ELEPHANTIASIS.

Elephantiasis, Sauv. gen. 302. Vog. 321. Sag. gen. 128, Elephantia Arabum, Vog. 322.

The best account of this disease is that by Dr Heberden, published in the first volume of the Medical Transactions. According to him, frequently the first symptom is a sudden eruption of tubercles, or bumps of different sizes, of a red colour, more or less intense (attended with great heat and itching), on the body, legs, arms, and face; sometimes in the face and neck alone; at other times occupying the limbs only; the patient is feverish; the fever ceasing, the tubercles remain indolent, and in some degree leathery, of a livid or copper colour, but sometimes of the natural colour of the skin, or at least very little altered; and after some months they not unfrequently ulcerate, discharging a foul ichorous humour in small quantity, but never laudable pus.

The features of the face swell and enlarge greatly; the part above the eyebrows seems inflated; the hair of the eyebrows falls off, as does the hair of the beard; but Dr Heberden has never seen any whole hair has not remained on his head. The alveoli are swollen and sebaceous; the nostrils patulous, and sometimes affected with ulcers, which corroding the cartilage and septum nasi, occasion the nose to fall. The lips are tumid; the voice is hoarse; which symptom has been observed when no ulcers have appeared in the throat, although sometimes both the throat and gums are ulcerated. The ears, particularly the lobes, are thickened, and occupied by tubercles. The nails grow sebaceous and rugose, appearing something like the rough bark of a tree; and the distemper advancing, corrodes the parts gradually with a dry scalding scab or gangrenous ulcer; so that the fingers and toes rot and separate joint after joint. In some patients the legs seem rather poits than legs, being no longer of the natural shape, but swelled to an enormous size, and indurated, not yielding to the pressure of the fingers; and the surface is covered with very thin scales, of a dull whitish colour, seemingly much finer, but not so white as those observed in the lepra Graecorum. The whole limb is overspread with tubercles, interspersed with deep fissures; sometimes the limb is covered with a thick moist feisty crust, and not unfrequently the tubercles ulcerate. In others the legs are emaciated, and sometimes ulcerated; at other times affected with tubercles without ulceration. The muscular flesh between the thumb and forefinger is generally extenuated.

The whole skin, particularly that of the face, has a remarkably shining appearance, as if it was varnished or finely polished. The sensation in the parts affected is very obtuse, or totally abolished; so that pinching, or puncturing the part, gives little or no uneasiness; and in some patients, the motion of the fingers and toes is quite destroyed. The breath is very offensive; the pulse in general weak and slow.

The disease often attacks the patient in a different manner from that above described, beginning almost insensibly; a few indolent tubercles appearing on various parts of the body or limbs, generally on the legs or arms, sometimes on the face, neck, or breast, and sometimes in the lobes of the ears, increasing by very slow degrees, without any disorder, previous or concomitant, in respect of pain or uneasiness.

To distinguish the distemper from its manner of attacking the patient, Dr Heberden styles the first by fluxion and the other by congestion. That by fluxion is often the attendant of a crapula, or surfeit from gross foods; whereby, perhaps, the latent seeds of the disorder yet dormant in the mass of blood are excited; and probably from frequent observations of this kind (the last meal being always blamed), it is, that according to the received opinion, either fish, (the tunny, mackerel, and shell-fish, in particular), melons, cucumbers, young garden-beans, or mulberries, eaten at the same meal with butter, cheese, or any preparation of milk, are supposed to produce the distemper, and are accordingly religiously avoided.

Violent commotions of the mind, as anger, fear, and grief, have more than once been observed to have given rise to the disorder; and more frequently, in the female sex, a sudden suppression of an accustomed evacuation, by bathing the legs and feet in cold water at an improper season.

The disorder by fluxion is what is the oftener endeavoured to be remedied by timely application; that by congestion, not being so conspicuous, is generally either neglected or attempted to be concealed, until perhaps it be too late to be cured, at least unless the patients would submit to a longer course of medicine and stricter regimen of diet than they are commonly inclined to do.

Several incipient disorders by fluxion have been known to yield to an antiphlogistic method, as bleeding, refrigerant salts in the saline draughts, and a solution of crystals of tartar in water, for common drink, (by this means endeavouring to precipitate part of the peccant matter, perhaps too gross to pass the pores by the kidneys); and when once the fever is overcome, cinchona, combined with sassafras, is the remedy principally to be relied on. The only topical medicine prescribed by Dr Heberden, was an attenuating embrocation of brandy and alkaline spirit. By the same method some confirmed cases have been palliated. But, excepting in one patient, Dr Heberden never saw or heard of a confirmed elephantiasis radically cured. He adds, however, that he never met with another patient possessed of prudence and perseverance enough to prosecute the cure as he ought.