in the subcutaneous tissue of the swollen part a number of stout
silk threads--_lymphangioplasty_. By their capillary action they drain
the lymph to a healthy region above, and thus enable it to enter the
circulation. It has been more successful in the face and upper limb than
in the lower extremity. If the tissues are infected with pus organisms,
a course of vaccines should precede the operation.

[Illustration: FIG. 97.--Elephantiasis in a woman aet. 45.]

A similar type of elephantiasis may occur after extirpation of the lymph
glands in the axilla or groin; in the leg in long-standing standing
varix and phlebitis with chronic ulcer; in the arm as a result of
extensive cancerous disease of the lymphatics in the axilla secondarily
to cancer of the breast; and in extensive tuberculous disease of the
lymphatics. The last-named is chiefly observed in the lower limb in
young adult women, and from its following upon lupus of the toes or foot
it has been called _lupus elephantiasis_. The tuberculous infection
spreads slowly up the limb by way of the lymph vessels, and as these are
obliterated the skin and cellular tissues become hypertrophied, and the
surface is studded over with fungating tuberculous masses of a livid
blue colour. As the more severe forms of the disease may prove dangerous
to life by pyogenic complications inducing gangrene of the limb, the
question of amputation may have to be considered.

[Illustration: FIG. 98.--Elephantiasis of Penis and Scrotum in native of
Demerara.

(Mr. Annandale's case.)]

Belonging to this group also is a form of _congenital elephantiasis_
resulting from the circular constriction of a limb _in utero_ by
amniotic bands.

_Elephantiasis occurring apart from lymphatic or venous obstruction_ is
illustrated by _elephantiasis nervorum_, in which there is an overgrowth
of the skin and cellular tissue of an extremity in association with
neuro-fibromatosis of the cutaneous nerves (Fig. 89); and by
_elephantiasis Graecorum_--a form of leprosy in which the skin of the
face becomes the seat of tumour-like masses consisting of leprous
nodules. It is also illustrated by _elephantiasis involving the scrotum_
as a result of prolonged irritation by the urine in cases in which the
penis has been amputated and the urine has infiltrated the scrotal
tissues over a period of years.

#Sebaceous Cysts.#--Atheromatous cysts or wens are formed in relation to
the sebaceous glands and hair follicles.