1911 Encyclopædia Britannica/Elephantiasis

ELEPHANTIASIS (Barbadoes leg; Boucnemia), is a disease dependent on chronic lymphatic obstruction, and characterized by hypertrophy of the skin and subcutaneous tissue. Two distinct forms are known, (1) elephantiasis arabum, due to the development of living parasites, filaria sanguinis hominis (or filaria Bancrofti), and (2) the non-filarial form due to lymphatic obstruction from any other cause whatsoever, as erysipelas, the deposit of tuberculous or cancerous material in the lymphatic glands, phlegmasia dolens (white leg), long-continued eczema, &c. The enlargement is limited to a particular part of the body, generally one, or in rare cases both of the lower limbs, occasionally the scrotum, one of the labiae or the mammary gland; far more rarely the face. An attack is usually ushered in by febrile disturbance (elephantoid fever), the part attacked becoming rapidly swollen, and the skin tense and red as in erysipelas. The subcutaneous tissues become firm, infiltrated and hard, pitting only on considerable pressure. The skin becomes roughened with a network of dilated lymphatics, and vesicles and bullae may form, discharging a chyle-like fluid when broken (lymphorrhoea). In a later stage still the skin may be coarse and wart-like, and there is a great tendency for varicose ulcers to form. At the end of a variable time enlargement ceases to take place, and the disease enters a quiescent state: but recrudescences occur at irregular intervals, always ushered in by elephantoid fever. At the end of some years the attacks of fever cease, and the affected part remains permanently swollen. The only difference in the history of the two forms of the disease lies in the fact that the non-filarial form progresses steadily, until either the underlying condition is cured, or in the case of cancer, &c., brings about a fatal issue. The elephantiasis due to filaria is spread by the agency of mosquitoes, in whose bodies the intermediate stage is passed. The dead mosquito falls upon the water, which thus becomes infected, and hence the ova reach the human stomach. The young worm develops, bores through the gastric mucous membrane and finally becomes lodged in the lymphatics, usually of one or other of the extremities. A large number of embryonic filariae are produced. Some remain in the lymphatic spaces and cause lymphatic obstruction, while others enter the blood stream by night (filaria nocturna), or by day (filaria diurna). It is supposed that a mosquito, biting an infected person, itself becomes infected with the blood it abstracts, and that so a new generation is developed.

Treatment for this condition is unsatisfactory. Occasionally the dilated lymph trunks can be found, and an operation performed to implant them in some vein (lymphangeioplasty). And in some few other cases artificial lymphatics have been made by introducing sterilized silk thread in the subcutaneous tissues of the affected part, and prolonging it into the normal tissues. This operation has been most successful when performed on elephantoid arms dependent on a late stage of cancerous breast. Elevation of the limb and elastic pressure should always be tried, but often amputation has to be resorted to in the end. The disease is totally different from the so-called elephantiasis graecorum or true leprosy, for which see Leprosy.