COUKSE AND TERMINATION. 271 



attacks, even in a mild form of lymphangitis, resulting in 

 hypertrophy and indm'ation of the interconnective-tissue of 

 the limb, ultimately terminate in permanent organization of 

 the products which, from the appearance conferred upon the 

 skin, and the truly libroid condition of the cellular connective- 

 tissue, the result of the often-recurring diseased action and 

 steadily progressive change of the exudate, has received the 

 name of ' Elephantiasis,' or ' Elephantiasis fibroma.' These 

 cases of chronic lymphangitis are always the result of several 

 attacks, rarely of one, of the disease ; and very often these 

 are not of the most severe character, but follow closely upon 

 each other : while I have remarked further that such as termi- 

 nate in this chronic induration and hypertrophy of the inter- 

 connective-tissue of the limb, are more frequently attacks 

 upon the absorbents themselves than of the glands, or of the 

 glands and absorbents combined. 



When fairly established this condition is very marked ; the 

 entire bulk of the limb is much augmented, the hair is 

 removed in patches, while the skin is rough and coriaceous- 

 looking, sometimes projecting in ridges or folds, generally dry 

 and scaly, more rarely moist and exhalent. 



In the course of the diseased action which has invaded 

 the subcutaneous tissue, the skin has become involved, for it is 

 also in its fibro-vascular structure, its papillary and connective- 

 tissue layers, become hypertrophied and indurated. Not all 

 cases, even after repeated attacks, terminate in this condition, 

 but only particular instances ; while, even when observing cases 

 of the disease, it is not possible to indicate the ones which shall 

 terminate in this manner. 



Occasionally, as the result of a first or second severe attack, 

 we have the formation chiefly on the inner aspect of the limb 

 of disseminated abscesses. The occurrence of these is some 

 time subsequent to the disappearance of the systemic fever, 

 when the infiltration of the limb not showing signs of lessening, 

 we may, on examination, discover some circumscribed portions 

 of tissue where it is evident, from the increased heat and pain, 

 that inflammatory action is in active progress ; it may never 

 have subsided, or a fresh exacerbation may have been estab- 

 lished. The detached portions of tissue become distended, 

 slightly elevated, gradually soften on the top, and bursting, dis- 



