PALLIATIVE TREATMENT OP ELEPHANTIASIS. 313 



little advantage and occasionally may do harm in those cases of elephan- 

 tiasis which present a smooth skin. 



After this treatment, the affected parts, in successful cases, are of 

 much smaller size, although the enlargement of the bones so frequently 

 found does not decrease. The skin becomes softer, more elastic, and 

 can be pinched up in folds. 



At this stage, when most of the subcutaneous tissue has been absorbed, 

 I suggest the surgical removal of the portions of the redundant skin, 

 when the disease affects the legs. Long elliptical strips of skin and the 

 subcutaneous tissue are removed and the margins of each wound stitched 

 together. This would not be practicable before the medical treatment, as 

 the coaptation of the opposed surfaces of the skin, they being enormously 

 thickened and elastic, would not be feasible. When the wounds have 

 healed, the patient is advised to wear elastic stockings and every night 

 for an hour, an elastic bandage. 



CASES TREATED. 



Case. 1. Elephantiasis verrucosa of the right leg. — Ganegada Singhappu, Sing- 

 halese, 18 years old, admitted to tlie clinic January 2, 1907. The first symptoms 

 of the disease appeared twelve years ago, when he suffered from repeated attacks 

 of fever accompanied by painful temporary swelling of the right leg. Later on 

 the enlargement of the leg became permanent, increasing gradually to such an 

 extent that the patient had to give up his work. He was an indoor servant. 



At the time of admission the whole limb below the knee was greatly enlarged, 

 the skin being thickened, hard, and rough ; on the dorsum of the foot and toes, 

 numerous, horny, hard prominences were present. The limb measured round the 

 ankle, 23-3 inches ; round the calf, 25$ inches ; the inguinal glands were not 

 enlarged, the scrotum and the left leg were not affected. No filarial were found 

 in the blood. 



The patient was first kept in bed for two weeks with the right leg slightly 

 elevated and tightly bandaged with flannel. Massage was given twice daily. 

 At the end of the two weeks the parts were slightly softer, but the dimensions of 

 the leg were practically the same. The thiosinamin treatment was then begun 

 using the precautions already mentioned. 



The patient received altogether sixty-two injections. During the last period of 

 treatment the limb was very tightly bandaged for one hour, three times daily 

 with a rubber bandage. At the end of the course of the injections, the condition 

 of the affected leg was strikingly improved, the circumference of the ankle 

 being reduced to 91 inches, and of the calf to 12 inches. Moreover, the skin 

 had become soft and of almost normal elasticity. 



The patient, finding himself so much improved and able to walk easily, whereas 

 when admitted he could scarcely move without help, asked to be allowed to 

 leave the clinic temporarily to go to his village where he had some business 

 to transact. I told him to use a flannel bandage continuously, and to come to 

 the clinic at the earliest practicable date. He returned two weeks later, con- 

 fessing that he had never used the bandages given him. The lower parts of the leg 

 and the foot were much enlarged (circumference of the ankle 12 inches), cede- 

 matous and soft. After twenty-four hours of complete rest in bed and rubber 

 bandaging, the swelling disappeared, and the measurements of the limb gave 

 the same results as when he had left. 



