19,3 Maxwell: Filariasis in China 287 
that die, and that the death of the tissues is due to the inflamma- 
tion set up by the death of the worm. 
Another point worth noting is the little constitutional dis- 
turbance manifest in the patient after the initial sharp attack is 
over. 
It may be urged that the evidence in favor of its being due to 
filarial infection is too slight. There is an important negative 
piece of evidence. I moved from Changpu, in the coast belt, 
to Yungchun, which is farther inland, and pari passu with the 
loss of practically all filariasis cases; gangrene of the scrotum 
became such a rarity that only one case was seen in twelve years, 
and the patient had resided for some time in the coast belt. 
FILARIAL HAEMOPTYSIS 
By filarial haemoptysis is meant haemorrhage from the lungs 
occurring in patients with filarial infection, correlated in time 
with an attack of filarial fever, with or without manifest evi- 
dence of lymphangitis. 
In the case specially studied by me, there was a heavy filarial 
infection, and there was no manifest evidence of lymphangitis. 
It is known that during the day the filarial embryos have their 
habitat in the lungs ; in the case that first directed my attention 
to the subject the haemorrhages took place during the day, and 
live filarial embryos were present in the expectorated blood. 
It may be said that the Chinese are very commonly subject 
to tuberculosis, and in the absence of post-mortems it is impos- 
sible to state that these haemorrhages are not tubercular in ori- 
gin. The only answer I can make is that the case here discussed 
has been under observation from time to time for the last twenty 
years; that the hemorrhages only occurred when he was the 
subject of filarial infection (he became free from infection for 
several years during this time) ; that the sputum was carefully 
examined for tubercle bacilli many times with negative results ; 
that examination of the chest was consistently negative ; and that 
the patient never presented any symptom, save the haemorrhage, 
that v/ould suggest a tubercular infection. 
I have never seen one of these cases die of the haemorrhage. 
It may be of fair quantity, but it stops with the fall of the tem- 
perature and does not recur apart from a definite attack of fila- 
rial fever. 
It is impossible to be dogmatic on the subject, but it is my 
conviction that the above diagnosis is correct, and this opinion 
