lymphatics, the other by more or less solid œdema. The exact way in which the parasite operates has not been definitely and absolutely ascertained for all types of filarial disease. Apparently, in some instances, a single worm, or a bunch of worms, may plug the thoracic duct, and act as an embolus or originate a thrombus; or the worm may give rise to inflammatory thickening of the walls of this vessel, and so lead to obstruction from the consequent stenosis or thrombosis. In other instances the minor lymphatic trunks and the glands may be similarly occluded. As an effect of either form of occlusion, the lymphatic areas drained by the implicated vessels are cut off from the general circulation, and varicosifcy or œdema, or both, ensue.
Pathology of lymphatic varix.— In consequence of the rich anastomosis existing between the contiguous lymphatic areas, on filarial obstruction occurring in one of them a compensatory lymphatic circulation is sooner or later established. But before this can be properly effected a rise of lymph pressure and a dilatation of the lymphatics in the implicated area must take place. This leads to lymphatic varix of different kinds, degrees, and situations. When the seat of filarial obstruction is the thoracic duct, the chyle poured into that vessel can reach the circulation only by a retrograde movement; consequently, this fluid may be forced to traverse in a retrograde way the abdominal and pelvic lymphatics, the lymphatics of the groin, scrotum, and abdominal wall. As a consequence, these vessels, together with the thoracic duct up to the seat of obstruction, become enormously dilated. In dissections of such cases (Fig. 114) the thoracic duct has been found distended to the size of a finger, the abdominal and pelvic lymphatics forming an enormous varix, perhaps a foot in diameter and many inches in thickness, concealing kidneys, bladder, and spermatic cords. In such cases, when one of the vessels of the varix is pricked or ruptures, the contents are found to be white or pinkish. They are not limpid like ordinary lymph. They are chyle,
