294 The Philippine Journal of Science 1921 
of her attack. Since that time she has had a distinct attack of 
chyluria, but not a severe one. 
As to treatment, I agree with those who have had experience 
of the subject that it is advisable to let these glands alone unless 
they are causing a large amount of trouble ; in troublesome cases, 
the glands may be safely removed. 
Septic lymphangitis used to be greatly feared in these opera- 
tions, and of course, unless care be taken, the operation is a 
dangerous one. No one who has not performed these operations 
can have any conception of the mass of dilated lymphatics, and 
these run when wounded and obscure the field of operation. As 
all the superficial veins and' arteries are embedded in the mass, 
care must be taken, especially at the saphenous opening. The 
external saphenous vein is often a large one, and if cut just 
at the opening, it may be difficult to secure. As far as possible, 
the dilated lymphatics entering the mass should be ligatured, as 
this greatly diminishes the lymphorrhagia. The best material 
to employ for this purpose is fine catgut. 
It must always be remembered that removal of these glands 
may precipitate an attack of chyluria or elephantiasis of the 
leg. An appearance of the beginning of elephantiasis of the 
leg, however, must not be taken as a certain sign that this trouble 
is going to supervene. In one patient I was much distressed to 
find that, a fortnight after the operation, the leg presented every 
appearance of commencing elephantiasis. It was swollen, and 
with a solid oedema affecting the skin in parts. Six months later 
the leg was perfectly normal, and it was clear that the condition 
was only temporary, due to the collateral circulation not having 
become fully established. 
That the operation is very satisfactory in some cases is proved 
by the fact that the patient mentioned above came back in order 
to have a second operation on the opposite groin. 
Rarely these varicose glands are met with in other exposed 
situations. One case of varicose axillary glands has been seen. 
In this case the mass was not very large. 
In some cases the mass of glands forms the dwelling place 
of the parent worm. 
If the glands are not removed, the daily painting of the skin 
over them with linimentum iodi seems to exert a beneficial 
effect. How it does this is not clear, but it certainly in many 
instances relieves the aching and dragging pain of which the 
patients frequently complain. 
