TESTICLE (ABNORMAL ANATOMY). 



creases widely, invading the whole scrotum 

 to the perineum, and laying bare the crura 

 penis. At the same time it penetrates deeply 

 to the tunica vaginalis, which becomes firmly 

 connected to the morbid scrotum and ad- 

 herent to the testicle. This organ may also 

 become involved in the disease, and be the 

 scat of a deep excavated sore. The glands 

 in the groin often enlarge at an early period 

 from irritation ; but at length they become 

 indurated and diseased. The inguinal glands 

 sometimes suppurate, and form intractable 

 ulcers in the groin similar in character to the 

 sore on the scrotum. The ulcer spreads to- 

 wards its circumference widely and super- 

 ficially, whilst in the centre it burrows deeply 

 until in many instances it reaches the great 

 vessels of the thigh, destroys their coats, and 

 causes death by haemorrhage. In other cases 

 the glands remain unaffected, but ulceration 

 advances slowly in the direction of the cord, 

 and a frightful sore is produced. 



The small excrescence in which cancer 

 scroti usually originates is soft, vascular, and 

 sensitive ; and in many respects similar to 

 the soft warts which occur on the internal 

 membrane of the prepuce and on the glans 

 penis. The soot-wart appears, in fact, to con- 

 sist of a congeries of morbidly enlarged papillae. 

 The Museum of the London Hospital contains 

 a remarkable specimen of chimney-sweeper's 

 cancer, in which nearly the whole scrotum 

 is occupied by a cauliflower excrescence, 

 which exhibits these papillae in a very ad- 

 vanced state of developement. It was removed 

 from an old man, about sixty-four years of 

 age, who afterwards left the hospital cured. 

 The morbid growth is composed of a number 

 of projecting processes densely grouped to- 

 gether, of variable size, but many very large, 

 with their summits lobulated, expanded, and 

 elevated on narrow peduncles, more or less flat- 

 tened. They are represented in the subjoined 

 engraving. The soot-wart is sometimes co- 

 vered with a dense and thick concretion, formed 



Fig. C58. 



1015 



by successive layers of incrustation, the su- 

 perficial still remaining attached, so as to form 

 a projecting elongated conical process, which 

 is not unlike the spur of the cock, and when 

 very long is occasionally twisted like the horn 

 of a ram. Some curious excrescences of this 

 kind are represented in the clever etchings of 

 Mr. Wadd.* The subjoined figure taken 



Fig. 059. 



from one of them, exhibits the process of its 

 exact size. 



Upon dissecting a portion of scrotum af- 

 fected with chimney-sweeper's cancer, the part 

 is found to present very similar appearances 

 to those of carcinoma of the lip. The tissue 

 at the base of the ulcer is dense, indurated, 

 and distinctly laminated, and possesses very 

 little vascularity. On examining some matter 

 scraped from the base of a soot-wart shortly 

 after its removal from the body, I perceived 

 a number of caudate and spindle-shaped 

 nucleated cells. Epithelial cells have likewise 

 been observed in several cases, and the dis- 

 ease is regarded as belonging to the epithelial 

 form of cancer. On examining some diseased 

 glands in the groin in a case of scrotal cancer, 

 I found them enlarged and indurated, and 

 composed of a whitish brown or yellowish 

 white substance, mixed up in some places with 

 a soft curd-like matter, or greyish pus, con- 

 tained in thin white cysts. 



Carcinoma scroti is, with few exceptions, 

 confined to chimney-sweepers ; and the irrit- 

 ating action of the soot on the skin of the 

 scrotum is no doubt its exciting cause. A 

 similar disease occasionally occurs in other 

 parts of the skin, but the scrotum being sel- 

 dom cleansed and well adapted to harbour soot 



* Cases of Diseased Prepuce and Scrotum, pi. x, 

 xi. xii. 



3x4 



