he removed from the neck of an East Indian, and which weighed, after removal, 30 lb. I have often seen limited areas of elephantoid thickening of the skin, particularly on the thighs. These conditions are easily dealt with by simple operations.
Chylous dropsy of the tunica vaginalis, and of the peritoneum; chylous diarrhœa.— Chylous dropsy of the tunica vaginalis is not an unusual occurrence in the tropics. A fluctuating swelling of the tunica vaginalis, which does not transmit light, and which is associated possibly with lymph scrotum, with varicose groin glands, with chyluria, or with microfilariæ in the blood, would suggest a diagnosis of this condition. These collections of chylous fluid in the tunica vaginalis generally contain enormous numbers of microfilariæ. Large numbers of cretified adult filariæ have been found in the thickened tunica vaginalis and in the epididymis in this condition.
These chyloceles may be treated as ordinary hydroceles, either by aseptic incision or by injection.
Filarial orchitis with effusion into the tunica vaginalis, according to Maitland, is best treated by incision of the tunica vaginalis, turning out any clot that may be found in the sac, and stuffing the latter with iodoform gauze. This procedure, he says, gives immediate relief.
Chylous dropsy of the peritoneum and chylous diarrhœa of filarial origin are very rare.
Prophylaxis of filarial disease.— The prevention of filarial disease resolves itself into antimosquito measures and protection from mosquito bite. With this in view, unprotected wells, tanks, or stagnant pools must not be permitted in the neighbourhood of dwelling-houses. The influence of these in spreading filarial disease has been ably demonstrated by Daniels in Demerara, and by Low in Barbados. All vessels used for storing water should be emptied at least once a week. The mosquito net is indispensable in filarial as well as in malarial countries.
The subjects of filariasis should be regarded as dangers to themselves and to the community and be compelled to sleep under mosquito nets.
