The death of the parent filaria is apt to be lost sight of as a possible cause of abscess in the subjects of filarial infection. Deep-seated pain in the thorax or abdomen, with inflammatory fever followed by hectic, and a diminution in the number of microfilariæ in, or their entire disappearance from, the peripheral blood, should in such circumstances suggest a diagnosis of filarial abscess and indicate exploration and, if feasible, active surgical interference.
Lymphangitis and elephantoid fever. Symptoms.— Lymphangitis is a common occurrence in all forms of filarial disease, particularly in elephantiasis, varicose glands, and lymph scrotum. When occurring in the limbs the characteristic painful, cord-like swelling of the lymphatic trunks and associated glands, and the red congested streak in the super jacent skin, are usually apparent at the commencement of the attack. Very soon, however, the connective tissue and skin of the implicated area become inflamed and tense, and high fever, preceded by severe and prolonged rigor, sets in. The attack may continue for several days, and be accompanied by severe headache, anorexia, often vomiting, and sometimes delirium. After a time the tension of the inflamed integuments may relieve itself by a lymphous discharge from the surface. Usually the attack ends in profuse general diaphoresis. The swelling then subsides gradually though not entirely. Lymphangitis may be confined to groin glands, testis, spermatic cord, or abdominal lymphatics. When it affects an extensive abdominal varix, symptoms of peritonitis are rapidly developed and may prove fatal.
Diagnosis.— This fever, appropriately named by Fayrer " elephantoid fever," occurs habitually at varying intervals of weeks, months, or years, in nearly all forms of elephantoid disease. Its tendency to recur, the severe rigor ushering it in, and the terminal diaphoresis cause it to be mistaken for ague. In Barbados, where there is no malaria, it is habitually called " ague." The implication of the lymphatics, the local pain, the erysipelatoid redness and swelling, the prolonged pyrexial stage, the
