290 The Philippine Journal of Science 1921 
out to be a lymphatic varix of considerable size situated in the in- 
guinal canal. The lymph vessels were the size of a large quill 
and ran lymph on being wounded. The whole mass was re- 
moved, the vessels being tied as if they were a mass of varicose 
veins, and the patient made a good recovery. 
On two occasions, when operating for elephantiasis of the scro- 
tum, marked dilatation of the lymph vessels about the spermatic 
cord was seen over and above the general lymphatic dilatation 
seen in these cases. 
As a rule, lymphatic varix is best let alone. If giving trou- 
ble, and if it is possible to remove the whole varix, this may be 
done ; but it must be remembered that the varix is partly com- 
plementary, and any interference with it may involve the 
production of another varix elsewhere, or the formation of 
lymphatic fistula in some other part of the varicose area. 
LYMPHATIC FISTULA 
Under the heading of lymphatic fistula there are three varie- 
ties to be described — the spontaneous, the inflammatory, and 
the operative. The first forms spontaneously in an area already 
in a condition of lymphatic varix. 
Spontaneous . — As an example may be adduced the case of a 
man, aged 23, the subject of filariasis. On the outer surface 
of the left thigh, rather toward the front of the limb and about 
its middle, was a small aperture from which lymph slowly 
drained away. A fine probe was passed in about a quarter of 
an inch (0.6 centimeter) inward and upward. There was no 
inflammation about the mouth of the fistula, the history of which 
was that it had formed spontaneously three days previously. 
Its appearance was preceded by a vesicle, and the lymph coming 
from it was transparent and free from blood. 
This form is rarely seen, and the mouth of the fistula remains 
free from redness or swelling, unless secondary infection takes 
place. Unfortunately with native patients, who love to meddle 
with any aperture or wound, this almost always occurs, and 
then it becomes a septic sinus. Unless it is giving much trouble, 
it is best let alone, as its presence probably saves the patient 
from many attacks of elephantoid fever. In one case I cau- 
terized and got the fistula to heal, but immediately the attacks 
of elephantoid fever, which had intermitted while the fistula 
was open, recurred. 
Another patient presented a small, uninflamed aperture on the 
front of a small lymph scrotum. At times lymph would spout 
