The management of these cases becomes very difficult. Total disability finally succeeds inability, and patients in the last stages are often bedridden. The repeated attacks of erysipeloid should be treated with antiseptic applications and elevation of the part, but without too much compression, as germs may be forced into the circulation.
In elephantiasis of the lower extremities it has been suggested to tie the femoral arteries, hoping thereby to deprive the limb of at least a portion of its fluid supply. This may be of some avail early, but when it is done late it is likely to be followed by gangrene of the limb, from whose consequences not even amputation can save the patient.
In the tropics, especially where the external genitals are sometimes involved, extensive operations have been of great service, and among the surgeons of India reports of operations of this kind are frequent.
Fig. 189
Elephantiasis (“Barbadoes leg”). (E. J. Meyer.)
Elephantiasis is most common in men; occurring in women it is not limited to the external genitals, for the writer has seen illustrations of the disease in the legs alone. In the Western Hemisphere it is met frequently in the Barbadoes, and is called Barbadoes leg ([Fig. 189]). The principal dangers from operations on these cases pertain to the risks of hemorrhage, shock, and infection. Nothing short of amputation of limbs or ablation of the genitals is of real benefit. In all these operations the veins as well as the arteries should be ligated, and the ligatures used en masse, introduced with a needle. There is usually copious oozing, and drainage should be provided.
CHYLOCELE.
This term is applied to a condition also referred to as chylous hydrocele. It implies a collection of milky fluid in the cavity of the tunica vaginalis. Occurring in a patient known to be suffering from filariasis it may be diagnosticated before exploration. In some instances where the sac of fluid is less translucent than usual, if the candle test fail when applied, chylocele may be suspected. Careful examination of the sac may show widely opened lymph vessels or lymph spaces. It is to be distinguished from spermatocele, whose contents also are milky fluid, but rarely collecting to the same amount. Chylocele may be treated by tapping, or by open division or extirpation of the sac, exactly as recommended elsewhere for the treatment of hydrocele. (See [Fig. 187].)
Chylocele is to be distinguished from lymph scrotum, which is a form of localized lymphangitis of mild degree rather than a circumscribed collection of chylous fluid. It presents febrile, not to say inflammatory features, and in the chronic form the skin will be frequently seen to ooze fluid closely resembling lymph, which condition is called lymphorrhagia. The scrotum rarely becomes as large as in extreme cases of dropsy, and yet may assume an uncomfortable size. This condition, like that previously mentioned, is usually associated with filariæ. It may appear, however, spontaneously, and after persisting for a long time disappear, with as little apparent reason as that which produced it. When the condition becomes unbearable ablation may be practised. (See [Fig. 187].)