Elephantiasis of the scrotum is a morbid affection of the integuments, analogous to the enlargement of the extremities commonly known by the name of Barhadoes leg ; with which, indeed, in those countries where the disease is prevalent, it is liable to be com bined. Elephantiasis of the scrotum, how ever, grows to a greater size and makes more rapid progress than the same disease in the leg, owing to the very loose texture and de-. pending state of the parts. The labia pudendi of females in warm climates are subject to a similar change, though not to the same extent nor so frequently as the scrotum. This dis ease appears to be the result of a low form of inflammation of the veins, and to be analogous to the affection termed phlegmasia dolens. It is preceded by febrile attacks, attended with pain and heat in the part, and swelling and tenderness of the glands in the groin. After a time, the scrotum continues to enlarge, in dependently of febrile attacks. In December, 1847, I saw a gentleman, from Barbadoes, who had this disease in the early stage. The whole scrotum was considerably enlarged, forming a doughy inelastic swelling, fissured in two or three places. A portion of skin at the root of the penis was a little red and puffy as if affected in a slight degree. The glands in the left groin were enlarged, but those on the right side were unaffected. The testicles were sound.
Hypertrophy of the scrotum is an affection of the same nature as the knotty and lobulated growth of the skin occasionally observed on the nose and in other parts. In this disease the integuments appear as if composed of lobes divided by fissures. In the Museum of St. Bartholomew's Hospital there is a pre paration of this kind, but no history is at tached to it. The hypertrophied scrotum appears to have been removed during life. Many years ago I saw a case of the kind at the hospital of La Charite in Paris. The patient was a young man whose scrotum was hypertrophied to about four times its natural size. This disease is liable to be confounded with elephantiasis, but differs from it in the circumstance that the morbid enlargement is entirely confined to the skin, the subcutane ous areolar tissue being unaffected.
Cancer Scroll, or, as it is commonly called, chimney sweeper's cancer, is a disease of the skin, which attacks the scrotum of persons who have been exposed to the contact of soot. It is originally developed in the form of a small pimple or warty excrescence, termed soot wart, which often remains on the scrotum for months or even years without undergoing any change, Usually, there is only a single wart at the lower part of the scrotum ; sometimes there are two or three of different sizes ; and occasionally they are so numerous and so abundantly and largely developed as to form a considerable cauliflower excrescence. After a time the wart becomes soft, excoriated and red, and exudes a thin irritating discharge, which becoming dry forms an incrustation over the excrescence. After the scab has
been picked off, or rubbed off by friction against the dress, ulceration ensues, destroys the wart and produces a painful chronic sore, possess ing the ordinary characters of a carcinomatous ulcer on the skin, — thick, indurated and everted edges, and an irregular excavated base, the surface of which discharges a thin sanious fluid. The ulcer, if suffered to proceed, in creases widely, invading the whole scrotum to the perineum, and laying bare the crura penis. At the same time it penetrates deeply to the tunica vaginalis, which becomes firmly connected to the morbid scrotum and ad herent to the testicle. This organ may also become involved in the disease, and be the scat of a deep excavated sore. The glands in the groin often enlarge at at early period from irritation ; but at length they become indurated and diseased. The inguinal glands sometimes suppurate, and form intractable ulcers in the groin similar in character to the sore on the scrotum. The ulcer spreads to wards its circumference widely and super ficially, whilst in the centre it burrows deeply until in many instances it reaches the great vessels of the thigh, destroys their coats, and causes death by haemorrhage. In other cases the glands remain unaffected, but ulceration advances slowly in the direction of the cord, and a frightful sore is produced.
The small excrescence in which cancer scroti usually originates is soft, vascular, and sensitive ; and in many respects similar to the soft warts which occur on the internal membrane of the prepuce and on the glans penis. The soot-wart appears, in fact, to con sist of a congeries of morbidly enlarged papillm. The Museum of the London Hospital contains a remarkable specimen of chimney-sweeper's cancer, in which nearly the whole scrotum is occupied by a cauliflower excrescence, which exhibits these papillm in a very ad vanced state of developement. It was removed from an old man, about sixty-four years of age, who afterwards left the hospital cured. The morbid growth is composed of a number of projecting processes densely grouped to gether, of variable size, but many very large, with their summits lobulated, expanded, and elevated on narrowpeduncles, more or lessflat tened. They are represented in the subjoined engraving. The soot-wart is sometimes co vered with a dense and thick concretion, formed by successive layers of incrustation, the su perficial still remaining attached, so as to form a projecting elongated conical process, which is not unlike the spur of the cock, and when very long is occasionally twisted like the horn of a ram. Some curious excrescences of this kind are represented in the clever etchings of Mr. AVadd.# The subjoined figure taken from one of them, exhibits the process of its exact size.