Page:Transactions of the Royal Society of Tropical Medicine and Hygiene, volume 1.djvu/195

Rh the appearance of a typical case of elephantiasis of both legs, and in a tropical country would have been accepted as a case of filarial elephantiasis, and the fact that no filaria were found in the blood would have been cited as a proof that it was caused by F. bancrofti, and that the obstruction had shut off the embryos from the blood-stream. But this case occurred in a country where the possibility of filarial infection was definitely excluded, and the obstruction was found to be due to a fibrosis of the lower part of the thoracic duct. The following extracts from the post-mortem will be of interest—

"The lower extremities and abdominal wall below the umbilicus were the seat of brawny oedema. . . . The receptaculum chyli and the origin of the thoracic duct were involved in an extensive pre-vertebral fibrosis, whilst from the first lumbar vertebra that duct was dilated to the size of a quill pen, until its entrance into the subclavian vein. The inferior vena cava and aorta did not appear to be constricted by the fibrosis, nor did the larger vessels in the groins. The fibrosis in the neighbourhood of the receptaculum chyli contained some lymph glands, with well-marked, dilated varicose spaces lined with endothelium, and evidently lymph channels, similar channels appearing in the fibrous and adipose tissue round the glands. The enlarged, soft inguinal glands showed similar dilatation of the channels, together with some thickening of the fibious trabeculse. ..

"The morbid appearances may be summarised as follows : Chronic peritonitis, with especially prominent perihepatitis, perisplenitis, and pre-vertebral fibrosis surrounding the lymphatics about the level of the receptaculum chyli. Anatomically the condition is explainable on the view that the fibrosis had interfered with the lymphatic course at about the level of the receptaculum chyli. Below this a varicose condition of all the lymphatics and an cedematous and hyperplastic condition of the parts drained by the affected vessels, but not of the mesenteric lymphatics or lacteals."

This case is interesting as illustrating several points : first, the situation of the obstruction in a case of double elephantiasis; second, that in this situation the oedema and hyperplasia involved the abdominal wall; and, thirdly, that a condition indistinguishable from Tropical Elephantiasis can be produced without recurring attacks of lymphangitis.

3. We now come to the third suggestion, which is that elephantiasis is due to the adult female aborting, from