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712 absence of the malaria parasite from the blood, the presence there very possibly of microfilariæ, and the powerlessness of quinine to control the fever, suffice for diagnosis. Nevertheless, error in diagnosis is common, particularly when the attacks recur frequently and with a certain degree of regularity, as is usually the case.

Treatment.— The treatment should consist in removing any cause of irritation, in rest, elevation of the affected part, cooling lotions or warm fomentations, mild aperients, opium or morphia to relieve pain, and, if tension is great, pricking or scarifying the swollen area under suitable aseptic conditions. Subsequently the parts, if their position permits, should be elevated and firmly bandaged.

Varicose groin glands (Figs. 115, 116).— Varicose groin glands are frequently associated with lymph scrotum, with chylous dropsy of the tunica vagiualis, or with chyluria. Occasionally all four conditions coexist in the same individual.

Symptoms.— As a rule the patient is not aware of the existence of these varicose glands until they have attained considerable dimensions. Then, a sense of tension, or an attack of lymphangitis, calls attention to the state of the groins, where certain soft swellings are discovered. These swellings may be of insignificant dimensions or they may attain the size of a fist. They may involve both groins, or only one groin; they may affect the inguinal glands alone, or the femoral glands alone, or (and generally) both sets together. To the touch they feel soft, doughy, and obscurely lobulated. The skin, natural in appearance, can be glided over the surface, but the swellings themselves are not movable over the subjacent fascia. Occasionally hard, kernel-like pieces can be felt in their interior, or the entire mass may be more or less indurated. On thrusting a hypodermic needle into the swellings, white or reddish chylous, or clear lymphous fluid can be aspirated, sometimes in great abundance. This fluid coagulates rapidly, and usually contains living microfilariæ or filarial ova.