e abdomen was hard
and distended, which appearance vanished in the evening. In this case
there was a history of an injury in the upper iliac region.

The first accurate ideas in reference to elephantiasis arabum are given
by Rhazes, Haly-Abas, and Avicenna, and it is possibly on this account
that the disease received the name elephantiasis arabum. The disease
was afterward noticed by Forestus, Mercurialis, Kaempfer, Ludoff, and
others. In 1719 Prosper Alpinus wrote of it in Egypt, and the medical
officers of the French army that invaded Egypt became familiar with it;
since then the disease has been well known.

Alard relates as a case of elephantiasis that of a lady of Berlin,
mentioned in the Ephemerides of 1694, who had an abdominal tumor the
lower part of which reached to the knees. In this case the tumor was
situated in the skin and no vestige of disease was found in the
abdominal cavity and no sensible alteration had taken place in the
veins. Delpech quotes a similar case of elephantiasis in the walls of
the abdomen in a young woman of twenty-four, born at Toulouse.

Lymphedema, or elephantiasis arabum, is a condition in which, in the
substance of a limb or a part, there is diffused dilatation of the
lymphatics, with lymphostasis. Such a condition results when there is
obstruction of so large a number of the ducts converging to the root of
the extremity or part that but little relief through collateral trunks
is possible. The affected part becomes swollen and hardened, and
sometimes attains an enormous size. It is neither reducible by position
nor pressure. There is a corresponding dilatation and multiplication of
the blood-vessels with the connective-tissue hypertrophy. The muscles
waste, the skin becomes coarse and hypertrophied. The swollen limb
presents immense lobulated masses, heaped up at different parts,
separated from one another by deep sulci, which are especially marked
at the flexures of the joints. Although elephantiasis is met with in
all climates, it is more common in the tropics, and its occurrence has
been repeatedly demonstrated in these localities to be dependent on the
presence in the lymphatics of the filaria sanguinis hominis. The
accompanying illustration shows the condition of the limb of a girl of
twenty-one, the subject of lymphedema, five years after the inception
of the disease. The changes in the limb were as yet moderate. The
photograph from which the cut was made was taken in 1875 A