302 
The Philippine Journal of Science 
1921 
the hospital at once. He did not seem to be acutely ill. The 
fluid coagulated on standing, but not completely. 
It is remarkable that this, form of the disease is not more 
frequent. It is possible that small leakages take place more 
frequently than is known and that the peritoneum is able to 
dispose of such leakages without their actually causing ascites. 
CHYLOUS DROPSY OF THE TUNICA VAGINALIS 
Chylous dropsy of the tunica vaginalis is by no means as rare 
as chylous dropsy of the peritoneum. Presenting the characters 
of an ordinary hydrocele, with the one exception of translucency, 
it is very often undiscovered until tapped, when milky fluid 
flows through the cannula. This milky fluid generally contains 
many filarise, quite out of proportion to what one might expect. 
Parent worms have never been found in one of these lympho- 
celes, which rarely attain great size. The fluid drawn off from 
one of these swellings does not always coagulate. 
Lymphocele is usually associated with some other manifesta- 
tion of filarial disease, such as lymph scrotum, varicose groin 
glands, or elephantoid fever. 
It should be treated as an ordinary hydrocele. If not large, 
it may be let alone or treated by excision of the sac. This is a 
much safer way than injection. Certainly, if a case of this 
kind were to go wrong after injection, it would be much more 
serious than in the case of an ordinary hydrocele, owing to the 
varicosity of the lymphatics. This, raises the whole subject of 
the relation of ordinary hydrocele to filarial disease. Man- 
son, (34) years ago, suggested that the great frequency of hydro- 
cele in tropical countries might be due to the presence of filarial 
disease, and James (16) advances the same view and gives a few 
points bearing on the subject. The matter is not yet cleared up, 
and from what I have observed I doubt that filarial infection is 
the cause of more than a small percentage of cases. Out of the 
last series of Charles’s (7) elephantiasis operation cases, eighty 
in number, fifty-nine suffered from hydrocele. Of my own 
operation cases, every one suffered from hydrocele, small or 
large, so that I may justly say that in elephantiasis cases hydro- 
cele is the rule and not the exception. Of course, it may be 
alleged that this is a secondary matter, and primarily not due 
to the filarial disease, but to the elephantoid change in the tissues. 
Excluding these cases, certainly not above 10 per cent of the 
hydroceles in the coast belt with which I have had to deal by 
tapping or other operation have been the subjects of filarial 
