#Sporotrichosis# is a mycotic infection due to the sporothrix Shenkii.  It presents so many features resembling syphilis and tubercle that it is frequently mistaken for one or other of these affections.  It occurs chiefly in males between fifteen and forty-five, who are farmers, fruit and vegetable dealers, or florists.  There is usually a history of trauma of the nature of a scratch or a cut, and after a long incubation period there develop a series of small, hard, round nodules in the skin and subcutaneous tissue which, without pain or temperature, soften into cold abscesses and leave indolent ulcers or sinuses.  The infection is of slow progress and follows the course of the lymphatics.  From the gelatinous pus the organism is cultivated without difficulty, and this is the essential step in arriving at a diagnosis.  The disease yields in a few weeks to full doses of iodide of potassium.

#Elephantiasis.#—­This term is applied to an excessive enlargement of a part depending upon an overgrowth of the skin and subcutaneous cellular tissue, and it may result from a number of causes, acting independently or in combination.  The condition is observed chiefly in the extremities and in the external organs of generation.

Elephantiasis from Lymphatic or Venous Obstruction.—­Of this the best-known example is tropical elephantiasis (E. arabum), which is endemic in Samoa, Barbadoes, and other places.  It attacks the lower extremity or the genitals in either sex (Figs. 97, 98).  The disease is usually ushered in with fever, and signs of lymphangitis in the part affected.  After a number of such attacks, the lymph vessels appear to become obliterated, and the skin and subcutaneous cellular tissue, being bathed in stagnant lymph—­which possibly contains the products of streptococci—­take on an overgrowth, which continues until the part assumes gigantic proportions.  In certain cases the lymph trunks have been found to be blocked with the parent worms of the filaria Bancrofti.  Cases of elephantiasis of the lower extremity are met with in this country in which there are no filarial parasites in the lymph vessels, and these present features closely resembling the tropical variety, and usually follow upon repeated attacks of lymphangitis or erysipelas.

The part affected is enormously increased in size, and causes inconvenience from its bulk and weight.  In contrast to ordinary dropsy, there is no pitting on pressure, and the swelling does not disappear on elevation of the limb.  The skin becomes rough and warty, and may hang down in pendulous folds.  Blisters form on the surface and yield an abundant exudate of clear lymph.  From neglect of cleanliness, the skin becomes the seat of eczema or even of ulceration attended with foul discharge.

Samson Handley has sought to replace the blocked lymph vessels by burying in the subcutaneous tissue of the swollen part a number of stout silk threads—­lymphangioplasty.  By their capillary action they drain the lymph to a healthy region above, and thus enable it to enter the circulation.  It has been more successful in the face and upper limb than in the lower extremity.  If the tissues are infected with pus organisms, a course of vaccines should precede the operation.