Supplement to the pharmacopoeia of the King and Queen's College of Physicians in Ireland, MDCCCL.

  • King and Queen's College of Physicians in Ireland.
Date:
1856
Catalogue details

Licence: Public Domain Mark

Credit: Supplement to the pharmacopoeia of the King and Queen's College of Physicians in Ireland, MDCCCL. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    19/48 (page 53)
    Mr. Day, on Elephantiasis, or “ Cochin leg. Case No. 6, [48 in the list.] Left thigh removed by myself for ulcerated elephantiasis, with severe irritative fever, (the right forearm being also affected,) he recovered from the effects of the operation, but still suffers from elephantoid fever. On March 30th, 1860, when Hast saw him, the enlargement of the right forearm was slowly progressing, but his general health had improved. No doubt can be entertained of the necessity of removing a limb affected with elephantiasis, when the whole surface of the skin is ulcerated, thereby setting up irritative fever : for the pain is so severe that the patient rapidly becomes exhausted, and death closes the scene, should nothing be done for his relief. Two other instances are now under observation, in both of which I advise amputation : in the first, (Case 46,) the patient can only follow a sedentary occupation, his left lower extremity appears like a paviour’s hammer, anchoring him to his post; a little increased exertion causes excessive pain, and on one occasion inflammation ending in two toes sloughing away. Useless for progression, and productive of much suffering, I propose its removal. In the second case the pain is more severe, the whole of the foot and ankle being covered with tubercles from the size of a pea to that of a large cherry. The foregoing six cases of amputation corroborate what has previously been advanced by others, both in India and Ceylon ; viz., that recovery from the constitutional symptoms of elephan- tiasis may follow the removal of an afiected limb, but this does not prove it to be a local disease ; in Case No. 4 both lower extremities being diseased, the subsidence of elephantoid fever occurred, after the amputation of one of them : the swelling probably requires a large amount of nutrition, and thus becomes a drain on the system, which being removed, the patients’ health is re-established. On the other hand, as in Case No. 6, the system has become so implicated by the disease, that its eradication is impossible. In the preceding paper I have purposely confined my remarks to the disease as affecting the extremities, and witnessed by myself in Cochin, such full accounts of elephantiasis scroti have recently been published, both in Bengal and Bombay, that I deemed more than a casual mention of them superfluous. On April 20th, 1860, I saw two of the cases of leprosy already alluded to, as having elephantoid fever without effusion, and each of the patients at this date had one extremity enlarged : thus distinctly proving, that the constitutional symptoms may -exist previous to the local ones becoming apparent: the first of these cases was of anaesthetic leprosy, elephantoid fever had been of a year’s standing: the second was of the tubercular variety, ele- phantoid fever had likewise existed above a year. Cochin, April 25th, 1860.