Volume 1

The Cyclopaedia of practical medicine : comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc. / edited by John Forbes ... Alexander Tweedie ... John Conolly.

Date:: 1833-1835

Credit: The Cyclopaedia of practical medicine : comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc. / edited by John Forbes ... Alexander Tweedie ... John Conolly. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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$to tins affection. It has been observed in the head, the tongue, the neck, the breasts, tlie abdomen, the tliigh, and the skin in general. The condensation of the cellular tissue of new- born or very young children is a form oT ele- phantiasis. The parts most frecpiently affected are the superior and inferior extremities, the vulva, and the scrotum. 'I'he internal organs are also liable to be- come affected. Is it not probable tliat some varieties of enlargement of the liver, and the sarcomatous morbid structure of the ovaria and uterus, are kindred affection.s, if not the .same ? Dr. Musgrave thinks this disease should be termed the migratory injhuinnatioti of the lym- phatic xj/stem. He .says, “ whatever may be Its original seat, the patient is never secure, while the constitutional disturbance subsists, from a sudden retrocession to some vital organ. 1 have seen it in the same case translated from the scrotum to the head, from thence, after a few hours, descend with the ra])idity of lightning to the abdomen; again migrate to the chest, to return jrerhaps to the encephalon and prove fatal there; or, under more favourable circum- stances, resume its comparatively harmless situation, and run its subsequent course, as if nothing untoward had occurred ; and, while occupying the different cavities, giving rise to the ordinary symjitoms of acute inflammation of that particular viscus which it had selected for its temporary abode.”* It is not common for more than one part of the body to become morbidly enlargetl in the same individual, although this circum- stance sometimes occurs. A schoolnuLster at Point de (ialle had both arms and both legs affected. 'J’he scrotum is sometimes greatly increased in size: there was a mendicant at (ialle, in whom it descended to the ankle, and who, when he sate to solicit alms, used to sit upon this j>art of the body, as he would have done upon the trunk of a tree! The leg is, we believe, the part of the body which is most frequently affected, and sometimes it l)e- comes enormously eidarged. Occasionally the swelling is uniform ; but commonly the skin is rough, rugged, and scaly, and the enlargement divided into unecpial jirotube- rances, which are intersected with dee]) fissures. The writer of this article w'as requested to visit a woman at (ralle, who, although only about tw'enty-five years of age, had both of her in- ferior extremities so much enlarged and de- formed, that the back part of the legs rested upon the ground and projected behind the heel, about nine or ten inches. The fissures and interspaces between the pn)jecting and pendulous protuberances had idcenited, and were discharging a most offensive .sanies. I.ife could not be long preseiwed under such extensive disease. Organic chaagex.—This disease is evidently, in the first instance, constitutional; and the local affection seems to be a result of some • Udinburgli Med. and Surg. Journal. No. 82. form of the process of inflammation, which recurs at inter\als. A (]uantity of sero-albu- minous fluid is effused from the exhalents into the cellular ti.ssue of the affected part, which is not removed by adequate absoqition; and the part of the body that may be affected be- comes tumid, hard, and mis-shapen. Upon examination after death, the sul> cutaneous ti.ssue of an affected limb is found hard, dense, and inters])ersed with small cells filled with serous fluid; the aponeurosis which covers the muscles is thickened, as also the cellular and intermuscular tissue. The mus- cles are less red than natural. The arteries and veins are commonly not materially al- tered. It deserves to be remarked, that the effused fluid in this disease is always coagulated ; it consecpiently differs much from the serous effusions found in anasarca or a.scites. It is still ima.scertained why it is so seldom ab- sorbed, and so rarely excites inflammation and con.sequent ulceration. This effusion appears to be extra-vascular, although the fluid does not seem to have the effect of an extraneous body. Remote cauxex.—We know nothing satisfac- tory respecting the remote causes of elephant leg. It is admitted to be comparatively a new dis- ease in Barbadoes, in as fiir as imported, if not Creole w hites are concerned ; and no very important recent change has been observed in the climate of the island. 'I’he aboriginal inhabitants of Demerara are not liable to this affection, although it is not rare among imported and Creole Africans and the half-caste. It occurs occasionally among the Creole wjiites; and jierhaps there are about two cases of ele[)hant leg in the colony among the imported Europeans. Tlie pro- geny of Dutch families are more liable to morbid enlargements of the body than British Creoles. In this colony the disease is chiefly obsened on the sea-coast. In Ceylon it scarcely ever occurs except among the indigenous inhabitants of about eighty miles, or one-ninth, of the sea-coast of the island. At Point de Calle, which is the ])rincipal village embraced by the above range, the dise.ase is extremely frequent; so much so that perhaps one-third, if not one-half, of the susceptible inhabitants are more or less af- flicted witli morbid enlargement of some j)art of the body. In other respects this is as healthy a portion of the island as any other : it is remarkably free from remittent or inter- mittent fever. Elephant leg seems to be endemic in the south-west coast only; and persons who are regularly affected witli pe- riodic attacks in that part of the island escape a recurrence of the paroxysms when they change their place of residence to the interior, or to another part of the coast. Cochin is con- sidered a very healthy sUition for troops. E.rciting causex —The exciting t-auses are equally obscure. Drs. Hillary and Hendy attribute it to sudden changes of temjierature ; but we think without good foundation. We$