ELEPHANTIASIS ARABUM. 377 



on a larger scale. As regards its etiology, I will only remark 

 at present, that we have many reasons for believing it to be a 

 chronic inflammation. Oar description of eczema omhrum on a 

 former page, was broken off abruptly at the point where it passed 

 into chronic inflammatory thickening of the cutis. We reserved 

 this for our chapter on Elephantiasis, because no anatomical 

 difference of any moment can be shown to exist between these 

 two forms of cutaneous hypertrophy. Moreover in those coun- 

 tries where elephantiasis is endemic (the tropical and subtropical 

 regions of the globe), it is a well-known fact that the disorder 

 usually begins with phenomena having all the characters of 

 erysipelas (see § 288). During this inflammatory stage the 

 lymphatic glands, which receive their lymph immediately frcm 

 the inflamed part, become swollen ; in erysipelas of the leg, the 

 inguinal glands, in that of the arm the axillary, in that of the 

 face the cervical glands. The swollen glands do not subside. 

 The lymph-paths tlu'ough them remain permanently blocked. 

 There ensues a stasis of the lymph ; the outflow of the super- 

 fluous nutrient fluid is checked, and this must be regarded as 

 the immediate cause of the hypertrophy. 



§ 320. We will begin by giving a general sketch of the 

 histology of elephantiasis, derived from recent investigations. 

 Teichmann asserts that the above-described dilatation of the 

 lymphatics may be traced to their origin in the j^apillse of the 

 skin. Vircliow adds that an irritative condition of the corpus- 

 cular elements of the connective tissue may be shown to exist from 

 the very first, in parts affected with elephantiasis ; proliferation 

 of nuclei and fissiparous multiplication of cells being found 

 particularly in the radicles of the lymphatics. The smallest 

 lymph-paths are richly lined with an epithelial stratum of un- 

 usual thickness. This would point to a direct connexion between 

 the morbid growth and its chief causal element, the dilatation of 

 the lymphatics. 



I regret that I cannot speak of the first beginnings of 

 elephantiasis from personal observation. I have only had the 

 opportunity of subjecting its later stages to an adequate histo- 

 logical analysis. Here too, the blood-vessels and lymphatics 

 play a prominent part ; but what chiefly arrests attention is the 

 increased bulk and simultaneous condensation of the existing 

 bundles of connective tissue. How, we may inquire, is this 



