ELEPHANTIASIS 



the treatment gives much better and more lasting results in old- 

 standing cases, especially in those of the verrucose type, charac- 

 terized by the enormous new formation of fibrous tissue and absence 

 of fever. After treatment the patient should wear puttees or elastic 

 stockings, and the rubber bandage should be applied from time to 

 time. 



Handley has treated cases by first preparing a vaccine from the diplococcus 

 which he found in the blood, and administering this until the blood and 

 lymph become sterile, and then performing his operation of ' lymphangio- 

 plasty,' by silk introduced by means of long 

 probes, which are pushed along the subcu- 

 taneous tissues, through small incisions, 

 until a path is made from the affected region 

 to one with a normal lymph circulation. 

 In the cases so far reported there was 

 marked improvement at first after opera- 

 tion, but this did not last long. Madden 

 and Ferguson report unfavourably on lym- 

 phangioplasty as a treatment for elephan- 

 tiasis of the legs, as they find the temporary 

 improvement not maintained, because the 

 reactive changes in the tissues immediately 

 around the thread eventually obliterate the 

 new vessels. Sistrunk reports favourably on 

 the Kondoleon Operation, the aim of which 

 is to establish by a wide excision of the 

 aponeurosis, a communication between the 

 superficial and deep lymphatic channels. 



Other methods of treatment consist 

 in bandaging, massage, tapping with 

 Southey tubes, and even amputation, 

 but none of these are satisfactory. 



Elephantiasis of the Scrotum. 



The disease may begin as a lymph 

 scrotum, or with recurring erysipela- 

 tous attacks, with a red inflammatory 

 blush on the skin, and fever. After 

 each attack the scrotum is larger than 

 it was before, and it goes on growing, 

 if left alone, until it may reach the 

 weight of 224 pounds, as mentioned 

 by Chevers, which is probably the 

 largest ever described. When well developed it forms a triangular- 

 shaped mass hanging down between the legs, with the base down- 

 wards, and the apex upwards towards the pubes. On its anterior 

 and upper aspect there is an aperture which leads into a canal, 

 formed by the inverted prepuce, at the -bottom of which is the glans 

 penis. The penis itself is buried in the tumour. The testicles 

 are situated at the upper and back part of the tumour, and are usually 

 surrounded by hydroceles. 



If large, the base of the tumour is frequently ulcerated. 



Fig. 722. — Elephantiasis of 

 THE Scrotum. 



