Case of elephantiasis telangicctodes and molluscum iibrosum in a. small, rather deficient man who showed a number of sessile t111110rS, more or le,s subcutaneously mos-able, over the body and limbs. Patient's mother and father had also suffered from small subcutane ous tumors. There was inequality of the lower extremities, and marked irregular hypertrophy of the left femur, and on the left tibia was a large osteal growth. Larp-e. loose fold, of clephantiasie growth existed on the left thigh. The ease illtr,- trated the hereditary character of the affection: its occurring in one some what imperfectly developed in mind and body indicates the connection between elephantiasis and mollitscum fibrosum and a condition analogons to the fibro• va---eular hypertrophy of the subcutane ous C011110CIIVO ti,sue taking place in the ostoal tis-lie Calwell (Brit. Med. Jour.. Jan. 4, '90).
Diagnosis. — Cases of elephantiasis after reaching their full development are easily recognizable. The enlargement, with difficulty to cause pitting; the ap pearance of warty or keloid-like tunaors; the history of repeated attacks of ery sipelas, deep dermatitis, or a recurrent eczema, should be sufficient to draw at tention to this affection.
Care should be taken not to confound elephantiasis with pendulent tumors, such as overhanging forms of fibroma, 1-vhich may closely resemble the enlarge ment found in the former affection. En largements due to eczema or syphilis will usually present symptoms of both of these conditions sufficient to prevent error if care be taken. Acromegaly and myxcedema present symptoms which will be sufficient, if carefully studied, to make a proper diagnosis of these conditions. Constriction of a limb by means of band ages happens very frequently, and, as en largement may follow, close examination will reveal the reason for this increase. In fact, close attention to every detail should be carefully studied, when the diagnostic differences of the several simi lar affections may easily be detected.
Etiology.—While the affection may be observed in any country, certain regions, owing to their climate, are noted for the prevalence of an endemic type of ele phantiasis, while sporadic types prevail in other countries. It attacks both sexes, although thc male, however, three times more frequently than the female. Age does not seem to influence its appearance, but middle or adult life shows the largest number of cases. Congenital types may be noted.
The influence of heredity has been shown by many recorded cases. Change of climate seems to lessen the tendency of the disease, and cases are benefited in which the affection has proceeded for some time. Unhygienic surroundings—
such as malarious districts or parts bor dering upon the sea—exert a deleterious influence. The fair types of mankind do not show as marked a tendency to the affection as do the darker types.
The mosquito is thought to play an important part in the production of elephantiasis. Encroachments ,of large tumors, as well as pressure of various kinds, upon the veins and lymphatics are also considered as predominating eti ological factors.
Case in which, two years before, the patient had acquired syphilis and suf fered from suppurative buboes in both groins, the left side being the worse; she treated the affection herself. A year later she first noticed an increase in the labium majus of the left side, and this has steadily gone on until it is the size of the fist. In both groins there are scars, that on the left being deeper and more extensive. This case regarded as having an importa.nt bearing on the treatment of bubo. The extensive de struction of the inguinal lymphatic ves sels was the result of neglect of early incision and antiseptic treatment of the suppurative buboes. The elephantiasis described is due to the obliteration of the lymphatics. M. Schreider (Herm. Zeit., B. 2, H. 5, '95).
Case of elephantiasis observed in a little girl 3 years old. Her grandmother had had several attacks of lympliangitis of the legs, followed by elephantiasis. The mother of the child never had either of these diseases or erysipelas. A fall upon the abdomen is thought to have an etiological relationship to the disease of the child. When the baby was born a deformity of the face was found which was due to an abnormal production of a soft, elastic, uniform, and indolent tis sue, which spread from the zygoma to the external commissure of the eyelids and back to the insertion of the ear posteriorly from the mastoid process to the i»ferior border of the thyroid carti lage. A number of these cases observed, and the explanation advanced is that, streptococci having; fomid their way into the fcetal circulation through the pla centa, an inflammatory process was set up in the fcetal tissues, restilting in the overgrowth of tissue. Moneorvo (Pedi atrics, Dec. l, Two eases. one eertainly preceded by syphilis and the other accompanied with symptoms which were in all probability tertiary; in both excellent results were obtained by iodide of potassium, in one after amputation of the enlarged left labium. In the great majority of in stances chronic ulcerative processes of the vulva with elephantine thickening are .of syphilitic origin. Bamberg f. Bd. lxvii, H. 3).