Page:Tropical Diseases.djvu/774

722 the disease. The foot and ankle only, or the foot and leg, or the foot, leg, and thigh, may, each or all, be involved. The scrotum is also a common situation for elephantiasis. The arms are more rarely attacked; still more rarely the mammæ, vulva, and circumscribed portions of the integuments of the limbs, trunk, neck, or scalp (Fig. 118).

The recurring erysipelatoid attacks.—The disease in any of these situations commences with a rapidly evolved lymphangitis, dermatitis, and cellulitis accompanied by elephantoid fever. On the subsidence of the acute symptoms the skin and subcutaneous fascia of the affected part do not quite resume their original proportions; the inflammatory effusion not being completely absorbed, some permanent thickening remains. Recurrences of this inflammation once or twice a month, or perhaps once in six months, or every twelve months, or even at longer intervals, add a little each time to the bulk of the limb or scrotum. Thus, gradually, an enormous swelling may be built up. Occasionally, though very rarely, enlargement may progress after one, two, or more initial inflammatory attacks, and without further recurrence of these.

Clinical characters of the swelling.—The affected part is greatly increased in bulk. The surface of the skin, in confirmed elephantiasis especially, is rough and coarse; the mouths of the follicles are sometimes unusually distinct; the papillæ and glands are either hypertrophied or atrophied; the hair is coarse and sparse; the nails are rough, thick, and deformed. Around joints the thickened integuments are thrown into folds, the comparatively smooth-sided and deep