19, 3 Maxwell: Filariasis in China 295 
LYMPH SCROTUM 
In a well-marked cuse of lymph scrotum the appearances are 
characteristic. The scrotum is swollen, and the natural rugosity 
of the skin is increased. This appearance is partly due to the 
fact that, during the attacks of elephantoid fever, the parts 
become very cedematous and partly to the condition of the skin 
itself. The latter is a little thickened, and the surface is covered 
with small vesicles. The whole is part of an extensive lymphatic 
varix involving the scrotum; and, as might be expected in these 
cases, the groin glands on both sides are often varicose, but 
this is not always so. In some cases it is only the scrotal skin 
that is affected. 
The character of the fluid obtained from the vesicles varies 
with the site of the obstruction. If the obstruction is affecting 
the chyle vessels, the fluid will be chyle or sanguineous chyle; 
if not, it will be straw-colored only. When an acute attack su- 
pervenes, the vesicles on the skin, otherwise quite small, enlarge 
and become tense. If very carefully handled, the attack may 
pass off without any discharge of lymph; but, as a rule, the 
vesicles either spontaneously rupture or are broken by accident, 
and then lymph drains away. Sometimes it simply streams 
away, and I have collected an ounce (30 grams) in one and a half 
minutes from one opening. 
The strain on the patient due to this constant flow is most 
trying, and I have seen a patient in a critical condition from 
sheer exhaustion due to this cause. Such acute cases are for- 
tunately rare, and the main complaint that the patient makes 
is of discomfort due to his clothes being always in a wet con- 
dition. : 
Another point that should be borne in mind is that the dis- 
comfort of a lymph scrotum specially appears during or after 
an attack of lymph fever. Although the fever itself may have 
abated, there remains a recently inflamed lymphatic tract con- 
stituting a field of infection, ready to hand, in the area of scrotal 
lymphorrhagia. Occasionally most troublesome inflammation of 
the whole lymphatic region starts in this way, spreading into 
the superficial inguinal regions and then down the thighs fully 
halfway to the knees. 
Erysipelatoid inflammation and elephantoid fever are common 
concomitants of lymph scrotum; and abscess, either preceding 
or accompanying the affection, is not rare. It must be remem- 
bered that all varieties of lymph scrotum are met with, from 
