92 TROPICAL MEDICINE AND HYGIENE 



The established elephantoid condition is far more 

 common in the legs than in any other part of the body. 

 One leg alone may be involved or both legs to an equal 

 or unequal extent. Sometimes the condition is limited to 

 the part below the knee, more commonly there is also 

 thickening of the thigh. Where boots are worn regularly 

 the swelling of the foot may be less than that of the legs. 



Next in frequency is elephantiasis of the external 

 genitalia. In the male both scrotum and penis are usually 

 affected, but cases occur of the penis only, and sometimes 

 of the scrotum only (fig. 42). In the female the labia 

 majora are the parts affected. Elephantiasis of the upper 

 extremities is rarer, but is commoner in the natives of the 

 Pacific Islands than in other places. 



The breast, either one or both, may be elephantoid, and 

 localized patches of skin, usually in the groin, but occa- 

 sionally in other parts of the body, are sometimes found, 

 with or without elephantiasis of the legs. The swelling in 

 the part attacked may be enormous. The scrotal tumour 

 may weigh over 100 lb., and tumours weighing 40 or 

 50 lb. are common. Even the localized groin tumours 

 may weigh from 10 to 20 lb. On section of an elephantoid 

 tumour there is a free discharge of watery fluid, usually 

 clear, and it will be seen that the tumour is formed 

 entirely by the subcutaneous tissues. The muscles are 

 not enlarged, and the intermuscular fibrous tissues appear 

 normal. 



The thickness of the subcutaneous tissue is greatly 

 increased and usually there is abundant fat. The skin is 

 frequently thickened and presents a pitted appearance, as 

 the effusion is between the strands of the subcutaneous 

 fibrous tissue, and these are still effective in binding the 

 skin down. 



Owing to the deep folds formed near a joint, it is 

 difficult to keep the skin clean, and epithelial debris, sweat 

 and dirt collect in these folds, and ulceration and 

 eczema are common. 



The vitality of the skin is not high, ulcers readily form 

 and heal with difficulty ; more rarely gangrene occurs. 



