Book II ELEPHANTIASIS 165

though in the cities one sees houses called hospitals, built and
furnished with beds at the public expense, prepared to receive
those suffering from elephantia. But of all the cases that I
have observed, so far, not one of those admitted, or only few,
seemed to me to be suffering from elephantia, but only from
leprosy, or to be afflicted by a severe form of impetigo.*?

"TThe above are praetically all the signs that regularly man—
ifest themselves in elephantia. From them anyone can see
that the disease called '*French^ is very different, for it has its
seat not in the black bile humor but in foul phlegm; it does
not infect by fomes, or by the breath; sexual excitement is
wholly absent; and it is accompanied by very severe pains.
Now since elephantia also is a contagious disease, it is evident
that like other such diseases it contains in itself the germs of
contagion. But these are analogous, not with mucous and
foul pituita,7? as is the case with French Sickness but rather
with the black bile humor. 'This is shown most clearly by the
pustules themselves, which are hard, dry and purple; also by
the hardness and inequalities of the skin, a symptom which, as
I have said, is attested by all who before me have written on
this disease. Galen says: "Vou must treat cases of elephantia
by the same method as cancer, for their substance is the same'.
In his treatise 'On Tumors', he says: "*Elephas is an affection
especially generated in melancholic blood; but in the course of
time black bile is produced'. For this reason the pustules are
drier, and the ulcers are less mucous, though they have their
own peculiar foulness, since every putrefaction is per se foul.
This contagion attacks men rather than women, because men
have more black bile in their blood. But why is it that cold
countries and the Germans and Scythians'' suffer from it
more than the Italians and Greeks where the climate is damper?
'The reason, I think, is that they are very full—blooded, and their
blood is rich and oily, and hence there is considerable exhala—
tion from it; when this reaches the outer skin, because of its
density and the coldness of the climate it does not evaporate
entirely, but only its thinner element, while the denser element
collects under the skin and there becomes inflamed; this readily
occurs on account of the oily element, and this prevents it from
transpiring through the skin, and so it putrefies and engenders
this malady. For the germs of this malady are analogous with
those parts of the blood that are denser and melancholic and