380 MORBID ANATOMY OF THE SKIN. 



reader that Hecher has described a case of congenital elephantiasis 

 in which the tissue distinctly exhibited a cavernous structure. 

 This condition of the vessels however, occurs in all fibromata ; and 

 for the conversion of an ordinary fibroma into a cavernous 

 fibroma, a peculiar process of contraction has first to take place 

 along the axes of the vessels (cf. § 129). 



The elephantiastic overgrowth spreads from the cutis into the 

 subcutaneous areolar tissue ; first the fasciae, finally the inter- 

 muscular and periosteal connective tissue, become involved. The 

 more complex organs, such as muscles and nerves, which arc 

 included in the growth, as well as the adipose tissue, undergo 

 atrophy and disappeai'. The periosteal growth leads to enlarge- 

 ment of the bones by the apposition of new layers of osseous 

 substance. Numberless exostoses cover their surface ; affording 

 ample proof of the possibility of true bone being developed, not 

 from the periosteum only, but from the adjacent intermuscular 

 connective tissue as well. On the other hand the papillary body 

 is involved in the hypertrophy. The papillary body is, after all, 

 only the outermost layer of the cutis. The skin in elephantiasis is 

 therefore very often covered with overgrown papillae, and also 

 with thorny projections, which make it look like an ox's tongue. 

 The process, however, is always more widely spread in the deeper 

 layers of the cutis, than in the papillary body ; the implication 

 of the latter being always secondary. 



§ 321. Pachydermia lymphangiectatica, an interesting 

 variety of ordinary elephantiasis, has its seat of election in the 

 scrotum, penis, mens veneris, and the anterior part of the 

 perinasum. The hypertrophied skin is studded with innumerable 

 vesicles, the largest of which is not bigger than a pea ; it is 

 evident at the first glance, that these vesicles are not produced 

 by detachment of the cuticle, as in the bullous exanthem, but 

 that they are really cavities in the uppermost layer of the cutis 

 itself. For their roof is comparatively tough; the clear fluid 

 they contain, can be squeezed out of them, retui'ning in 

 proportion as the pressure remits. On puncturing any one 

 vesicle, true lymph flows from the puncture, often in enormous 

 quantities, while the swollen cutis and all the other vesicles 

 subside contemporaneously. This shows clearly enough that 

 the vesicles are in connection with the lymphatic system ; but 

 the histological investigation of vertical sections through the 



