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 p.u.b.erty. 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, pota.s.sium iodide, iron and other tonics are occasionally useful; and, especially in the earlier stages, climatic change is often of value. Between the inflammatory attacks the parts are to be rubbed with an ointment of iodine or mercury, together with galvanization of the involved part.

In elephantiasis of the leg, a roller or rubber bandage, or the gum stocking, is to be worn; compression and ligation of the main artery, and even excision of the sciatic nerve, have all been employed, with more or less diminution in size as a result. In elephantiasis of the genitalia, if the disease is well advanced, excision or amputation of the parts is to be practised.

Eczematous inflammation, if present, is to be treated with the ordinary remedies.

Dermatolysis.

(_Synonym:_ Cutis Pendula.)

Give a descriptive definition of dermatolysis.

Dermatolysis is a rare disease, consisting of hypertrophy and looseness of the skin and subcutaneous connective tissue, with a tendency to hang in folds.

Describe the symptoms and course of dermatolysis.

It may be congenital or acquired, and maybe limited to a small or large area, or develop simultaneously at several regions. All parts of the skin, including the follicles, glands and subcutaneous connective and areolar tissue, share in the hypertrophy; and this in exceptional instances may be so extensive that the integument hangs in folds. The enlargement of the follicles, natural folds and rugae gives rise to an uneven surface, but the skin remains soft and pliable. There is also increased pigmentation, the integument becoming more or less brownish.

What course does dermatolysis pursue?

Its development is slow and usually progressive. It gives rise to no further inconvenience than its weight and consequent discomfort.

Give the etiology.

The etiology is obscure. It is considered by some authors as allied to mollusc.u.m fibrosum, and, in fact, as a manifestation of that disease, ordinary mollusc.u.m tumors sometimes being a.s.sociated with it. It is not malignant.

What is the pathology?

The disease consists of a simple hypertrophy of all the skin structures and the subcutaneous connective tissue.

What is the treatment of dermatolysis?

Excision when advisable and practicable.

CLa.s.s V.--ATROPHIES.

Albinismus.

What do you understand by albinismus?

Congenital absence, either partial or complete, of the pigment normally present in the skin, hair and eyes.

Describe complete albinismus.

In complete albinismus the skin of the entire body is white, the hair very fine, soft and white or whitish-yellow in color, the irides are colorless or light blue, and the pupils, owing to the absence of pigment in the choroid, are red; this absence of pigment in the eyes gives rise to photophobia and nystagmus. _Albinos_--a term applied to such individuals--are commonly of feeble const.i.tution, and may exhibit imperfect mental development.

Describe partial albinismus.

Partial albinismus is met with most frequently in the colored race. In this form of the affection the pigment is absent in one, several or more variously-sized patches; usually the hairs growing thereon are likewise colorless.