t the present
time (seventeen years later) the case presents the typical condition of
the worst form of elephantiasis. Repeated attacks of lymphangitis have
occurred during this period, each producing an aggravation of the
previous condition. The leg below the knee has become enormously
deformed by the production of the elephantoid masses; the outer side of
the thigh remains healthy, but the skin of the inner side has developed
so as to form a very large and pendant lobulated mass. A similar
condition has begun to develop in the other leg, which is row about in
the condition of the first, as shown in the figure. Figure 273
represents this disease in its most aggravated form, a condition rarely
observed in this country. As an example of the change in the weight of
a person after the inception of this disease, we cite a case reported
by Griffiths. The patient was a woman of fifty-two who, five years
previous, weighed 148 pounds. The elephantoid change was below the
waist, yet at the time of report the woman weighed 387 pounds. There
was little thickening of the skin. The circumference of the calf was 28
inches; of the thigh, 38 inches; and of the abdomen, 80 inches; while
that of the arm was only 15 inches.

The condition commonly known as "Barbadoes leg" is a form of
elephantiasis deriving its name from its relative frequency in
Barbadoes.

Figure 275 represents a well-known exhibitionist who, from all
appearances, is suffering from an elephantoid hypertrophy of the lower
extremities, due to a lymphedema. Quite a number of similar
exhibitionists have been shown in recent years, the most celebrated of
whom was Falmy Mills, one of whose feet alone was extensively involved,
and was perhaps the largest foot ever seen.

Elephantiasis seldom attacks the upper extremities. Of the older cases
Rayer reports four collected by Alard. In one case the hard and
permanent swelling of the arm occurred after the application of a
blister; in another the arm increased so that it weighed more than 200
Genoese pounds, 40 of which consisted of serum. The swellings of the
arm and forearm resembled a distended bladder. The arteries, veins,
and nerves had not undergone any alteration, but the lymphatics were
very much dilated and loaded with lymph.

The third case was from Fabricius Hildanus, and the fourth from Hendy.
Figure 276 represents a remarkable elephantoid change in the hand of an
elderly German woman. Unfortunately there is no m