Elephantiasis of hand, acquired.
Of the acquired forms of elephantiasis, those seen in the tropics are nearly all expressions of filariasis. Sporadic instances are met with in colder climates, and a condition resembling it is occasionally observed for which no existing cause can be detected. Such a case is illustrated in [Fig. 186], which occurred in a convict in the penitentiary in Buffalo, who had never been outside the limits of the county, and in whom no parasites could be detected. [Figs. 185], [187], and [188] illustrate typical instances of elephantiasis, [Fig. 188] being taken from a Klamath Indian woman in the Northwest Territory, the condition being similar to that met with in the tropics.
The worms belong to the nematoids, the adult being 0.03 or thereabouts in length, thinner than the diameter of a red corpuscle, rarely remaining long in the quiescent state. They can thus pass into the capillaries, which they may plug. The mosquito is discovered to be the medium of transportation, either directly or indirectly, through exposed drinking water, where the insect deposits her infected eggs. The adult worms outside the body may attain a length of 1 Cm. From the intestinal canal they pass into the lymph current and are carried until their progress is checked, where they establish a permanent home and breed and act as local irritants. The embryos which they produce are innocent; it is the adult and parent organisms that produce the damage. Lymph flow being thus obstructed the area previously drained by a given vessel will undergo various changes in the direction already described. In proportion, then, to the number of adult worms, and in accordance with their location, will be involvement of an entire member or of a more limited area, e. g., lymph scrotum ([Fig. 187]) or chylous hydrocele.
Fig. 187
Fig. 188
Elephantiasis of scrotum.
Elephantiasis of vulva (Klamath Indian woman).
(Contributed by Dr. H. L. Raymond, U. S. A.)
As yet there is no cure for filariasis; hence there is no relief for elephantiasis produced by it, except, when localized, to remove the part. In the tropical forms it is the lower part of the body which is usually involved. It begins in a limb, usually in the toes. It produces discomfort rather than actual pain, at least until such time as distention of the parts becomes unbearable. Along with lymphatic engorgement there is a peculiar liability to erysipelas, which becomes an exceedingly serious malady in tissues so saturated with lymph, and with such possibility for the propagation of germs. A milder degree of cutaneous and subcutaneous infection than is implied by the term erysipelas, as used in this work, may be called erysipeloid or cellulitis; it is quite common and frequently recurs. With each attack of this kind the condition is aggravated and the limits of the lesion extend. After a time the member becomes enlarged to a degree which disables, while the skin itself undergoes changes that alter its appearance; not only is it thickened, but there develop upon it papillomatous projections, with infiltration of the corium, that give it an unnatural appearance and feeling. Epithelial proliferation is also rapid, and is accompanied by a sort of caseous discharge which may decompose and add extremely offensive features to these cases.