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ELEPHA NT I A SIS 1 6i 3 



After some years the attacks of fever may cease altogether, though 

 the condition of the leg usually remains unchanged. In some 

 rare cases elephantiasis may develop without the patient ever having 

 an attack of fever. 



Treatment. — radical method of treatment has yet to be found. 

 Of the various palliative ones the most satisfactory is perhaps that 

 introduced by Castellani, which consists in keeping the patient at 

 complete rest in bed, with thiosinamin or fibrolysin injections and 

 methodical bandaging. The details of the treatment are as follows : 

 The patient is kept in bed and an injection of 2 to 4 c.c. of fibrolysin 

 Merk (which consists of thiosinamin and salicylic acid dissolved 



Fig. 720. — Elephantiasis of the Leg: Before Treatment. 



in water) is given daily for three to six months, the injections being 

 interrupted for a few days from time to time. The injections may 

 be made in the affected parts, or deeply into the gluteal region, 

 where they cause much less pain. After each injection the whole 

 limb is tightly bandaged with flannel bandages, which are kept in 

 place day and night. In some cases rubber bandages may be used 

 with great advantage, especially in cases of verrucose elephantiasis, 

 because they render the skin much smoother. Unfortunately, 

 many patients cannot stand rubber bandaging. To increase the 

 pressure on the hardest parts pads of inelastic material may be 

 applied before bandaging, and for this purpose small cylindrical 



