PALLIATIVE TREATMENT OP ELEPHANTIASIS. 315 



The woman was kept in bed for ten days, and the parts bandaged with flannel 

 bandages; after this treatment the skin became softer, but the dimensions of the 

 limb remained practically unchanged. I then began giving thiosinamin injections. 

 After having received thirty-five injections, she left the clinic at her own request, 

 wishing to visit her family in a distant village. She was better at the time of 

 leaving, the dimensions of the foot and leg having greatly decreased. When the 

 patient was admitted to the clinic she could not move her toes; on leaving, such 

 movements could easily be made. 



Case 5. — Bennet Gregory, Singhalese boy, aged 10 years; admitted to the 

 clinic on June 25, 1907. Three years ago the patient began suffering from attacks 

 of fever with contemporary swelling of the left leg and of the lymphatic inguinal 

 glands of the left side. On admission, the left leg and foot were greatly enlarged, 

 the skin being thick and hard, but with a smooth surface. The lymphatic inguinal 

 glands of the left side were slightly enlarged and hard. The maximum circum- 

 ference of the calf was 144 inches. 



Treatment was begun on June 28, 1907. He received twenty-five injections and 

 the limb was regularly tightly bandaged with flannel and for one hour every other 

 day with rubber bandages. On July 23 the injections were discontinued; they 

 were resumed on the 29th of the same month. During the interval only massage 

 and the use of India-rubber and flannel bandages were continued. After the. first 

 twelve injections a distinct improvement was noticeable, the parts having become 

 softer and the size of the limb decreased. On July 15 and 16, however, the affected 

 parts again became enlarged and very hard, although there was no fever. This 

 condition lasted for three days, when on the 17th the improvement again began 

 and steadily continued. 



At the time of writing (January, 1908) the improvement is well marked, the 

 maximum circumference of the calf being 7 inches. The skin is much more 

 elastic and can be pinched up in folds almost everywhere. I hope it will soon be 

 possible to perform the same operation as in Case 1- It is to be noted that the 

 patient remained without any treatment during November and December, 1907, 

 as his parents took him back to their bungalow. 



Case 6. — Elephantiasis verrucosa of the right leg. Vejcanda, Singhalese man 

 40 years of age. Admitted to the clinic on September 3, 1907. The disease was 

 of fifteen years' standing; the right leg and foot were enormously enlarged, 

 the maximum circumference of the calf being 28* inches; the skin was thick, 

 inelastic, and covered with numerous, hard, corneous projections; the lymphatic 

 glands of the right side were enlarged and hard; the scrotum was not affected. 

 Numerous eosinophiles (15 per cent), but no Filaria nocturna, were encountered in 

 the blood. 



Treatment was started on the 9th of September, 1907; the patient up to the 

 present time (January, 1908) has received seventy-five thiosinamin injections. He 

 remained without treatment during the month of November. The whole limb 

 has been regularly bandaged, flannel pads, etc., being applied. The case has much 

 improved; the maximum circumference of the calf now being 16 inches and the 

 skin has become much softer. I propose to continue the treatment for one month 

 and then, if the skin has become elastic, the same operation as in Case 1 will be 

 performed. 



CONCLUSIONS. 



1. The treatment I have devised for elephantiasis, namely thiosinamin 

 (fibrolysin) injections and methodical bandaging, followed by removal 

 of portions of the redundant skin when most of the subcutaneous tissue 

 has been absorbed, is of utility in a certain number of suitable cases. 



