Page:Transactions of the Royal Society of Tropical Medicine and Hygiene, volume 1.djvu/205

 was exceedingly rare at home ; one might see two or three cases in a lifetime ; but if one went to a place where F. nocturna was common, probably twenty or thirty cases would be seen in a day. The author had said that it was diflScult to understand how a single live worm could produce such complete obstruction as to lead to stasis of the lymph stream. Why only one worm ? As a matter of fact, in those cases which had been dissected masses of worms, not lying in the long axis of the lymphatic, but inextricably coiled up together, had been found. Given, however, stenosis of a lymphatic, it did not follow thaft elephantiasis, or even swelling of a limb, would follow. Inflammatory conditions must be superadded, and he agreed with the author when he stated that those inflammatory conditions might be produced by a streptococcus. It was known that a streptococcus played an important part in the production of the inflammation. The first step was lymphangitis attacks, like erysipelas, which, unlike that condition, were not infectious, but which in other respects were exactly like a streptococcus infection. The cases most difficult of explanation were those in which there was a localised blocking of one limb, say, a hand, or a wrist, or a foot, or an ankle, or, as the author stated, the scrotum, in which both sets of inguinal lymphatics must be blocked. It was impossible to get absolute proof of the mechanism without more post-mortem examinations ; but he thought most medical men were agreed that filaria was a cause of these conditions. Embryos of filaria were always found in varicose glands and in tropical chyluria, and the association was evident. Admitting certain points which had been made, he did not think the author had brought forward anything that was conclusive or definite. Dr. Prout criticised all our present ideas, but presented no alternative explanation except that of the streptococcus, and everyone agreed that the streptococcus played a part in the production of elephantiasis.