elevated, and itchy, just where the scrotum lies habitually in contact with the thigh. It spreads circumferentially, healing in the center. The border of the eruption is sharply defined, and forms the distinctive feature of the disease. It is composed of papules, vesicles, excoriations, and crusts. The parts within this festooned border over which the disease has passed are left of a brown color. Often, little heaps of dried-up scales lie here and there upon this surface. Patches of eruption break out in the neighborhood or within the border, and behave exactly like the patches first constituting the disease. The affection is slow in getting well, and tends strongly to relapse. Friction and moisture of the parts, together with the parasite, are necessary for its production. Among the scales scraped from the margin, the microscope may detect the moniliform filaments and spores of the tricophyton of Malmster, the parasite of ordinary ringworm. In certain stages of the disease, the parasite is difficult to find. Treatment.-Dilute lead-water or oxide-of-zinc ointment may be used locally at first if there be much inflammation of the skin, to be followed by parasiticide lotions, or the latter may be commenced with at once. The best of these is a mild solution of corrosive sublimate in water, gr. j-jss to the 3j, which should be kept constantly applied. Sulphurous acid, pure, is an excellent parasiticide; tincture of iodine may be used, or an ointment of turpeth mineral (hydrarg. sulph. flav.) gr. x-xx to the 3j. Treatment should be kept up for some time after apparent cure, as relapses are the rule, and can only be averted in this way. PRURITUS GENITALIUM.-This, like other purely pruriginous skinaffections without eruption, is excessively obstinate. Rheumatic and gouty subjects most often are the sufferers, and with such, any dietetic or hygienic errors seem liable to induce or aggravate the disorder. After the exclusion of animal or vegetable parasites from the rôle of causality, the treatment consists in hygienic and dietetic precautions, with the internal exhibition of alkalies, and, if need be, tonics. Turkish and Russian baths are often very serviceable. The following are among the most generally useful local measures, what is suitable for one case often having no effect upon another. Hygiene and change of air are sometimes the only really curative agents. Hot water, tar, pure or in combination, yellow wash, chloral, camphor; or, Finally, local electricity, either the induced or the continued current, has moderate curative power over some cases. PEDICULI PUBIS.-These parasites may be found upon the scrotum, as they may, in fact, upon any part of the body from which the hairs of puberty grow. They exist in greatest abundance, however, about the genitals, and particularly on the mons α FIG. 103. veneris. They are plainly visible to the naked eye, as are their eggs attached to the hairs (Fig. 105, a). They may be destroyed by sprinkling the parts with calomel, or by applying a lotion of gr. j-iij corrosive sublimate to j of Colognewater, or a wash made of equal parts of tincture delphinii and water, or by the free local use of kerosene-oil. When they infest the whole body, some few usually escape the ordinary application of lotions, and these soon breed a new Care and patience, however, will always finally dislodge them. No treatment is better than the old-fashioned blue mercurial ointment, half an ounce of which may be rubbed into the hairy parts about the pubis and perinæum and somewhat down the thighs, the patient going to bed in drawers and sleeping in the ointment all night. Two such applications, at a few days' interval, generally destroy the colony. The treatment is a very dirty one, and much soap and hot water form essential parts of it. Moursou, a French naval surgeon, first pointed out the relation between certain blue spots on the skin and pediculi pubis,* and Douguet confirmed the relationship by inserting a bruised pediculus under the skin and producing a spot. Mallet proved that the coloring matter resides in the salivary glands of the pediculus. In the early spring the spots are more abundant than in other months. URINARY INFILTRATION has been already described. PHLEGMONOUS ERYSIPELAS.-Upon the scrotum this is an exceedingly dangerous disease. It is most frequently observed in the aged or debilitated. Injuries and operations may also be occasionally attended by it. The so-called metastatic inflammations occurring in typhus, variola, scarlet fever, mumps, etc., are in reality phlegmonous erysipelas, described by some English authors as acute cedema. Symptoms.-A sharp chill announces the disease. The scrotum becomes at once the seat of increased heat and redness, with pain, and rapidly enlarges. Blood escapes into the subcutaneous connective tissue, so that the whole scrotum may be black and shining, or its color may be mottled. The scrotum may reach the size of a child's head, the integument is put upon the stretch, the epidermis may crack or *"Lancet " (editorial), September 16, 1882, p. 454. may be raised into vesicles or bullæ. The general tendency of the disease is always toward gangrene. Pain is not very great, but the prostration is excessive. The pulse runs up to 120-160, is small, feeble, and irregular. The appetite fails, the tongue gets brown and dry, the patient breathes hurriedly, is depressed and overcome. The skin is hot and dry at first, but becomes subsequently moist from depression. The diagnosis is between infiltration of urine and hæmatocele. From the former it may be distinguished by the greater severity of the attack, the rapid change of color of the parts, the fact that one side of the scrotum is more seriously involved than the other in phlegmonous erysipelas, and that the oedema does not so certainly extend to the penis and abdomen. The patient is more depressed, and no pre-existing cause for infiltration is present. In true hæmatocele one side only of the scrotum is enlarged, and there is not much thickening of the skin. The swelling may be often made out as involving the testicle. The general symptoms in hæmatocele are not formidable. The dangers in phlegmonous erysipelas of the scrotum are twofold: the life of the patient is in danger; the integrity of the scrotum is at stake; any portion or the whole of it may slough, leaving the testicles uncovered. Treatment. The treatment should be energetic and supportive. Repeated small doses of brandy, whisky, or wine, must be