ted, the papillae enlarged and prominent,
and with more or less fissuring and pigmentation.

#What is the further course of the disease?#

There is gradual increase in size, the parts in some instances reaching
enormous proportions; the skin becomes rough and warty, eczematous
inflammation is often superadded, and, sooner or later, ulcers,
superficial or deep, form--which, together with the crusting and
moderate scaliness, present a striking picture. There may be periods of
comparative inactivity, or, after reaching a certain development, the
disease may, for a time at least, remain stationary.

#Are there any subjective symptoms?#

A variable degree of pain is often noted, especially marked during the
inflammatory attacks. The general health is not involved.

#State the cause of elephantiasis.#

The etiology is obscure. The disease rarely occurs before puberty. It is
most common in tropical countries, more especially among the poor and
neglected. It is not hereditary, nor can it be said to be contagious.
Inflammation and obstruction of the lymphatics, probably due, according
to late investigations, to the presence of large numbers of filaria
(microscopic thread-worms) in the lymph channels and bloodvessels, is to
be looked upon as the immediate cause.

#What is the pathology?#

All parts of the skin and subcutaneous connective-tissue are
hypertrophied, the lymphatic glands are swollen, the lymph channels and
bloodvessels enlarged, and there is more or less inflammation, with
[oe]dema. Secondarily, from pressure, atrophy and destruction of the
skin-glands, and atrophic degeneration of the fat and muscles result.

#What are the diagnostic characters of beginning elephantiasis?#

Recurrent erysipelatous inflammation, attended with gradual enlargement
of the parts.

The appearances, later in the course of the disease, are so
characteristic that a mistake is scarcely possible.

#Give the prognosis of elephantiasis.#

If the case comes under treatment in the first months of its
development, the process may probably be checked or held in abeyance;
when well established, rarely more than palliation is possible.

#What is the treatment of elephantiasis?#

The inflammatory attacks are to be treated on general principles.
Quinia, potassium iodide, iron and other tonics are occasionally useful;
and, especially in the earlier stages, climatic change is often of
value. Between the inflammatory attacks