tch or a cut, and after a long incubation period
there develop a series of small, hard, round nodules in the skin and
subcutaneous tissue which, without pain or temperature, soften into
cold abscesses and leave indolent ulcers or sinuses. The infection is
of slow progress and follows the course of the lymphatics. From the
gelatinous pus the organism is cultivated without difficulty, and this
is the essential step in arriving at a diagnosis. The disease yields in
a few weeks to full doses of iodide of potassium.

#Elephantiasis.#--This term is applied to an excessive enlargement of a
part depending upon an overgrowth of the skin and subcutaneous cellular
tissue, and it may result from a number of causes, acting independently
or in combination. The condition is observed chiefly in the extremities
and in the external organs of generation.

_Elephantiasis from Lymphatic or Venous Obstruction._--Of this the
best-known example is _tropical elephantiasis_ (E. arabum), which is
endemic in Samoa, Barbadoes, and other places. It attacks the lower
extremity or the genitals in either sex (Figs. 97, 98). The disease is
usually ushered in with fever, and signs of lymphangitis in the part
affected. After a number of such attacks, the lymph vessels appear to
become obliterated, and the skin and subcutaneous cellular tissue, being
bathed in stagnant lymph--which possibly contains the products of
streptococci--take on an overgrowth, which continues until the part
assumes gigantic proportions. In certain cases the lymph trunks have
been found to be blocked with the parent worms of the filaria Bancrofti.
Cases of elephantiasis of the lower extremity are met with in this
country in which there are no filarial parasites in the lymph vessels,
and these present features closely resembling the tropical variety, and
usually follow upon repeated attacks of lymphangitis or erysipelas.

The part affected is enormously increased in size, and causes
inconvenience from its bulk and weight. In contrast to ordinary dropsy,
there is no pitting on pressure, and the swelling does not disappear on
elevation of the limb. The skin becomes rough and warty, and may hang
down in pendulous folds. Blisters form on the surface and yield an
abundant exudate of clear lymph. From neglect of cleanliness, the skin
becomes the seat of eczema or even of ulceration attended with foul
discharge.

Samson Handley has sought to replace the blocked lymph vessels by
burying