MORBID ANATOMY OF THE SCROTUM.- The morbid appearances presented by the scrotum, when the seat of oedema, inflammation, and mortification, so closely resemble those of other parts where loose areolar tissue abound, that they require no particular description.
Elephantiasis. — This disease of the scro tum is rarely seen in Europe, but is of very common occurrence in many other parts of the globe. It consists in a morbid thickening, or hypertrophy of the tissues of which the scro tum is composed. The epidermis becomes thickened, rough as in icthyosis, and inter sected with fissures, or chaps. The corium is excessively consolidated, and often nearly an inch in thickness, and very dense. The chief bulk, however, of the tumour, is formed by the conversion of the loose areolar tissue of the scrotum into a large mass of fibrous tissue, infiltrated with a thick jelly-like fluid, evidently albumen, as it coagulates on the ap plication of heat, acid, or alochol, and some times on cooling after its removal from the body. The nreoi of this tissue vary a good deal in size, but some of them have been found large enough to admit the extremity of the little finger. Examined in the micro scope this structure exhibits the white and yellow elements of the areolar tissue, in some instances mixed with fat cells. When, the part is condensed by inflammation, there are often hardened masses in the substance of the tumour, which has a lardaceous appearance when cut, or resembles cartilage; they some times undergo conversion into bone. The testicles are buried in the morbid mass to wards its posterior part, but they are usually sound in structure. Occasionally there is a small quantity of serum in the tunics vagi nalis. In a case operated on in Calcutta, there was a hydrocele on both sides imbedded in the diseased parts, the largest of which contained between five and six pints of fluid.* The spermatic cords are elongated several inches, owing to the testicles being gradually dragged downwards during the growth of the tumour, but the cords are not otherwise diseased. In the remarkable case of Ho° Loo, a native of China, operated on by Mr.
Key, in Guy's Hospital, the cremaster mus cles were nearly as thick as the finger. The morbid growth is not very vascular. Its arteries are derived chiefly from the external pudic and perineal vessels; but these, owing to the magnitude of the tumour, become greatly increased in size. The veins are numerous, large, varicose, and very tortuous.
The integuments of the penis are often affected with a similar disease, and enlarge in the same ratio as the scrotum. In cases where the disease is confined to the scrotum, the penis becomes drawn in and ultimately disappears, being completely imbedded in the tumour ; whilst the prepuce being elongated, opens by a navel-like aperture on the anterior surface of the tumour, as may be seen in the subjoined woodcut. In confirmed cases of elephantiasis, the tumour increases until in the course of years it attains an enormous magni tude. As this takes place, the skin is bor rowed from the lower part of the abdomen, so that the hair on the pubes becomes thinly scattered on the front and upper part of the tumour. The tumour assumes an oval or pyramidal form, the apex being superior, and is attached to the body by a thick peduncle extending from the pubes, occupying the whole of the perineum, and terminating pos teriorly at the verge of the anus. There is scarcely any limit to the size which the tumour may attain. It has been known to acquire such a magnitude as to weigh more than two hundred pounds ±, exceeding the weight of the rest of the body. It has been found to measure more than four feet in cir cumference, and almost to reach the ground when the patient is in the upright position. In a case operated on by Clot Bey in Egypt, the morbid mass, which weighed one hundred and ten pounds, kept the patient's legs far apart, and obliged him to remain constantly on the ground ; it was so bulky that he could even sit upon it. In the accompanying figure of a black man, affected with elephantiasis, taken from Dr. Titley's work on " Diseases of the Genitals, in the Male," the tumour de scended nearly to the ankles.