The association of elephantiasis with obstructive changes in the lymphatic system is, of course, familiar. The rôle of secondary infection incident to reduced resistance and lymph stasis in these parts is also well recognized. That tuberculous involvement of a group of regional lymph nodes may be so extreme as to have the effect of a total surgical extirpation, is apparently less well known.
During the last six years, two cases illustrating the slow development of elephantiasis secondary to chronic edema from lymphatic obliteration in association with tuberculosis have been observed. The first case of this type was one of lupus vulgaris erythematoides of the legs of thirty-one years' duration. There was no history of glandular enlargement, or of acute attacks of intercurrent cellulitis punctuating the slow gradual enlargement of the leg, to suggest an intercurrent streptococcal factor. The gross lesion is shown in Figure 1. The observation of this case