The disease is always local and has no tendency to become generalized. Microscopical examination gives different results. In elephantiasis dura the tissue consists in dense thick bundles of fascia. The elements are spindle-cells with large oval nuclei. In Schliz's preparations there aro further white blood corpuscles and lymph corpuscles in large amount and regularly disseminated. These are also found in considerable numbers in the papillary layers of the cutis, arranged in circles. It is clear that these last cells are lymph cells, and that the density of the tissue depends on their number and their size. It is from these cells, further, that the milky exudate comes. As characteristic of the acute form of the disease the distension of the lymph-vessels has long been noted and described. But there is divergence of opinion in regard to the nature of the disten sion. Duchassaing claims that the disease is due to repeated attacks of erysipelas, and that there is stasis of the lymph and resultant peripheral varicosities. As a result of the inflammatory process the afferent lymph vessels are obliterated. The lymph stasis and consecutive hypertrophy of the tissue occur in layers, because, customarily, the adjoining lymph glands swell and oppose further progress; thus in disease of the lower limb the glands at the knee are affected, and in disease of the labia the inguinal glands, constituting indolent buboes. That lymph stasis may lead to elephantiasis many examples prove. Wernher, who does not en tirely admit this, describes a case where evidently elephantiasis was caused by obliteration of the lymph-glands. A strong and otherwise healthy maiden acquired, as the result of syphilitic infection, a distension of the lymph-glands, so that those of the right suppurated and were destroyed. The syphilis and the symptoms from the buboes were cured. Three months later she was seen with marked elephantiasis of the right labium, which was of the size of a child's head. Wernher hence concludes that although exceptionally elephantiasis may exist as the result of lymph stasis, this is not usually the case, for there is not only no narrowing of the lymph-vessels through swelling of the endothelium, but, on the con trary, a great widening of .those vessels so that any one can readily inject them. Wernher is certainly correct in the assertion that from one or two examinations we cannot vouch for lymph stasis because there is dis tension of some radicles, seeing that there is also present obliteration of many if not the majority of the efferent radicles.
In particular are the lymphatics altered in separate papillae. While, according to Teichmann, the extremities of the lymphatics never nor mally reach the very end of the papilla, in a case of amputation of the foot on account of elephantiasis the injection could be made much more completely. All the papillae, apparently unchanged in gross appearance, were really enlarged, and this enlargement included the lymphatics in all their dimensions. The extremities of the lymph-vessels were in particular widened, while the main branch which extended to the knee was normal. A similar description has been given by Herdy, and Schliz's microscopi cal examination leads to the same results.
The lymph-vessels of the superficies of the section are in part ectasic; those of the deeper layers and partly of the superficial are narrowed by swelling of the endothelium. According to Schliz the deeper portions
of the skin are first invaded by the disease, and there the obliteration is, at the outset, to be found. He claims that the cause of elephantiasis and its pathogeny depend on stasis in the extremities of the lymphatic vessels, and Wernher has recorded two instances which speak in favor of this view, although he does not grant its general truth. It is, however, al lowable to think that the affection may depend on a spontaneous swelling and widening of the lymph-vessels, and that this leads to great ectases.
From the diseased skin there flows on section an amount of lymph, indeed there exists occasionally a lymphorrhea from openings admitting only a hair. The papillae are exceptionally altered. They are usually of irregular shape and of variable size. According to Rindfleisch they are, in general, hypertrophied, but this hypertrophy is seen only in the later stages of the disease. On the surface of the papilbe there are not rarely elevated excrescences, which, when they are marked, resemble condylo mats. Instances of the kind have been described by Henle, and on the labia by Virchow, Desruelles, Krieger, and Dietz.
The cutis is greatly thickened, as well as the horny layer of the epithe lium. The hair follicles on the legs largely disappear, although those which remain are normal in structure. The cellular tissue is greatly thickened from the increase in the interstitial tissue, so that the fat has disappeared. The blood-vessels of every calibre are distended, but their walls are normal. (Schliz.) Elephantiasis occurs in the tropics and in the sub-tropical zones very frequently. It is rare with us. In certain of the lesser Antilles, Barba does for instance, every tenth individual is affected. In these countries, the West Indies in particular, elephantiasis begins with fever and its ac companiments, and further with erysipelatous swelling of the affected skin (usually of the lower limb). The fever only lasts a short time, thirty six to forty-eight hours, and on its disappearance there remain edema and swelling of the affected parts of the skin. In the leg, along the crural artery, there exists a hard, sensitive cord-like swelling, which may be followed to the neighboring lymphatic glands, and is a characteristic sign of elephantiasis arabum, at least of the acute type. In our climate the disease never develops so acutely. • In the further progress of the acute form there are recurrent attacks of erysipelas, and a constant increase in the swelling. .
On all the affected parts, especially the genitals, there appear ulcera tions the result of rubbing, uncleanliness, and stagnation of the dis charge. These rarely extend deeply, at least on the legs, although in case of the vulva Louis Mayer has reported an instance of deep ulceration which suggested carcinoma. These uNerations resist all treatment. They may alter into fungous tumors or rodent ulcer. The secretion consists in a lymph-like fluid which through stagnation may become fetid. These ulcers are often of the size of a fifty-cent piece, rarely larger. As the result of the swelling and tension of the affected tissue a superficial gangrene may supervene. Finally, as the result of fatty de generation, elephantiasis may change into sarcoma or into cancroid.