peripherally, caused by the introduction of a specific micro-organism, and resulting in the gradual narrowing and obstruction of the peripheral lymph vessels. Radcliffe Crocker points out that in a temperate climate erysipelas, either as a severe or diffuse cellulitis or from repeated attacks, is one of the most common causes of lymphatic obstruction. Sabouraud examined and cultivated the serum in a case of elephantiasis, and invariably found the streptococci of erysipelas, but the cultures in the intervals remained sterile. Phlegmasia dolens is another disease which may occlude the lymphatics and lead to attacks of elephantiasis, and repeated attacks of eczema are responsible for a certain number, though these are seldom extreme instances of the affection. In this form the peripheral lymphatics must be the first to be affected.
And in the Tropics, where all forms of microbic life flourish so luxuriantly, where people go about bare-footed and bare-legged, where abrasions and injuries of exposed parts are of daily occurrence, where there is a frequent lack of cleanliness, surely there is ample opportunity for the entrance of pathogenic organisms and resulting attacks of lymphangitis, thickening of the lymph channels, and eventual obstruction. Would a peripheral lymphangitis of the scrotum not account sufficiently for a localized symmetrical elephantiasis with healthy skin uniting it to the body? And would not the presence of a similar lymphangitis account for the formation of the localized elephantiasis of the arm which I showed you? In many cases they seem to me to be so strictly limited to a given lymphatic area as to preclude the possibility of a proximal obstruction, but to be perfectly explicable on the theory of a peripheral infection by a specific micro-organism gradually spreading up the lymphatics.
I then venture with all humility to suggest that research should take this direction, and that during the attacks of
