by Rhazes, it has received the appellation of Elephantiasis Arabum. To avoid ambiguity, these complaints must be considered distinct from each other, and from the cutaneous discases already noticed. ELEPHANTIASIS GRÆCORUM, OR TUBERCULATA. This disease consists in numerous flattened glossy tubercles, of a reddish colour, and of variable sizes, from a split pea to that of a large nut, occupying chiefly the face, ears, and limbs, sometimes, although rarely, extending to the trunk of the body. As the disease advances, some of the tubercles crack and ulcerate. On the extremities, from the accompanying languor of the circulation, gangrene has been known to take place. Nothing can be conceived more hideous than the aspect of the body under an aggravated degree of tubercular elephantiasis. In the early periods of the disease, the constitution does not sympathize. At a later period, the mind becomes depressed and melancholy, the general health gives way, and the patient slowly and miserably sinks, generally from supervening bronchial inflammation. Tubercular elephantiasis occurs chiefly in hot climates. The East Indies afford numerous instances of it. It has been seen in this country, and we are indebted to Mr. Lawrence for the details of a case observed by him in 1814.* The pellagra of Italy is closely allied to it. It has for its proximate cause a cachectic habit of body, the result of unwholesome diet, want of cleanliness, and damp air. It is strongly suspected to be hereditary. The disease is almost incurable. Tepid baths, soothing applications, and vegetable alteratives, such as sarsaparilla and guaiacum, with a nourishing diet, are recommended. Mercury is considered as pernicious. Dr. T. Heberden has recorded a case cured by bark. Arsenic has also been found useful. Every thing seems to show that the disorder is intimately connected with languid circulation, and deficient vitality. A tonic plan of diet and medicine seems therefore indicated.§ In the Medico-Chirurgical Transactions, there is an account, by Medico-Chirurgical Transactions, vol. vi. + Ibid. vol. viii. p. 1. Dr. Holland on "The Pellagra of Lombardy," Transactions of the London College of Physicians, vol. i. p. 23. § Ibid. vol. v. p. 297. Vol. x. p. 27. Mr. Robinson, of a particular variety of elephantiasis observed in Hindostan, in which the mudar, or bark of the root of the asclepias gigantea, is eminently serviceable. Its presumed virtues are deobstruent, diaphoretic, and alterative. ELEPHANTIASIS ARABUM, OR BARBADOES LEG. This disease is common in the West Indies, in Ceylon, in the peninsula of India, on the shores of the Red Sea, and in the islands of the Pacific Ocean. It chiefly affects the leg, but sometimes also the arms and scrotum. It is an inflammatory affection of the subcutaneous cellular tissue, setting in with rigors, headache, and other evidences of acute pyrexia. The leg becomes red, hot, swelled and painful. By degrees the constitutional symptoms recede, but the leg remains tumefied. A succession of such attacks induces at length that excessive enlargement of the limb from which the disease has derived its name. On examination after death the cellular membrane appears hard, dense, and interspersed with small cells filled with serous fluid. The aponeurotic and other fibrous structures often participate in the disease, and in severe cases the cutis vera is implicated. The skin appears rough, scaly, tuberculated, and fissured. Nothing is known regarding the remote causes of this peculiar affection of the cellular membrane. It is endemic in certain districts, and must depend therefore on some state of the air and soil peculiar to those localities, the precise nature of which is probably inscrutable. It has for its proximate cause the same condition of vessels which leads in this country to the phlegmasia dolens. The treatment of it consists in the employment of purgatives and mercurials, with confinement to bed, during the early stages. In the chronic form of the disease, medicine can do but little. Compression of the tumid limb has been practised with some degree of success. Iodine deserves a trial. 1 APPENDIX. FORMULE MEDICAMENTORUM. I. MEDICAMENTA PURGANTIA.* No. 1. Pulveris jalapæ, 9j. Supertartratis potassæ, 3j. Pulveris aromatici, gr. iij. Misce. Fiat pulvis catharticus. No. 2. Pulveris rhei, j. Potasse sulphatis, gr. xv. Aquæ menthe piperitæ, 3iss. Misce. No. 3. Pulv. rhei, 9j. Confect. arom. gr. xv. Aquæ menthe piperitæ, 3xij. Misce. No. 4. Aquæ menthe sativæ, 3xij. Magnesiæ sulphatis, 3vi. Conservæ rosæ, 3j. Acidi sulphurici diluti, mvj. Misce et cola. Fiat haustus aperiens. No. 5. Magnesia sulphatis, 3ij. Infusi rosa compositi, zix. Syrupi aurantiorum, 3j. Misce. No. 6. B Infusi sennæ comp. 3iiss. gent. comp. ziij. Liquoris potassæ, 3j. Tincture cardam. compos. 3iij. Misce. * See page 56. No. 7. Fructus tamarindi, 3j. Aquæ bullientis, zviij. Macera in vase clauso, et post horas duas cola. Sumat cochlearia tria majora secunda quaque hora, donec alvus soluta sit. No. 8. Confectionis sennæ, 3j. Fiat electuarium, cujus sumat cochlearia duo minora pro dosi. No. 11. B Pil. hydrargyri, Extracti rhei, sing. gr. xv. Olei anthemidis guttas duas. Divide in pilulas sex. Sumat unam nocte pro re nata. Aloes socotr. Extr. chamameli, sing. 3ss. Olei anthemidis, mvj. Misce. Divide in pilulas xxx. Sumat j vel ij hora somni. No. 14. B Extracti colocynth. compos. j. Pil. rhei compos. (Pharm. Edin.) 9ij. Misce. Divide in pilulas xij. Sumat ij pro dosi. II. MEDICAMENTA AMARA.* No. 1. B Decocti cinchonæ, 3jss. Extracti cinchonæ, gr. x. Tincturæ cinchonæ, 3j. Misce. No. 2. B Quinine sulphatis, gr. iij. Acidi sulphurici aromatici, (Ph. Edin.) mx. Tincturæ cinchonæ composite, No. 3. Quinine sulphatis, gr. j. Acidi sulphurici diluti, miij. Fiat haustus ter indies sumendus. No. 4. B Decocti cinchonæ, 3x. Pulveris cinchonæ, ǝj. Tincturæ cardam. compos. 3j. No. 5. B Infusi caryophyllorum, 3x. Quinine sulphatis, gr. ij. Tincturæ aurantii, 3ss. Syrupi, 3j. Misce. Fiat haustus ter die sumendus. No. 6. Infusi cuspariæ, 3j. Carbonatis ammoniæ, gr. iv. Tineturæ cinnamomi compositæ, 3j. Misce. Sumat haustum ter die. III. MEDICAMENTA EXPECTORANTIA.† No. 1. Olei amygdale, 3j. Acacia gummi, 3ij. Aquæ destillate, 3vj. Syrupi papaveris, 3ss. Tere oleum diligenter cum gummi, dein adde gradatim aquam, et syrupum. Sumat cochl. j amplum frequenter indies. |