Page:Transactions of the Royal Society of Tropical Medicine and Hygiene, volume 1.djvu/197

Rh were situated in the deep lymphatic trunks which accompany the lymphatics, they would only obstruct the deep inguinal glands, which are small and unimportant, as there is not a free anastomosis between the superficial and deep lymphatics, and we should still have the superficial lymph circulation going on freely.

Or, looking at an elephantiasis of the scrotum, in what situation does the worm lie so as to block up the superficial inguinal glands which command that lymphatic area? The worm must be in such a position that it will command both right and left sets of lymphatic vessels, for it is necessary to assume the blocking of both sets of inguinal glands. Elephantiasis of the scrotum is almost always symmetrical, and it is important to note that in elephantiasis of the scrotum alone, the blocking must be limited strictly to that area, as is shown by the fact that the skin uniting it to the abdomen is generally healthy. If that skin is involved, we know that the blocking must be above the glands, as described in the first case.

Or, again, take the case of localized elephantiasis of the arm which I have shown. Where can the worm be situated peripherally in the scheme of the lymphatics, so as to produce this localized infiltration and hyperplasia?

It is unnecessary for me to illustrate separately every situation in which elephantiasis occurs, but you will find that the same objection holds good.

I must confess, then, that to me this mechanical difficulty seems to form a great obstacle in the acceptance of this theory as an explanation of the production of elephantiasis.

Then there is another difficulty. In cases where we have multiple elephantiasis, for example the scrotum, one leg, and one arm, we must assume three adult females, all injured and all aborting. It seems to me that here it would be more reasonable either to assume an obstruction of some of the main lymphatics in the abdomen, or else, as