. Generally the diagnosis from ery- 
sipelas is easy because of these concomitant filarial affections ; 
but occasionally a patient will come into the hospital with ery- 
sipelatoid inflammation and cellulitis of one leg, in whom this 
is practically the first serious symptom of the disease, and in 
such a case it is almost impossible to make an absolute diagnosis 
from erysipelas at first sight. 
I have not found it possible to follow the Brazilian (5) phy- 
sicians in dividing erysipelatoid inflammations into several 
classes. The only division that seems to me to be at all useful 
is to distinguish two forms: . 
a. Erysipelatoid inflammation of all degrees of severity from simple 
erythema to an acute type to be described later, and which gen- 
erally terminates in the death of the part. 
b. Ordinary erysipelas in a filarial subject. 
The form in which the joints are simultaneously attacked is 
dealt with in a separate section. 
What is the materies morbi in these cases ? 
In the case of b undoubtedly the poison is Streptococcus ery- 
sipelatis, and the pathology of these cases is perfectly well 
known. 
In the case of a, however, the pathology is not so clear. 
There is, undoubtedly, lymph stasis in the infected area, and 
bacteriological examination of these cases is much needed. Such 
work as has been done is not conclusive. There is evidence to 
show that it is not merely a case of poison introduced from the 
outside. If a lymphatic fistula becomes established in an af- 
181052 — 2 
