OBSERVATIONS ON HUMAN FILARIASIS IN TRINIDAD, W.I
Authors: G. A. Vincent
Journal: BMJ (1902)

BRITISH I89been raised against the rationale of the operation, practice has proved that it is often successful in relieving the patient from the distressing symptoms which so frequently accompany the disease-that is to say, the periodical attacks of fever and pain.The following brief notes of three cases speak for themselves in regard to this point: CASE i.-Mr. - a Europealn, was attacked in the miiiddle of February, £897, with fever, accomiipanied by pain and swelling of tlle glands in the right groin, the attack lasting three or four days.Sinmilar attacks followed about once every week, and in six weeks he had seven attacks.In consequence of these frequently-recurring seizures he was prevented from attending to hiis businiess, and begged urgently for something to be done to relieve himii.The lylmiphatic glands in the right groin were found to be enlarged, forming a soft, collapsible mass having all the characters of a filarial ymphatic varix.An operation was performed, and the entire mass removed under cloroformii.Since that time, a period of four years, the patient has never lhad any trouble of any kind.CASE II.-A Hindu, aged 24, was admitted into hospital on February sgth, I889, for a tumour in the right femoral region.The disease had been in existence for eiglht years, during which time he had suffered from periodical attacks of fever accompanied by pain and swelling in the femoral region.On examination he was found to have a large lymphatic varix in the right femoral region, and the blood contained large numbers of embryo filariae.The great frequency of the attacks, which sometimes recurred only after five days interval rendered the patient's life miserable as well as useless, and he was ready to submit to any treatment that promised relief.A month after admission to hospital chloroform was administered and the tumour removed.The wound healed satisfactorily, and the patient was discharged from lhospital a month after operation.Two yeprs and a half later he wrote to me as follows: " It is beyond de- scription to write of the benefits of the operation.Before this to draw a bucket of water, to walk a mile and return, to stand for more than fifteen minutes was imiipossible.The beneflt of the operation is such as to make ime undertake an enterprising life."This satisfactory result was maintained for nine years.during which time he was " healthy and active and able to earn his bread."At the expiry of this period of time he was unfortunately attacked with a disease of a similar nature in the left groin, and later on symptoms appeared which pointed to the site of lymphatic obstruction being seated high up in the intra-abdominal vessels.Putting aside this fresh attack of disease, there can be no question as to the benefit derived from operation in this case.Nine years of health and comfort were added to the patient's life, and during the whole of that time he was Able to earn a livelihood.CASE iII.-AEuropean, aged I6, was admitted into hospital on August CtM, I894.The patient stated that he had noticed swellings in his groins for amonth previous to the date of admission, and had suffered from attacks of fever.On examination a large ympliatic varix was found in the right groin, and a smaller one in the left groin.The blood was examined,'and found to contain filariae.In addition to the inconvenience caused by the attacks of fever, the patient was suffering considerable imental anxiety owing to his knowledge of the nature of the disease, and he begged to have the s wellings renioved and the worms taken away if possible.Accordingly, a few days later chloroform was administered, and the varix in the riglht groin removed.On dissection of the tumour after removal it wasifound to contain one male and two female filariae.Healing of the wound was somewhat delayed by suppucation, but the patient was discharged quite well a month after the operation.Since the patient left hospital he has kept good health.The small varix in the left groin has not increased in size nor given rise to any trouble.During the month that the patient remained in hospital after operation no filariae could be found in the blood.Since that time there has been no opportunity of examining his blood.