vous system are to be looked upon as
influential. It is a rare disease, observed usually in early adult or
middle life, and is more frequent in women than in men.

#What is the pathology?#

In typical and advanced cases both the true skin and the subcutaneous
connective tissue show a marked increase of connective tissue-element,
with thickening and condensation of the fibers.

#Is there any difficulty in reaching a diagnosis in scleroderma?#

As a rule, no. The characters--rigidity, stiffness, hardness, and
hide-bound condition of the skin--are always distinctive.

The peculiar appearance, the course and character of the patches, of
morph[oe]a are quite distinctive.

#Give the prognosis of scleroderma.#

It should always be guarded. In many instances recovery takes place,
whilst in others the disease is rebellious, lasting indefinitely. The
prognosis of the variety known as morph[oe]a is less unfavorable than
general scleroderma, and recovery more frequent.

#What is the treatment of scleroderma?#

Tonics, such as arsenic, quinia, nux vomica, and cod-liver oil;
conjointly with the local employment of stimulating, oily or fatty
applications, friction, and electricity. Roentgen-ray treatment is often
of value, more especially in the morph[oe]a type.

#Elephantiasis.#
(_Synonyms:_ Elephantiasis Arabum; Pachydermia; Barbadoes Leg; Elephant
Leg.)

#Give a descriptive definition of elephantiasis.#

Elephantiasis is a chronic hypertrophic disease of the skin and
subcutaneous tissue characterized by enlargement and deformity,
lymphangitis, swelling, [oe]dema, thickening, induration, pigmentation,
and more or less papillary growth.

[Illustration: Fig. 35. Elephantiasis of moderate development.]

#What parts are commonly involved in elephantiasis?#

Usually one or both legs; occasionally the genitalia; other parts are
seldom affected.

#Describe the symptoms of elephantiasis.#

The disease usually begins with recurrent (at intervals of months or
years) erysipelatous inflammation, with swelling, pain, heat, redness
and lymphangitis; after each attack the parts remain somewhat increased
in size, although at first not noticeably so. After months or one or two
years the enlargement or hypertrophy becomes conspicuous, the part is
chronically swollen, [oe]dematous and hard; the skin is thickened, the
normal lines and folds exaggera