SUPPLEMENT 677 



Treatment consists in rest, raising the affected limb, applications 

 of vinegar and alum or liquor plumbi, in some cases incisions into the 

 swollen part under antiseptic precautions. 



Elephantiasis (Arabum) is usually situated in the lower extremities, 

 in men in the scrotum and penis, in women in the labium pudendi, 

 mons veneris, and the mammae ; more rarely it attacks the upper 

 extremities or, indeed, the head. The disease develops during repeated 

 attacks, which occur at irregular intervals of weeks, months or years, 

 of fever accompanied by symptoms of lymphangitis and erysipelas 

 (elephantoid fever], and especially as the result of different accidental 

 occurrences such as chills, bodily exertions, external irritation. The 

 extremities become shapeless, heavy cylinders, the scrotum occasionally 

 a colossal tumour, the female genitalia and the mammae smaller or 

 larger tumours; the penis often shares in the general thickening, the 

 inguinal glands form large hard prominent masses, and enormous 

 deformity is caused. The cause is more often seen in men than 

 women, rarely in children over 10, never in younger children. 



Treatment of elephantiasis of the extremities consists in raising the 

 affected part, massage, bandaging, vapour baths ; the large elephantoid 

 tumours of the genitalia and mammas can only be treated by operative 

 removal. 



Chyluria (haemato-chyluria), as a rule, begins by a series of attacks 

 and often ceases for weeks or months, the attacks being accompanied 

 by fever, pain in the back and lumbar region, about the kidneys and 

 in the perinaeum. The attacks are separated by intervals of months' 

 or even years' duration, a continuous chyluria being quite rare. The 

 disease may last many years without the constitution being markedly 

 weakened, but in other cases anaemia and debility ensue and result 

 in death from marasmus. In chyluria the urine becomes completely 

 opaque like milk ; but sometimes, from the presence of bloqd, is of a 

 peach-like redness : the sediment contains clotted blood, and micro- 

 scopically one finds fine dust-like fat granules and red cells and 

 leucocytes, and usually, but not always, filaria larvae. Sclerodermia 

 may possibly be caused by Filaria (Bancroft 1 ). 



Treatment consists in administration of ol. santali, methylene blue 

 (0*12 grm. dose several times daily), ichthyol (in pills from o - 5 to 

 1-5 grm. per day), ol. terebinthinae (0*5 to 1*5 gr. per day), thymol 

 (Ziemann 2 had no result from either thymol or methylene blue), 

 together with absolute rest in bed, diminution of all fatty nourish- 

 ment and administration of light purgatives. 



Orchitis is in acute attacks a relatively frequent symptom in 

 the East ; the chylocele is rarely marked ; the fluid usually shows 



Bancroft, Lancet, 1885. " Ziemann, Detitsch. med. Wochenschr,, 1905, xi. 



