ELEPHANTIASIS ARABUM. 



447 



fore the functional disease becomes apparent. The portion of the 

 body which swells during the inflammation does not return to its nor- 

 mal size after the fever subsides, but remains moderately enlarged,, 

 and assumes a soft, boggy consistence. Soon, usually within a few 

 months, another attack occurs, which runs the same course as the first 

 one, and results in a further enlargement of the affected part. As the 

 attacks are repeated, and as the intervals between them diminish, the 

 deformity and weight of the limb increase, and the doughiness, which 

 is a result of cedematous infiltration, gives place to a board-like hard- 

 ness, due to the formation of dense connective tissue. If, as the in- 

 flammation recurs, the pachydermy spread beyond the point originally 

 attacked, all the different grades of the disease are often exhibited 

 simultaneously in the same extremity. Excepting during the periods 

 of inflammation, there is no pain in the swollen part. It is often the 

 seat of a superficial (eczematous) inflammation of the skin, accompanied 

 by a liquid exudation beneath the epidermis and upon the free surface. 

 The mobility of the afflicted member is, of course, seriously impaired. 



TREATMENT. A suitable treatment will often afford great relief 

 in cases of pachydermia which have not advanced too far, and may 

 even effect a complete cure. During the initiatory stage of inflam- 

 mation the limb must be elevated, and this posture must be retained 

 for some time after the inflammation has subsided. Cold applications 

 are then to be made. The inunction of mercurial ointment is also 

 urgently recommended in this stage. After the inflammation has sub- 

 sided, we must proceed to methodical compression of the part. Hebra 

 recommends that the limb be enveloped in a cotton bandage previous- 

 ly soaked in water. This is to be applied from the toes upward, so 

 that each turn of the bandage shall almost cover the preceding one. 

 It may be drawn very tightly, as the patient can bear a very firm 

 pressure without inconvenience, and as even a very tight bandage 

 usually becomes loose in a few hours. This simple treatment, if kept 

 up methodically, often produces a most beneficial effect. 



In elephantiasis scroti, in which the scrotum sometimes reaches 

 down as low as the knees, and weighs over a hundred weight, and in 

 elephantiasis of the labia majora, the tumor must be removed by the 

 knife. 



II. ATROPHY OF THE SKIN. 



ATROPHY of the skin may appear as one of the symptoms of a gen- 

 eral marasmus, and not only in the senile marasmus, but also in that 

 premature general atrophy induced by exhausting illness. Upon 

 pinching up the skin of a marantic individual into a fold, or, upon cut- 



