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Scene: A university hospital in London in the 19th century.

1st student: "Anything good?"

2nd student: "You should have been here yesterday. We had a regular field day. A popliteal aneurysm, a Colles fracture, a spina bifida and an elephantiasis. How's that for a single haul...?" (From "Round The Red Lamp," Sir Arthur Conan Doyle, 1884.)

It is probable that the "second student" was as vague about the etiology of the elephantiasis as most of us who, as we read this, will assume that it was the result of microfilariae and that the patient came from the tropics. In fact, in West Africa today, filariasis is a relatively unimportant cause and accounts for less than 1% of the numerous cases seen there: it may well have been that the student's patient had never left England, and that his elephantiasis had a more simple origin!

All the gross deformities of elephantiasis are caused by lymphatic obstruction, with or without venous involvement (see Figs. 26.4, 26.5). The commonest cause in some parts of the world is filariasis, but in others it is probably tuberculous lymphadenopathy, followed by chronic pyogenic infection: the latter two may occur together. Malignant disease is a relatively uncommon cause and there is an "idiopathic" variety for which no explanation has yet been found (Fig.26.40). To confuse the subject a little further, in most countries where filariasis is the cause there is a higher incidence in men than women for reasons so far undetermined.

Fig. 26.40. The histopathology of idiopathic elephantiasis (podoconiosis). There is proliferation of the fibrous tissue with hyalinization. The collagen is both constricting and dilating the lymphatics. H&E, x100. (From Itakura 1995)


Elephantiasis. Podoconiosis. Chronic lymphedema. Elephantoid fever. Filarial fever. Ague (Barbados). Barbados leg. Mumu fever (Samoa). Wanganga (Fiji). Elephantiasis of Arabia. Fefe. Dalfil. Mal arabica. Fes febricitans. Sp: Mal de Cayena. Pierna de Barbados. Elephantiasis de los Arabes. Fr: Elephantiasis des payschands. Ger: Elefantiasis (arabum).


Elephantiasis is the name given to the gross swelling of the soft tissues which results from obstruction of the lymphatic flow.

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Copyright: Palmer and Reeder