A manual of the practice of medicine / by Frederick Taylor.

  • Taylor, Frederick, Sir.
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: A manual of the practice of medicine / by Frederick Taylor. Source: Wellcome Collection.

    884/966 page 864
    leg), or the leg below the knee only, or the scrotum, or the ears, or lips, or an arm, or the lower part of the abdominal wall. If the leg is affected, it becomes enlarged to two or three times its natural size. The skin looks oedematous, but it does not pit on pressure ; it is obviously greatly thickened. Where folds naturally occur, as about the knee or ankle, there are deep sulci, and these may be moist from retained sweat or sebum. Pigment is in- creased in the limbs, the surface becomes rough and scaly, here and there are patches of hypertrophied papillae, and, in other parts, vesicular or moniliform prominences due to dilated and varicose lymphatic vessels. Sometimes these burst, and discharge a more or less turbid lymph. The scrotum has sometimes grown to a tumour weighing more than one hundred pounds. In tropical countries the disease often begins by attacks of swelling and redness like erysipelas, accompanied by fever, after the subsidence of which the leg is left bigger than normal. A fresh attack of fever and local inflammation after some months again leaves the leg worse than it was after the first, and the evil goes on increasing. Sometimes, however, the enlargement is gradual, and not at any time associated with febrile attacks. In England erysipelas and phlegmasia alba dolens are occasionally causes of a permanent elephantic change. Local pressure on veins and lymphatics may cause it, and I have seen it as a part of extreme obesity. In all cases it would seem that it arises from obstruction to the lymphatics, and though in some cases the method of obstruction can be recognized, this is not so in all. It is only within the last few years that it has been discovered that in the endemic cases of tropical climates the obstruction is due to the presence of the Filaria sanguinis hominis lying within the lymphatic vessels {see p. 763). Anatomy.—The change affects chiefly the subcutaneous layer, which is enormously thickened by the growth of new connective tissue, partly gelatinous, but mostly in dense flbrous bands. The blood-vessels and lymphatics are much enlarged, and some- times the nerves, the corium and epidermis are only slightly affected. Treatment.—Very little can be done, except surgically ; thus a large scrotum can be removed. But in any other part of the body such a measure is too serious. Bandaging, especially with rubber bandages, and elevation of the limb, may give temporary relief. Ligature of the artery has been tried and failed.
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