some other part of the implicated lymphatic area, by chyluria, or by elephantiasis in one or both legs.
I have suggested that these tumours might be treated by establishing an anastomosis between one of the dilated lymphatic vessels and a neighbouring vein. Sir Rickman Godlee has twice performed such an operation for me with partial success: it is somewhat difficult, owing to the fragile nature of the dilated lymphatic vessels, and the shortness of their course.
It is said (Azema) that these glands tend to diminish in size after the age of 40. I cannot confirm this statement from personal observation.
Similar varicose dilatation of the axillary glands is sometimes, though much more rarely, found. Bancroft designated these varicose axillary and groin glands "helminthoma elastica."
Cutaneous and deeper lymphatic varices.— Occasionally cutaneous lymphatic varices are seen on the surface of the abdomen, on the legs, arms, and probably elsewhere. Sometimes they are permanent; sometimes, when more deeply situated, they constitute little swellings which come and go in a few hours. I believe these latter often depend on the actual presence of parent filariæ in the tumour. Such varices are evidence of lymphatic obstruction. Filarial lymphangiectasis of the spermatic cord is not uncommon. The contents may be milky and chylous, or straw-coloured and lymphous, according to situation and connections.
Thickened lymphatic trunks.— Maitland has frequently seen in Madras cases of lymphangitis in which, after the initial swelling and inflammation had subsided, a line of thickening remained. On excising this thickened tissue and carefully dissecting it, he has found minute cyst-like dilatations of the lymphatic involved, and in these cysts, coiled up, adult nlarise, sometimes dead, sometimes a,live. The lymphangitis, he believes, is caused in these cases by the death of the filarise. Daniels has made similar observations in British Guiana. Such a case I saw under the care of Dr. Abercrombie at Charing Cross Hospital in London. On the subsidence of a filarial lymphangitis of the arm a thickening, about the size
