318 
The Philippine Journal of Science 
1921 
other labium, varying in size, and comparable with the narrow- 
necked form of elephantiasis scroti. Plates 23 and 24 show 
cases of this kind well. The patients lived in the coast belt and 
had masses of filarial groin glands, which can be seen in the 
photograph of one case (Plate 24). 
In this form of the disease, operation is simple and consists 
of amputating the tumor through the neck. The only point 
especially important is to note that the vessels are stretched and 
should be picked up and tied before they retract. 
Charles (9) recommends that a catheter be introduced into 
the bladder before the operation and be retained there, in order 
to prevent the wound being douched with urine during or after 
the operation. Of course, the operation must be conducted 
under strictly antiseptic precautions. Recovery is generally 
rapid and satisfactory. 
ELEPHANTIASIS OP THE LEGS 
Elephantiasis of the legs may effect one or both legs and is, 
as a rule, much more marked below the knee, although the lower 
part of the thigh is often affected at the same time. Very rarely 
the thigh is affected before the leg, and I have seen at least one 
good example of this condition. The pathology and history of 
the growth of the legs are much the same as those of the scro- 
tum. Very frequently the glands of both groins are varicose, 
even though the elephantiasis is confined to one leg. 
The muscles of the part are frequently atrophied from pres- 
sure, constriction, and disuse. They are also said to undergo 
fatty degeneration from a like cause. The vessels are enlarged, 
and their coats are thickened. The bones may be thickened and 
have osteophytic growths; more rarely they are atrophied. 
The skin is very coarse, does not sweat at all readily, and is often 
ulcerated, especially about the ankle, where in a normal case of 
elephantiasis there is a constriction permitting of movement 
of the joint. The leg may attain an enormous size, having been 
found as much as 24 inches (61 centimeters) around the ankle. 
Still it is surprising how active some of these patients remain; 
for example, a patient, a horse keeper whom I used frequently 
to employ, whose leg was not less than 16 inches (40.5 centi- 
meters) in circumference, and who had been in hospital for 
abscess in the leg and for filarial fever. Yet he has walked 
12 miles (19.3 kilometers) after his ponies without any difficulty, 
and that over rough mountain paths. This for a man of 54 
years of age cannot be considered a poor performance. 
