296 PHALBN AM) NICHOLS. 



(high. The femoral glands were also swollen and tender. As this 

 patient lived a long distance from the post of Daraga, the further course 

 of the disease could not be observed. 



Thirty-four well marked cases of elephantoid disease were seen. Of 

 this number, nineteen were males and fifteen females. The ages varied 

 from 12 to 80 years, a large proportion being above 50 years of age. 

 The average age at which the disease first made its appearance was 

 somewhat between 30 and 35 years. The parts affected, either alone 

 or in association with other parts, were as follows : Both lower ex- 

 tremities, 13 cases or 36.4 per cent; one lower extremity, 20 cases or 

 5S.S per cent; one upper extremity, 2 cases or 5.8 per cent; scrotum, 

 11 cases or nearly 58 per cent of the males; and groin glands, 3 cases or 

 nearly 8 per cent of the total number. 



The lower extremities. — Xearly every case of elephantoid disease 

 observed had some involvement of either one or both of the lower ex- 

 tremities. The degree of enlargement varied from the most moderate 

 grade up to instances where the calf exceeded 25 inches in circumference. 

 (Plate I, fig. 1.) Usually, the foot and leg were involved, but in a 

 few cases only the foot and ankle, and in others the foot, leg, and thigh. 

 The skin was usually tense and glossy over the enlargement of the leg 

 and thigh, while it was rough and warty around the ankle and over the 

 foot. In one ease large tuberose swellings were situated entirely over 

 the ankle and foot. (Plate I, fig. 1.) Increased pigmentation was 

 usual, the glandular structures were atrophied, the hair thinned and 

 roughened or absent, the nails rough, thick, and brittle. Sensation was 

 diminished. Deep pressure, long continued, produced pitting, but the 

 under tissues were felt to be hard and indurated. The subcutaneous 

 tissues were seen to be increased in volume. At the ankle the skin was 

 thrown into folds, deep fissures intervening, permitting a small' range 

 of motion to the joint. The knee joint, when the thigh was involved, 

 was less affected and in the eases observed, movement was not interfered 

 with. Despite the hypertrophy of these parts, the vitality appeared to 

 be good, ulceration or abscess was not observed in any of these cases. 



The cases of enlargement of the upper extremity were of moderate 

 degree, and presented no features of importance. 



The scrotum. — Somewhat over half of the males affected with ele- 

 phantoid disease had some involvement of the scrotum. Usually, the 

 enlargement was of a moderate degree, the size of a coconut or a little 

 larger. The largest seen hung to the level of the patient's knees, was 30 

 inches in circumference and weighed approximately 30 pounds. No 

 case of lymph scrotum as described by Manson or Scheube was observed, 

 the lesion being invariably an elephantiasis. The skin was rough and 

 coarse and the subjacent, tissues enormously thickened. The penis was 

 always retracted to some degree, and in the extreme cases (Plate I, 



