RECORD OF MEDICAL SCIENCE.
SURGERY.
Case of Elephantiasis Arabum of the Right Inferior Extremity, suc-
cessfully treated by ligature of the Femoral Artery. By J. M. Carno-
ciian, M. D.—Charles Roller, of lymphatic temperament, and short
stature, set. 27, born in Aix-la-Chapelle, occupation, merchant, left his
home in December, 1849, landed in New York in February, 1851, went
thence to Connecticut, where for eight months he worked in a factory,
standing during his hours of labors; thence went to Virginia, where he
worked on a farm for about six months, at the expiration of which period
he was taken with fever, of an intermittent character. Up to that time,
he had always been in good health.
During the fever, the inguinal glands became swollen and painful; the
swelling and pain extending in the course of the femoral vessels as far
as the knee. The pain was followed by swelling and redness of the
thigh down to the knee. From the knee, the pain and swelling contin-
ued to extend downwards as far as the toes; being, at this time confined
chiefly to the portions of the limb along the course of the saphena vein,
and also of the posterior tibial vessels. The redness and tumefaction
here, as in the thigh, were preceded by deep-seated pain. The tumefac-
tion of the limb continued to increase; while, at the same time, febrile
exacerbations occurred at intervals, varying from two to six days. After
a period of about six weeks from the commencement of the disease, the
fever entirely disappeared, and by this time, also, the pain and redness
had entirely ceased; the limb, however, remaining hard, swollen and
rough, and presenting, in a marked degree, the peculiar characteristics of
Elephantiasis Arabum, in the chronic period of the disease. From this
time forward, the hardness and intumescence gradually increased, and
the limb became so cumbersome that the patient was obliged to give up '
all business, and confine himself chiefly to a recumbent posture. In this
condition, the patient left Virginia for the purpose of seeking medical re-
lief at the New York Emigrants’ Hospital, into which he was admitted the
fifteenth of January, 1851. The appearance of the patient upon enter-
ing the Hospital was somewhat emaciated. He had no febrile symptoms,
and the chief difficulty, under which he labored, arose from the enlarged
and hypertrophied condition of the right inferior extremity.
The limb was enlarged from the toes to within a short distance below
Poupart’s ligament. The thigh, although enlarged, was not much indu-
rated ; while, from a short distance above the patella, downwards, the
limb presented a dense, hypertrophied, hard, scaly, shapeless mass.
The morbid condition of the tissues pervaded the foot and toes, there
presenting groups of tuberculated growths. The circumference of the
limb around the ankle, was nearly as large as that of the calf; measur-
ing fifteen and one-half inches, while the circumference of the calf
measured nineteen and one half inches.
The patient was put under treatment upon entering the Hospital.
The recumbent posture was enjoined, and for some time various discu-
tient lotions were used. Bandaging was resorted to, with frictions of
ung. Potass. Iodid.; the Iodide of Potassium being also prescribed inter-
nally.
At times, also, the limb was painted with strong tincture of Iodine;
local and general baths were used, regular bandaging of the limb, from
the toes upward, being the while carefully observed.
This plan of treatment was perseveringly adhered to from the fifteenth
of January to the twenty-second of March, a period of a little over two
months, without any amelioration. Having thus tried, without success,
the method of treatment most approved of, I proposed to place a ligature
upon the femoral artery, with a view of changing the morbid condition
of the structures supplied by the branches of this arterial trunk. A con-
sultation was held, and my proposition was acceded to as preferable to
amputation, the usual alternative resorted to in this stage and extent of the
disease. Accordingly, on the twenty-second of March, 1851, I secured
the femoral artery, a short distance below the origin of the arteria pro-
funda. Upon exposing the femoral artery, this arterial tube was found
to be changed, so as to present an appearance somewhat like the color of
the aorta of the ox, and to be larger than the common iliac of the hu-
man subject. In consequence of this appearance of the artery, after
some hesitation, I applied the ligature, preferring to do this, rather than
to expose the external iliac, of the soundness of which I could not be
certain.
The ligature came away from the femoral artery on the eleventh day,
accompanied by secondary hemorrhage, the occurrence of which I ex-
pected as probable. For the purpose of arresting the hemorrhage, the
external iliac artery was secured by ligature, by Dr. A. E. Hosack, who
happened to be on duty at the time in the Hospital. The external iliac
was found to be about the size of the brachial artery. This, for a time,
apparently had some influence upon the hemorrhage; but on the follow-
ing day, bleeding was again renewed from the orifice, in the femoral ar-
tery, with as much profusion as ever.
The hemorrhage was now restrained by the prompt application of a
tourniquet, on the cardiac side of the bleeding orifice, by the house sur-
geons, Drs. Thompson and A. K. Smith.
This even failed to stop permanently the hemorrhage, and the blood
recommenced oozing copiously at intervals. The patient was now sink-
ing fast, and the ligature of the common iliac, or amputation at the hip-
joiut, appeared to be the only resources left. But the hemorrhage now
baing evidently reflux, it was suggested to apply the tourniquet, so as to
produce compression on the distal side of the bleeding orifice : this was
done, and was followed by a complete cessation of the bleeding.
From this time, (April fourth, 1851,) the house surgeon kept an in-
structive record of the case, which record I have now before me. For
several days, the pulse ranged from 115 to 108 : the dressings were care-
fully attended to, and light diet prescribed. On the twelfth, the leg was
found to be considerably reduced in size, and the ligature of the external
iliac, came away. On the seventeenth, brandy and quinine, with good
nourishment, were ordered. On May the first, finding the leg still more
reduced and the lower wound healed, I ordered tincture of iodine to be
painted on the leg, and the bandage to be continued; I also ordered a
solution of chloride of soda to be used as a wash on the upper wound,
which continued to discharge freely.
The patient now went on gradually improving in strength and ap-
pearance, and left the Hospital in the latter part of June, completely
cured of his malady. At this date, sixteen months after the ligature of
the femoral artery, the patient is in robust health, and presents no indi-
cations that the disease will return.
Report of Dr. Carnochan.