Lazari morbus vel malum; Phaeniceus morbus, is generally ranked as a species of leprosy (see Lepra Arabum); but is distinguished from the leprosy by being seated in the flesh, while the leprosy only affects the skin, or, at the most, the integuments. This disorder receives its name from its often affecting the legs, so as to make them resemble those of an elephant; but in many instances the legs are not affected.
Dr. Cullen places this genus of disease in the class cachexia, and order impetigines, and defines it a contagious disease, wherein the skin is thick, wrinkled, rough, and unctuous, divested of its hair; the extremities insensible, with respect to feeling; the face disfigured with hard tumours, called tubera; the voice hoarse and nasal. In different parts of the skin sometimes arise fungi, having the appearance of mulberries or raspberries.
Dr. Towne assures us, that negroes are very commonly the subjects of this disorder, and that it bears a great affinity to the best account we have of the lepra of the Arabians. He says those are the most subject to it, who, after severe acute fevers, long continued inter-mittents, or other tedious diseases, are either much exposed to the inclemency of rainy seasons, and the cold dews of the evening, or who are constrained to subsist on bad diet.
On the first attack the patient complains of shiver-ings; these continue a few hours, and are succeeded by a pain in the head, back, and loins; a nausea and vomiting soon follow, with pain in one of the inguinal glands (never in both): a severe fever follows; the gland reddens, becomes hard, but seldom suppurates; a red streak runs down the thigh, from the swelled gland to the leg, almost an inch broad, and of a flesh colour: this streak soon swells, and then the fever abates, and the matter is thrown upon the leg by an imperfect crisis. By degrees the leg is more and more tumefied, and the veins are formed into large varices, which are very apparent from the knee downward to the toes. Soon after, the skin grows rugged and unequal; a scaly substance soon forms on it, with fissures interspersed. These scales do not dry, but are daily protruded forward, until the leg is greatly enlarged. Though this scaly substance appear harsh and insensible, if it is very superficially touched with the point of a lancet, the blood freely oozes out. Notwithstanding the monstrous size of the diseased leg, the appetite remains good, and in all other respects the patient is healthy: many continue in this state for twenty years or more, and make no other complaint than what the enormous size of the leg occasions. It rarely happens that both legs are affected. White people suffer from this disorder when in the same circumstances which produce it in the negro. The 'disease is infectious, and often found to be hereditary.
The cure is uncertain: after cleansing the first passages, warm diophoretics may be mixed with antimo-nials, and administered with the bark. The diet and mode of living should conduce to increase the vis vitae. Mercury is said to be injurious; but experience has occasionally shown its utility, when joined with the remedies just mentioned.
Aretaeus describes the elephantiasis with great accuracy. Towne is particular in the account of it. See Turner also in his Diseases of the Skin, and Brook's Practice of Physic.
In the London Medical Transactions, vol. i. p. 23, is inserted a description of the elephantiasis,as it appears in Madeira, with the method which in one instance was attended with success. In this country the disorder appears at first in the form of tubercles on any or all parts of the body; in time they ulcerate: if they occur on the beard or eye brows, the hairs fall of!*; but this does not always happen on the head. The legs swell, and arc hard; white scales cover them, and fissures occasionally appear, though the legs are sometimes emaciated and full of ulcers. The alae nasi are swollen and rough; the cartilage of the nose sometimes destroyed; the lobes of the ears are swollen; the voice hoarse; the nails are thick and scaly; the skin white, shining, and insensible; the breath offensive; the pulse weak and slow. Many other very disagreeable symptoms occur in different patients. None are observed"to receive this disorder from others by contact; but generally the children of the diseased are subjected to it.
It usually appears here as a chronic disease on the decline of life, and every circumstance shows a great deficiency of nervous power. We never saw, in the few cases that have occurred to us, any advantage from medicine; but the bark, with the following embrocation and blistering, is said to have relieved after mercurials and antimonials had failed. The following is the mode recommended: Applicetur emplastrum epispasti-cum nuchae. cort. Peruv. pulv. i ss. cort. radicis sassafrae pulv. ss. syr. q. s. fiat, electar. cap. q. n. m. majoris bis in die.
Spt. vini tenuior. viii. lixiv. tart. i. spt. sal amnion. 3 ii. m. f. embrocatio qua inungantur partes af-fectve mane nocteque.
The disease was, however, apparently mistaken, or the event unfaithfully related.
The cause is often indigestion, and it has been attributed, in the island of Madeira, to the poison offish. Sometimes emetics, and in some instances cooling antiphlogistic medicines, are said to have been there serviceable. In the elephantiasis of the East (see Asiatic Researches), white arsenic is said to have succeeded. Dr. Semple advises mercury and antimony, with an embrocation consisting of eight ounces of spirit of wine, an ounce of aqua kali, with twice as much aqua ammoniae.