given, with milk, cream, and beef-tea. The quantity of stimulant varies in every case. Eight or ten ounces of brandy or whisky in twenty-four hours, in small portions at a time, is a fair average quantity. A good effect of the stimulant will be noticed in the pulse, which will decrease in frequency and become more strong and regular. The tongue will get moist, and the patient rally from his depression. The local treatment is equally important. Hope of aborting the disease need not be entertained. One long, free incision parallel to the raphe, on either side, should be made well down into the subcutaneous tissue of the oedematous discolored mass. Persulphate of iron may be used, if necessary, to check bleeding, and water-dressings, with one per cent carbolic acid, applied. If gangrene has already commenced, and sloughs begun to separate, or if the latter form in spite of the incision, they should be detached and removed as soon as possible. The testicles hang out uninjured in these cases, suspended by the cord, and if left to themselves and kept moist, or, perhaps better, mildly stimulated, granulations will sprout out upon them, and a cicatrix will form, binding them up under the pubis in a manner not unsightly nor inconvenient. The patient is always agreeably disappointed in the final result. If the process of repair does not form a good scrotum, recourse may be had to oscheolasty (ooxéov, scrotum ; πλáσσew, to form), as performed by Delpech, Dieffenbach, Dürger, and others, by transplanting from neighboring parts flaps of skin large enough to cover in the testicles. ELEPHANTIASIS SCROTI.-This disease, not uncommon in some portions of the globe, is rare in the United States. Hypertrophic overgrowth may attack the scrotum or penis alone, but usually both are involved, the scrotum to the greater extent. The scrotum may enlarge until it touches the ground. It has been known to reach the weight of one hundred and sixty-five pounds! A scrotum of this weight was removed by Wilkes.* The only remedy for the disease is the knife. Curling advises a disregard of the penis and testicles in operating, if the tumor be very large. Patients are apt to die on the table, from hæmorrhage, which is always excessive. If the mass is not excessively large, the penis, testicles, and cords may be dissected out, enough of the healthiest tissue being left to cover them. Many cases of successful operation are recorded, among others, one by Thebaud, of New York, the mass weighing, when removed, sixty-three pounds. LYMPH SCROTUM (pachydermia lymphangiectatica-Rindfleisch) is analogous to and suggestive of elephantiasis scroti. The names of Carter, Manson, Roberts, and Wiedel are best known in connection with it. Numerous vesicles and tubercles, discharging lymph when punctured, are found upon an hypertrophied scrotum, and the malady tends to prolong itself indefinitely. The disease is doubtless due to filaria Bancroftii. Busey † considers the subject. In one of Carter's cases, chylous urine alternated more or less regularly with a flow of lymph from the tubercles on the scrotum. A punctured tubercle would sometimes yield a pound of chylous fluid a day. Cystic, fatty, and fibrous tumors of the scrotum are found occasionally. Small steatomatous cysts are common. They may reach a large size. CANCER OF THE SCROTUM, in this country, is a rare disease. When it occurs, it is almost invariably epithelial. Scirrhous and medullary cancer, recurrent fibroid, and melanotic sarcoma, are encountered at long intervals, but not as differing in any way from the same growths elsewhere. EPITHELIOMA OF THE SCROTUM has been denominated chimneysweeps' cancer, since it is somewhat common in England upon chimney-sweepers. Soot seems to be the exciting cause in England, although in other countries those whose occupation brings them into contact with this substance do not seem to suffer. On the contrary, our countryman, Warren,# states that he has seen it a few times in * Titley, "Diseases of the Genitals,” p. 317. +"Congenital Occlusion of Lymph-channels," New York, 1878, p. 98. # "Surgical Observations on Tumors," p. 329. the United States, but never in chimney-sweepers. Coal-dust is entirely inoperative. The disease begins as one or more small, soft warts, or tubercles, usually at the lower fore-part of the scrotum. These remain unchanged for a time, but finally indurate slightly, become excoriated, scab over, and ulcerate, the ulcer extending backward, and destroying, with more or less rapidity, the whole scrotum. Sometimes the testicles are involved, sometimes they escape. The ulcer resembles an epithelial, cancerous ulceration, wherever seen. It has the same hardened, irregular, purplish, everted, knotty borders; the same hard, uneven, unhealthy-looking base; the same ichorous discharge, now sanguinolent, now purulent. Death occurs by exhaustion, or by hæmorrhage, if a large vessel be severed by the advancing ulceration. The disease continues local for some time. It is only tardily that the inguinal glands become involved. Treatment. Thorough removal with the knife offers the only chance for safety. If the inguinal glands have not become infected, the operation is a simple one. If either testicle should be found involved, or even adherent to the diseased mass, it should be removed. If the glands in the groin are greatly enlarged and indurated, operation is unadvisable. If they are only slightly enlarged, they may be left; but, if they are at all indurated, they too must be removed. The earlier the operation is undertaken the less the chance of relapse, which is always to be feared. A second and third operation may be advisable, if the patient's general condition be not seriously impaired. (For mucous patches of the scrotum, see SYPHILIS.) CHAPTER XXII. DISEASES OF THE TESTICLE. Anatomy.-Anomalies.-Cryptorchidism.—Luxation.-Hypertrophy.-Atrophy.-Injuries.— Hæmatocele.-Hæmatocele of the Cord.-Free Bodies in the Tunica Vaginalis. THE testicles, suspended each by its spermatic cord, lie loosely in the scrotum, surrounded by connective tissue. The left is usually slightly larger than the right and hangs lower, evidently for the purpose of allowing these important organs the more readily to elude violence. It has been observed, in transposition of the viscera and blood-vessels, that the right testicle hangs the lower. The mean dimensions of the testicle, according to Curling, are one and three fourths inch long, one and a fourth inch antero-posteriorly, and one |