1944 there were 875 African soldiers admitted to the 37th General Hospital at Accra in the Gold Coast. Of these there were 10 who showed genital oedema in which filariasis was suspected. The oedema affected the penis in all of these patients and the scrotum also in 7 of them. On each an examination was made for microfilariae, by means of a day-and-night blood film to detect blood-borne varieties, and of the taking of a small.skin scraping from the inner aspect of the thigh to detect the

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... c-borne embryos of Onchocerca volvulus. In addition a blood count was done for the detection of eosinophilia. Parasites were demonstrated in 7 of the patients, of whom 5 showed the microfilariae of Loa loa in the blood and one had microfflariae of Acanthocheilonema perstans; in another the existence of onchocerciasis was proved by the skin scraping. Loa loa Of the 5 cases with Loa loa infection, 3 had had attacks of genital oedema during the past 3 years, and all denied-probably falsely-recent sexual intercourse. One was undergoing arsenical treatment for syphilis, but none had active venereal disease at the time of examination. All the patients had swelling of the penis. Two had also gross scrotal oedema, the scrotum reaching the size of a grape-fruit in each case, and in another there was a hydrocele. In all these cases the skin scrapings gave negative results, but in 3 of them an eosinophilia between 15 and 20 pex cent was found. Treatment was by means of a suspensory bandage, and in 4 cases the attack subsided within a week and the men were discharged from hospital. In the case of the fifth patient, who had both penile and scrotal oedema, the surgeons performed an operation, removing the elephantoid skin of the penis and scrotum, transplanting the testicles into the thighs, and restoring the appearapce of the penis by a skin graft. The immediate results of this procedure were very satisfactory. Microfilariae perstans (Acanthoceilonema perstans) The man infected with microfilariae of A. perstans had very well marked oedema of both penis and scrotum and, although the patient denied sexual intercourse during the previous 4 months, there was an associated acute gonococcal urethritis. There was no eosinophilia and nothing abnormal was seen in the skin scraping, but the microfilariae perstans were readily demonstrated in the blood. The patient did not give any history of a previous attack, but, in view of the severity of this, 178 copyright. on 22 July 2018 by guest. Protected by