312 CASTELLANI. 



in addition to its peculiar softening action on various fibrous tissue, 

 possesses also some antiseptic properties. Thiosinamin injections are 

 very painful and I have therefore iised fibrolysin, which is a water 

 soluble combination of thiosinamin with sodium salicylate, prepared by 

 Mendel and manufactured by Merck. Fibrolysin can be obtained in 

 sterile glass ampullae, each containing 2 cubic centimeters of liquid cor- 

 responding to 0.2 gram of thiosinamin. 



I may state at once that the simple injection of thiosinamin without 

 rest, massage, and most important of all, proper systematic pressure is 

 not conducive to improvement. 



TECHNIQUE OF THE TREATMENT. 



The patient is first kept at complete rest in bed for a week, the affected 

 parts bandaged with flannel or India rubber, and massaged regularly 

 twice daily; they do not show much improvement as regards size after 

 these manipulations, but they become somewhat softer. Next I begin 

 injecting thiosinamin. I make the injections in various parts of the 

 affected regions, using ordinary antiseptic precautions. I use an anti- 

 toxin syringe supplied with a strong needle. A sterile pad of gauze is 

 applied at the place of the injection and the whole limb is tightly band- 

 aged with flannel. To increase the pressure, pads of inelastic material, 

 like stiff compressed gauze or boiled cotton wool or wood or iron bars, 

 may be applied on the more prominent or harder parts, before bandaging. 

 In some cases an elastic rubber bandage is applied for one hour two 

 or three times daily over the flannel bandages directly over the skin. 



The injections are almost painless; after two or three hours there 

 may be a little jjain locally, and the following day the part may feel 

 harder than before, but in the successful cases, after two or three days 

 the spot where the injection was made and the parts surrounding it 

 become softer. As regards dosage, I generally inoculate 2 or 3 cubic 

 centimeters of fibrolysin every day or every other day, according to the 

 features of the ease, for about a month, and then discontinue the injec- 

 tions for a week, during which time the use of flannel and India-rubber 

 bandages is continued. The India-rubber bandaging is most useful in 

 cases of elephantiasis verrucosa, because it has no action on the deep 

 lesions of the disease, but renders the skin much smoother, the hard 

 verrucose-like projections disappearing or becoming smaller. The dis- 

 appearance of the hard, corneous formations' is facilitated by applying 

 before bandaging a spirit lotion containing resorcin and salicylic acid, 

 10 grams of each to thirty of rectified spirit. After a week or ten 

 days, a second course of thirty or more injections is given; then again 

 a week's rest with rubber bandaging, followed by another course or 

 several other courses of injections. It is to be noted that while rubber 

 bandages are very useful in elephantiasis verrucosa, they are "of very 



