than elsewhere, tempting the surgeon to utilize it for the formation of flaps—not always a wise proceeding. The penis (A a, B f) always lies in the upper and fore part of the neck of the mass; it is firmly attached to the pubes by the suspensory ligament. The sheath of the penis is sometimes specially hypertrophied, standing out as a sort of twisted ram's-horn-like projection on the anterior surface of the tumour; this, however, is unusual. Generally the sheath of the penis is incorporated in the scrotal mass, the prepuce being dragged on and inverted so as to form a long channel leading to the glans penis and opening (A l) half-way down, or even lower, on the face of the tumour. The testes (A c), buried in the central blubbery tissue, usually lie towards the back of the tumour, one on each side, in large tumours generally nearer the lower than the upper part. They are more or less firmly attached to the under part of the scrotum by the hypertrophied remains of the gubernaculum testium (A d)—a feature to be specially borne in mind by the surgeon. As a rule both testes carry large hydroceles with thickened tunicæ vaginales. The spermatic cords also (A b, B g) are thickened and greatly elongated. The arteries supplying these enormous growths are of considerable size; the vein's, too, are very large, and, as they permit regurgitation of blood from the trunk, are apt to bleed freely.

Fig. 121.—Diagram of anatomy of elephantiasis of scrotum. (For reference, see text.)

Their importance.—Beyond inconvenience caused by their weight, the presence of the cumbersome mass between the legs, the suffering attendant on recurring attacks of inflammation and elephantoid fever, the sexual disability, and the unsightliness, these tumours are not of great importance; they do not, as a rule, directly endanger life. They may grow rapidly or slowly; they may attain a large size in two or three years, or they may be in existence for years and at the end of this time amount to little more than a slight thickening of the scrotum. Occasionally, in large tumours, portions of the mass become gangrenous, or abscess may form, and in these ways life may be endangered.