316 CASTELLANI. 



2. I am not yet in position to give any definite explanation on the 

 mode of action of the treatment, which I consider only palliative. 

 Probably thiosinamin acts by softening the fibrous tissue so profuse in 

 elephantiasis, and possibly, the antiseptic properties of thiosinamin, 

 though very slight, may play a certain role. An observation which, if 

 confirmed, may throw some light on the question, is that in the majority 

 of my cases (five out of seven), the thiosinamin injections induced a 

 fairly well-marked, though transient, leucocytosis ; in one case (Case 1) 

 the number of leucocytes rose from 9,000 to 17,500 per cubic millimeter. 



It is to be noted that the thiosinamin treatment without a constant, 

 well-distributed pressure on the affected parts, best obtained by the 

 application of hard pads and by careful bandaging, does not cause any 

 marked improvement. 



Constant pressure on the affected parts by means of bandaging, etc., 

 without thiosinamin injections, has practically no effect in severe chronic 

 cases, although it may be of temporary benefit in recent ones. 



