On the treatment of elephantiasis of the legs by lymphangioplasty : being a paper read in the Section of Tropical Medicine at the Annual Meeting of the British Medical Association, Liverpool, 1912 / by Frank Cole Madden, Aly Ibrahim and A.R. Ferguson.

  • Madden, Frank Cole, 1873-1929.
Date:
1912
Catalogue details

Licence: In copyright

Credit: On the treatment of elephantiasis of the legs by lymphangioplasty : being a paper read in the Section of Tropical Medicine at the Annual Meeting of the British Medical Association, Liverpool, 1912 / by Frank Cole Madden, Aly Ibrahim and A.R. Ferguson. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    II. The Conditions after Lymphangioplasty in a Healthy Patient. To examine the condition of threads introduced into healthy tissues, the operation of lymphangioplasty was performed on a patient with a healthy limb by Dr, Aly Ibrahim ; and twenty-one days later a block of tissue containing a portion of the thread and the surrounding tissues was cut out and examined. The piece of tissue was embedded in celloidin and sections cut out and stained by Professor A. K. Ferguson, who reports as follows : The thread is seen in both longitudinal and transverse direc- tions, more particularly in the former, the fibrils of the thread are slightly separated, and between them leucocytes have made their way from their margins inwards. Peripherally the thread is closely invested by an extremely cellular tissue in which are set considerable numbers of active phagocytes (giant cells). Some of them are pointing directly inwards towards the frayed-out margins of the thread. The tissue in which the giant cells lie is composed of young connective tissue corpuscles, and is crowded with polynucleated leucocytes. A few newly- formed blood capillaries occur in this tissue also. Externally to this layer is a well-defined concentric zone of comparatively dense fibrous tissue, which gradually merges into the surround- ing fibro-adipose subcutaneous tissues. The few lymphatic channels seen in the neighbourhood of the smaller arteries of this region are the seat of a lymphangitis, as indicated by a leucocytic infiltration in and around their walls, of the same nature as that noted above at the site of the thread. From the dense tissue and apparently progressive nature of the reaction which has taken place round the introduced thread, it does not appear probable that anything of the nature of a lymphatic channel sufficient to maintain a permanent drainage of lymph from the surrounding tissues into the canal round the thread could occur. III. Condition of Thread and Surrounding Tissues after Lymphangioplasty for Elephantiasis. Our next experiment was to cut out a thread which had been inserted in the course of the operation of lymph- angioplasty on a patient with elephantiasis of the leg. The line of the thread was marked at the time of the opera- tion, and twenty-one days later a piece of tissue, 1 in. in length, consisting of skin, subcutaneous tissue, and the thread, was removed en bloc and examined. It was seen at once that the thread, apparently quite unaltered, slid up and down in a thick-walled canal of fibrous tissue, and was only with difficulty retained in its place in the sec- tion. Microscopical sections were cut with some difficulty owing to the looseness of the thread, and showed the following appearances. Professor Ferguson again reports : When this piece of tissue was removed the thread, although in situ, was very loose, and during the preparation of sections, cut from celloidin blocks, has unfortunately dropped out. The section, therefore, shows a well-defined space surrounded by a cellular tissue, having essentially the same features as that described as existing round the thread in healthy tissue. The cellular reaction in degree, however, is much less, and the numbers of the giant cells in particular are much reduced. The surrounding lymphatics of the district are marked by collections of lymphatics; but in a considerable number of