19,3 Maxwell: Filariasis in China 285 
opened and drained. He made a good recovery with a movable 
joint. 
One more case of this kind has come under my care. The 
same joint was affected, and the history was identical. In this 
case the affection followed an operation for fistula in ano. Ke- 
covery followed drainage of the joint, but the movements of 
the joint were far from perfect. 
These cases are the only two, in a hospital practice of twenty 
years’ duration, where infection of a joint has followed an every- 
day operation, and it is curious that both should have occurred 
in the subjects of filarial infection, filariae being easily found 
in the blood. The usual antiseptic precautions were taken in 
both cases. 
In regard to the second kind — that is, cases where the infec- 
tion was part and parcel of the inflammation depending on the 
presence of the parasite — strange to say, in both cases seen 
the joint affected was the wrist joint. The first case was that 
of a man 40 years of age. He had a lymph scrotum, and his 
blood swarmed with filarise. On February 21, 1902, he was 
attacked with erysipelatoid inflammation of the right arm and 
forearm. Three days later his right wrist joint had become 
very painful. He was treated in the usual way, and the inflam- 
mation subsided except around the wrist joint, which remained 
swollen and very tender. On March 6 he was put under chlo- 
roform, and the joint was explored through a palmar incision. 
A little turbid fluid came out, and the ends of the bones enter- 
ing into the joint were rough. The incision was then closed, 
and the part was put up in plaster of Paris. This was kept 
on for a month, and then massage was applied. The patient 
made a perfect recovery, the movements of the joint being normal 
when he was last seen. 
Guided by the last case the treatment of the second patient 
was modified considerably. He was a man of 50, who had 
suffered from lymph scrotum for twenty-five years. He was 
attacked in the same way as the first patient — if anything, more 
severely. There was marked grating in the joint, which was 
intensely painful. After the acute symptoms had subsided, the 
part was put up in a fixed apparatus, and the joint was soon 
well. 
Acute rheumatism is not present in this region, and both 
patients were otherwise free from disease. 
