interlying sulci permitting limited movement. There is no distinct line of demarcation between healthy and diseased skin. The implicated integuments are hard, dense, pit but slightly if at all on pressure, and cannot be pinched up or freely glided over the deeper parts.
Its macroscopic anatomy.— On cutting into the swelling, the derma is found to be dense, fibrous, and enormously hypertrophied. The subjacent connective tissue is increased in bulk, having, especially in the case of the scrotum, a yellowish, blubbery appearance from lymphous infiltration. A large quantity of fluid wells out on division of such tissues. The muscles, nerves, and bones are not necessarily diseased, although in rare instances they may be degenerated and slightly or considerably atrophied from pressure. The blood-vessels are large; the lymphatics dilated; the associated lymphatic glands, both of the same side and, very often, of the opposite side, enlarged and dense.
True elephantiasis permanent.— Though in recent cases the bulk of -the limbs may be much reduced temporarily by treatment, the disease is never permanently recovered from. Simple lymphatic œdema in areas which have never become inflamed subsides readily enough on pressure or elevation.
Elephantiasis of the leg (Fig. 119). Elephantiasis of the lower extremities is usually, though by no means always, confined to below the knee. The, swelling may attain enormous dimensions and involve the entire extremity, the leg or legs attaining a circumference, in aggravated cases, of several feet.
Treatment.— In the treatment of elephantiasis of the leg the patient should be encouraged to persevere with elastic bandaging, massage, and elevation of the limb. Castellani claims good results from a combination of these measures with daily injections of fibrolysin 2 c.c. Ligature of the femoral artery has been practised; it is probably useless, and is certainly not a justifiable method of treatment. Sometimes, in extreme cases, good results are got from excision of redundant masses of skin, a longitudinal strip of three or four inches in breadth by a foot or more in
