288 The Philippine Journal of Science 1921 
is shared by both Dr. H. T. Whitney and Dr. J. H. Montgo- 
mery, of Fukien, who have had a large experience with filarial 
disease. 
DISEASE DUE TO OBSTRUCTIVE INTERFERENCE WITH THE 
LYMPHATIC SYSTEM 
In commencing this section on disease due to obstructive inter- 
ference with the lymphatic system, it must be clearly understood 
that this division is an arbitrary one. While it is true in the 
main that the diseases of the one set are chiefly the result of in- 
flammation, it must be borne in mind that there is at the same 
time, as a rule, lymphatic stasis in the affected part. On the 
other hand, although we speak of disease due to obstructive inter- 
ference with the lymphatic system, it must be remembered that 
in the production of the lymphatic obstruction inflammation 
plays an important part. This point being clearly understood, 
we can turn to the consideration of details. 
There are two main forms of filarial disease to be discussed 
under this section. Roughly speaking, the one is characterized 
by dilatation of the lymphatic, the other by the production of 
more or less solid oedema in addition to this dilatation. One 
of the main proofs that all of these diseases are due to the same 
cause is found in the fact that all grades of disease may be seen, 
from the small lymphatic varix to the most solid forms of 
elephantiasis. 
How do these diseases originate? It cannot be said that it 
is always clear, and each case will be discussed in its proper 
section. The parent worm or worms may act as an embolus in 
one of the larger lymphatics, and may cause an attack of in- 
flammation, or bleeding into the lumen, ending in the stenosis 
or occlusion of the vessel. The ova of the worm, if discharged 
prematurely, are probably able to block the smaller lymphatics, 
and are also able to block the circulation through the lymph 
glands. In either case a portion of the lymphatic system be- 
comes wholly or in part cut off from the general lymphatic cir- 
culation. The pressure in this area rises, and varicosity of the 
lymphatics, or lymphatic oedema, or one of the many combinations 
of these two, results. 
LYMPHATIC VARIX 
The ramifications and anastomoses of the lymphatic system 
are fortunately very free, so that a compensatory circulation is 
not very difficult to establish. But in any case of lymphatic 
obstruction (especially if large trunks, such as the thoracic 
duct, are occluded) it takes a little time for this compensation 
