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XL] Though usually silky to the touch, on inspection the skin presents a few, or a large number of, smaller or larger lymphatic varices which, when pricked or when they open spontaneously, discharge large quantities of milky, or sanguineous - looking, or straw-coloured, rapidly coagulating lymph or chyle. In some cases 8 or 10 oz. of this substance will escape from a puncture in the course of an hour or two; it may go on running for many hours on end, soiling the clothes of the patient and exhausting him. Usually microfilariæ can be discovered in the lymph so obtained, as well as in the blood of the patient. In a large proportion of cases of lymph scrotum the inguinal and femoral glands, either on one or on both sides, are varicose.

Probably provoked by friction against the thighs and clothes, erysipelatoid inflammation and elephantoid fever are frequent occurrences. Abscess is not uncommon. In time, in a proportion of cases, the scrotum tends to become permanently thickened and to pass into a state of true elephantiasis.

Treatment.— Unless inflammation be a frequent occurrence, or there be frequent and debilitating lymphorrhagia, or unless the disease tend to pass into true elephantiasis, lymph scrotum— kept scrupulously clean, powdered, suspended, and protected— had better be left alone. Should, however, for these or other reasons, it be deemed expedient to remove the diseased tissues, this can be effected easily. The scrotum should be well dragged down by an assistant whilst the testes are pushed up out of the way of injury. A finger knife is then passed through the scrotum, and in sound tissues, just clear of the testes, and the mass excised by cutting backwards and forwards. No diseased tissues, and hardly any flap, should be left. Sufficient covering for the testes can be got by dragging on and, if necessary, dissecting up the skin of the thighs, which readily yields and affords ample covering. It is a very common but a very great mistake to remove too little. As a rule, the wound, if carefully stitched and dressed antiseptically, heals rapidly.