ST. GEORGE'S HOSPITAL

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that the complaint was generally associated with organic.disease of the heart; but he has not found this opinion to bebased on reality, and has repeatedly removed limbs with thehappiest results. In these cases there does not appear to beany tendency towards recurrence of the disease.Some years ago Dr. Carnochan, in view of the intractable

character of elephantiasis, and with the object of avoidingamputation, ligatured the principal artery of the limb. Hedescribes (New Yo2-k- Journal of _Medicine, 1852) five cases inwhich he adopted this plan, and in all with complete success.’The example was followed, we believe, by Mr. Statham, atUniversity College Hospital, about a dozen years ago. The.case was one of long-standing solid oedema of the foot, occur-ring in a man thirty-five years of age, and the anterior tibialartery was tied with the result of materially diminishing the.swelling. The patient left the hospital, and we have no meansof knowing the issue of the case. Mr. Butcher, in his " Ope-rative Surgery," recently published, relates a case in which hetied the femoral artery in a woman aged forty-four, who hadbeen affected with elephantiasis of the leg for eighteen years.At the end of six months she was able to walk well; and,when seen four years afterwards, she was quite free from the,disorder, and following a laborious occupation. With the ex-ception of Mr. Bryant’s case, we do not know of any othersin which Dr. Carnochan’s plan has been adopted in GreatBritain.Mr. Bryant intends, we believe, to bring the subject before

one of the medical societies, so that it will only be necessaryto give a very brief account of his case.The patient, M. T-, is a stout, healthy-looking brunette,

single, twenty-five years of age, and employed in domesticoccupations. She is a native of Carmarthen, and was admittedinto the hospital on Oct. 10th, 1865. It is eight years sinceher left leg began to enlarge, and the increase in bulk hasgradually extended upwards. She says that four years agotwo quarts of fluid were discharged suddenly from her calf.She took to her bed, and at the end of five months the limbwas nearly the same size as the other. As soon as she gotabout again, however, the swelling recurred, and in a shorttime the leg was as large as ever. Last summer she lay upagain for six weeks, and the limb much diminished in girth.Previous to her admission she had been about for three months,and measurement gave this result: right leg-calf 14 in.,knee 14 in. ; left leg-calf 22 in., knee 17 in. To try the effectof rest, she was left in bed for three weeks. In the first weekthe limb decreased 14 in., but after that there was no change.There were a few papules about the foot, and fissures, whichdischarged offensive matter. The thigh was also much en-larged, and of a hard brawny texture; it measured 25 in., asopposed to 20 in. on the sound side. In consequence of theenlarged state of the thigh, Mr. Bryant chose the externaliliac artery for deligation.On Oct. 31st this vessel was tied without difficulty. She

recovered from the operation without a bad symptom. A

fortnight after the ligature of the vessel, she had lost 2u in. atthe calf and 2 in. at the knee. The thigh had also decreasedseveral inches, but owing to its shape it was difficult to takeexact measurements. At Christmas the calf had lost 5 in.,and the integuments had become quite loose and flabby. Mr.Bryant then allowed the patient to get up with her leg ban-daged, but a tendency to swelling speedily showed itself, andshe returned to bed. Since then her progress has been mostsatisfactory. Measurement at the present date (Feb. 6th)gives 14 in. at the knee and 16 in. at the calf.

ST. GEORGE’S HOSPITAL.ELEPHANTIASIS OF THE LEFT LEG ; TREATMENT BY

LOCAL APPLICATIONS.

(Under the care of Mr. HOLMES.)

THE following case differs from Mr. Bryant’s in that the- swelling does not extend above the knee, whilst the papularexcrescences about the foot are very much more developed.BIr. T. P. Pick, surgical registrar to the hospital, has obligedus with the following account of the patient :

B1. B-, aged fifty, cook, admitted September 20th, 1865.For the last five or six years she has suffered from swelling ofthe left reg and ankle. It caused her no inconvenience at first,and it was not till three years ago that it began to assume itspresent appearance, and it is only for the last nine months thatshe has been obliged to lay up. She has never lived in a hot

climate. States that shortly before the disease commencedthe wheel of a carriage had passed over her foot, and taken theskin off. -

On admission, the left leg and foot were immensely enlarged,being three times their natural size. The dorsum of the footand ankle were thickly studded with hard, brawny, wart-like excrescences, which discharged a thin, watery fluid. Ina few places the excrescences were ulcerated, leaving foul, ex-cavated ulcers. In the upper half the leg was much swollenand hard, the skin tense and smooth, and resembling solidoedema. The leg was ordered to be placed on a single inclined

plane. This treatment was continued until October 22nd, withthe effect of somewhat reducing the swelling. She was thenordered to have pressure applied by means of sheet lead. Thiswas steadily persevered with until June 4th, 1866, and causedmaterial improvement, the warty excrescences being consider-ably diminished in size. The discharge from the leg, however,became extremely offensive. She was now ordered a lotionconsisting of equal parts of solution of bichloride of mercury(P.L.) and water, and at present the leg is still further im-proved ; the excrescences are very little raised. above the sur-face ; the swelling, however, in the upper part of the leg is notdiminished.When compared with a coloured sketch of the limb drawn

in October last by Dr. Westmacott, the leg now certainlyshows a marked improvement, especially in the size and pro-minence of the tubercular masses. Mr. Holmes is not satisfied

that the general hypertrophy of the limb has sensibly dimi-nished, and he has some idea of tying the femoral artery. Thepatient, however, is not at present disposed to submit to thisoperation.

ST. BARTHOLOMEW’S HOSPITAL.ELEPHANTIASIS OF THE RIGHT LEG.

(Under the care of Mr. T. SMITH.)THERE were certain appearances noticeable in the following

case which were wanting in those previously described. Theskin of the foot was covered with scales of regular form, andseparated by shallow fissures; and there were besides somepatches of very dark grey colour, rough in texture, and re-sembling very much the skin of an elephant.The patient, H. R——, was a married woman, thirty-seven

years of age, the mother of seven children; and she had beenaffiicted with her terrible burthen for fourteen years. She hadalways lived in London; and, since her marriage, had lookedafter her family. When asked as to any possible cause of thedisease, she told us a very curious story. Fourteen years ago,she said, whilst in service, she experienced a great fright. Shefancied thieves had broken into the house; and, whilst listen-ing for confirmation of her fears, she stood upon her right legin suspense, holding on by the chimneypiece. She felt greatpain in her shin at the time, and next morning there was muchswelling around the instep and ankle. Medical advice wasprocured, and a doctor, according to her account, told her thatfright had turned a mask of blood!" (This is an expressionwe have frequently heard from the lips of uneducated persons.Of what is it a corruption ?) Since that time the swelling con-

tinued, extending by degrees higher up the limb. In Septemberthe following measurements were taken :-

The enlargement here was most marked in the lower half ofthe leg. A very offensive discharge oozed from three or fourfissures on its under surface. Before the swelling began shehad never had any serious illness, and her general health con-tinued to be very good. As a rule, she was able to walk about,though with some dragging of the limb. Every now and then,however, the leg would become red and inflamed, she wouldhave great pain in it, and experience shivering. On this ac-count she had been in various hospitals six times. Ilest wouldmaterially abate her inconvenience, and bandaging always re-duced the swelling. She was always worst in the evening.Mr. Smith proposed to tie the femoral artery, but she de-

clined (at least for the present) to submit to this procedure,and left the hospital in October.In the Transactions of the Pathological Society, vol. xi.,

p. 303, Dr. John Ogle gives the result of a microscopical exa-F 2