ELECTRIC CURRENT INJURIES — see under Lightning Injuries. ELEPHANTIASIS.
This has been incidentally referred to under Chyluria, both conditions being the result of filaria3; the scrotum or legs are the parts usuallyaffected, and it must be remembered that cases of apparently typical elephantiasis may present themselves for treatment in patients who have never been out of Britain. As the disease when uncomplicated does not tend to shorten life, operative measures should not be undertaken till the tumour has become a serious inconvenience from its mechanical pressure or weight. When the leg is alone involved much may be done by keeping the limb elevated at night and wearing a woven rubber bandage all day to keep up firm pressure. The surface of the diseased skin is liable to ulcerate where pendulous folds come into contact with each other, hence the most scrupulous cleanliness must be observed. The practice of mercurial inunctions, biniodide of mercury ointment, blistering, ligature of the femoral artery, etc., has been abandoned, and no known drug has any effect upon the causal filariasis or upon the blocked lymphatics. Castel lani has reported favourably of deep injections of Fibrolysin into the buttock combined with tight bandaging of the limb. In mild cases permanent benefit may be obtained by Handley's operation of lymphan geioplasty, which consists in introducing deeply into the subcutaneous tissue of the affected part several strands of stout silk thread, which are to be left buried in situ after their proximal extremities have been drawn upwards and also buried deep in the normal subcutaneous tissue nearer to the trunk; the lymph is drained by their capillarity, and enters the cir culation above the affected part. As the tissues are often infected
with staphylococci or other organisms, Vaccine therapy must first he resorted to. Where ulceration has destroyed any considerable portion of the integument of the limb amputation of the leg or thigh may be demanded.
Handley's operation may be successfully employed for the relief of the elephantiasis which sometimes follows the removal of glands in the axilla and groin (see under Lymphangitis), and the writer has had very satisfac tory results from its performance by A. 13. Mitchell in a case of similar nature in which blocking of the lymphatics of the orbit following erysipelas caused such permanent oedema of the lids as to totally obstruct vision. The writer had tried Fibrolysin injections in this case without any benefit. When the elephantiasis involves the scrotum or labium, and the tumour grows to enormous proportions, it should be removed by careful dissection of the hypertrophied mass from the surrounding healthy tissues by a bloodless operation, after elevation and the application of elastic ligatures to the base of the growth.
Elliott recently has reported a case of Elephantiasis Nostras of the arm following vaccination treated by Massage and intramuscular injections of Antistreptococcus Serum.
Elephantiasis Grecorum is of true leprous origin, and must be treated as leprosy.
Elephantiasis Neuromatosa of Virchow caused by overgrowth of nerve tissue, which finally involves the skin and subcutaneous tissue, can only be treated palliatively by elevation and bandaging or by the radical operation of amputation.