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Maxwell: Filar iasis in China 
279 
large vessels. It is not an uncommon thing, on opening one of 
these abscesses, to be able to put a finger on or even around the 
main vessel of the limb. It is one proof of the mild form of 
inflammatory process that I have never seen one of these vessels 
give the slightest trouble from secondary haemorrhage, due to 
softening of the vessel wall and subsequent rupture. 
Of these abscesses, those in relation to the femoral artery give 
the most trouble. This is partly on account of their deep con- 
nections and the difficulty of thorough drainage. In some of 
them the lymphatic system seems to be so thoroughly dis- 
organized that they pass directly into the commencement of an 
attack of elephantiasis of the limb. Consequently prognosis of 
the ultimate result of treatment must be guarded. 
The treatment consists in free drainage; owing to the dif- 
ficulty of draining the deeper portions, it is well to make free 
openings under chloroform and insert large rubber tubes. 
Troublesome contracture of the lower limb may occur during 
the healing of large abscesses, especially those involving the 
popliteal space. This can be avoided by splinting the limb and 
using massage as soon as possible. But among Chinese pa- 
tients, who are absolutely intolerant of restraint, and over 
whom we have not the same command as in England, trouble- 
some contracture is by no means unknown. 
Intra-abdominal or intrathoracic abscess . — I have had no 
experience with intrathoracic abscess, but have met with four 
cases of the intra-abdominal form. In each case the illness coin- 
cided with the cessation of attacks of elephantoid fever, and 
each case was desperately ill when admitted to the hospital. 
All had commenced in the way hereafter described as typical. 
In two cases deep fluctuation was present in the left lumbar 
region, and under chloroform a postperitoneal abscess was 
opened that apparently had no connection with any of the large 
abdominal organs. The urine contained the faintest traces of 
albumen in one of these cases, but neither formerly nor at the 
time of operation were there any symptoms pointing to disease 
of the kidney. 
The first patient left the hospital at his own request; he was 
still desperately ill. The abscess was draining well, however, 
and he made an excellent recovery after having been ill for two 
and a half months. 
The second was a similar case. He was operated upon in 
the same place, but made a speedier recovery. 
