19, 3 , 
Maxwell: Filariasis in China 
305 
The rarity of elephantiasis of the upper parts, of the body is 
explained by the rare lodgment of the parasite in these regions 
and by the free anastomosis of the lymphatics in these parts. 
We come now to a discussion of erysipelatoid inflammation, 
which plays a large part in the formation of a fully developed 
case of elephantiasis of the leg. There are two views generally 
held. Many hold that the essential cause is a low form of strep- 
tococcic infection superadded on a limb that is already the subject 
of lymph stasis. Those who hold this view are unwilling to 
concede that the filaria plays any active role at all, and some 
deny even the passive role referred to above. (37) 
Others, including myself, are convinced that elephantiasis of 
the leg is infinitely more common in filaria-infected regions 
than in those free from the infection, and are not convinced 
that the filaria plays a merely passive role in the production of 
lymph stasis and the subsequent elephantoid development, hold- 
ing that the results of bacteriological examination of the tissues 
are not conclusive and that the inflammatory attacks may be 
due to a poison generated in the body itself. Why, for instance, 
should a case of lymphatic stasis due to sloughing of the glands 
in a case of plague be practically free from the constant inflam- 
matory attacks common in a filarial case, and why should a 
lymphatic fistula ward off these inflammatory attacks in a fila- 
rial case without preventing the slow increase in the size of the 
parts below the fistula? More investigation is badly needed in 
these cases, both of the exact nature of the obstruction and of 
the nature of these erysipelatoid attacks, before the question can 
be deemed to be satisfactorily settled. 
ELEPHANTIASIS SCROTI 
Elephantiasis scroti generally begins with attacks of ele- 
phantoid fever combined with erysipelatous inflammation of the 
scrotum. The part becomes swollen and oedematous, and hydro- 
cele not infrequently makes its appearance. The acute attack 
subsides, but leaves behind a legacy in the shape of some per- 
manent thickening and enlargement. This process recurs and 
is varied perhaps by the occurrence of suppuration in the 
scrotum. In whatever way started, the thickening tends pro- 
gressively to increase, and occasionally there are only a few 
attacks of fever throughout the whole disease. 
The disease is not uncommon in the coast belt, but as a rule 
the tumors are not of large size; and so little trouble do the 
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