ELEPHANTIASIS AKABTJM. 379 



examination failed to show any traces of embryonic tissue. If 

 I am called upon to express an opinion as to the mode in which 

 the cutaneous connective tissue increases in amount during the 

 later stages of elephantiasis, I cannot deny the probability that 

 the elongation of the fibrillae is primarily due to the progressive 

 and gradual hardening of the soft material at their ends. This 

 view indeed rests chiefly upon the absence of any other produc- 

 tive process in the hyperplastic cutis ; it affords a very plausible 

 explanation, however, of the naked- eye appearances. 



The fibres at first grow thicker at the expense of the same 

 material to which their elongation is due. This seems at first 

 sight paradoxical. But we must recollect that the soft ends of 

 the fibres are at the same time the cement for the ao^o;lutination 

 of such bundles as run in other directions. AVhy cannot the 

 same material serve for the elongation of some fibres while it 

 contributes to the increase in thickness of others ? The latter 

 increase however has its limits. No sooner does the fibre attain 

 an average diameter of half a millimetre than it separates sharply 

 from the cement round it ; a true interstice is thus produced,, 

 which isolates the fibre completely for a variable part of its 

 extent. These interstices undoubtedly communicate with the 

 lymphatic system, and contain those large quantities of clear, 

 coagulable lymph, which flow from the recently divided 

 surface of the affected skin. They attain their highest de- 

 velopment at the junction of the cutis with the subcu- 

 taneous connective tissue. Here too we find the thickest of 

 the fibrous bundles. Higher up, in the outer portions of the 

 cutis, the fibres are thinner ; no vestige of interfibrillar spaces 

 can be seen, nor any of dilated lymphatics, such as one might 

 expect to find, in accordance with the observations of Virchoio 

 and Teichnann on the early stages of the process. The state of 

 the capillaries is much more striking. The capillary network of 

 the cutis is neither closer nor more abundant than usual ; on the 

 contrar}^, it is obviously nothing more than the old capillary net- 

 work stretched over a greater area ; the individual vessels 

 however are wide and gaping ; their walls are intimately fused 

 with the surrounding connective tissue. The lumina of i\\Q 

 vessels in the dense substance of the cutis, closely resemble the 

 channels excavated in worm-eaten wood. I am inclined to call 

 this the first stage of cavernous metamorphosis, reminding the 



