ELEPHANTIASIS 



flaps are now made, practice determining the amount of covering 

 necessary. Place the right testicle under the skin flap on the thigh. 

 Repeat the same with the left testicle and draw the flaps to the 

 median line. A few temporary stitches to keep them in position, 

 whilst a continuous suture run quickly up holds them firmly. 

 Lastly flaps are stitched to the body of the penis. 



After the operation careful dressing, well and equally applied, is 

 of great practical importance. 



Elephantiasis of the Vulva. 



This arises in the same manner as elephantiasis of the scrotum, 

 and may affect the labia majora or the clitoris. It is, however, 

 very rare. The tumour, according to Manson, may weigh 8 to 

 10 pounds, or more. The treatment is removal. 



Elephantiasis of the Breast. 



Elephantiasis of the breast is very rare, but does occur, and the 

 enlarged breast may reach to the pubes or the knee. It may affect 

 one or both breasts. The treatment is removal. 



Elephantiasis of the Arm. 



This is rare, but may arise in the same manner as in the leg. 

 One arm or both arms may be affected. Bahr reports that the 

 natives of Fiji and probably of other South Pacific Islands are, in 

 comparison with natives of other regions, peculiarly liable to this 

 form of elephantiasis. 



Elephantiasis of the Scalp. 



Rarely the whole scalp is enormously thickened, and presents 

 deep furrows. 



Circumscribed Elephantiasis. 



Large pendulous tumours of filarial origin, one to several, may 

 be found. These are commonest in the upper part of the thigh, 

 just below the groin. 



RARER AFFECTIONS. 



Lewis has recorded a case of filariasis in which chyle containing 

 Micro filarice was discharged from both conjunctivae, while Maitland 

 has described cases of acute synovitis of the knee associated with 

 filariasis as being of too frequent occurrence to be looked upon as 

 merely coincidences. 



I02 



