306 The Philippine Journal of Science 1921 
smaller tumors give that the patients are usually not willing to 
submit to operation, unless the condition is such as to prevent 
sexual relations. 
As to the tumor itself, the scrotum is greatly increased in 
bulk, and the skin is thickened and rugose. Occasionally this 
rugosity is so marked as to make the surface appear to be 
covered as if by a crop of warts. The hair is scanty, dry, and 
coarse, and the mouths of the follicles stand out very distinctly. 
The skin is also firmly bound down to the subjacent tissue, and 
as a rule, when fully developed, the scrotum does not pit on pres- 
sure. The sweat and sebaceous glands, as a rule, are atrophied. 
It is generally very difficult to say precisely where the healthy 
skin ends and the unhealthy skin begins. The blood vessels of 
the scrotum are enlarged and slightly thickened, but this thicken- 
ing is as nothing when compared with the thickening to be seen in 
the lymphatics. Some of these at operation stand out as large, 
open-mouthed vessels. A hydrocele is often found with walls 
thicker than usual. If a hernia of old standing be present, the 
cord on that side may be so spread out over the hernial sac as 
to make it a matter of difficulty to recognize the former. 
The weight of these scrotal tumors varies very much. All 
sizes may be met, from the tumor weighing only a few ounces 
(grams) to the largest recorded of 224 pounds (102 kilo- 
grams).(35) The largest that I have operated on weighed, 
after removal, 71 pounds (32 kilograms). From 5 to 50 pounds 
(2.2 to 22.6 kilograms) is the commonest weight. 
These scrotal tumors may be classified in two ways; namely, 
according to the clinical characters of the swelling or according 
to the clinical characters of its neck. 
According to the first classification, we meet with four forms: 
a. A hard and solid type with no hydroceles or only very small ones. 
b. One with large hydroceles and a fair amount of elephantoid tissue, 
involving more than the skin. 
c. Elephantoid disease of the skin only, around a large hernia or 
hydrocele. 
d. Elephantiasis of the penile skin, the scrotum remaining practically 
unaffected. 
According to the second method of classification, the tumors 
are divided thus: 
a. Narrow-necked tumors. 
b. Broad-necked tumors. 
This may seem an arbitrary and unnecessary distinction, 
but its practical use is great; for the one kind of tumor, the 
