296 The Philippine Journal of Science 1921 
that in which the affection is just becoming manifest to that 
in which the scrotum is one mass of large vesicles. 
Another very common type is that in which the scrotum is 
partly varicose and party elephantoid. This is particularly likely 
to be the case if the patient has suffered much from erysipe- 
latoid inflammation in addition to the lymph scrotum. If, 
on the other hand, he has only suffered from elephantoid fever, 
and to a very limited extent from erysipelatoid inflammation, 
then the scrotum will remain a lymph scrotum to the end. 
It is difficult to follow up these cases in the Far East but, as 
a rule, they take one of two roads : either they become elephan- 
toid, in which case they may develop into large tumors like 
those scrota that are elephantoid from the beginning, or they 
remain varicose. In the latter event they tend, as the patient 
reaches to 50 years or more of age, to become atrophic. Some 
of the patients have had the disease for over thirty years. 
Two cases were kept under observation for four years. In 
one, in spite of recurring attacks of elephantoid fever, the 
scrotum steadily shrunk. This patient was over 55 years of 
age. In the other case there were fewer attacks, but the ery- 
sipelatoid inflammation was more marked, and the scrotum 
double in size and was rapidly becoming an elephantiasis 
scroti. 
Embryo filarise are generally found in the blood in these cases, 
and very often they may be obtained from the lymph flowing 
from the scrotum. On one occasion, as mentioned on a previous 
page, filarial ova were found in the fluid from a scrotum of this 
kind, when repeated examination had failed to discover the 
embryo in the blood. In this case the fluid flowing from the 
varices was straw-colored, and the groin glands were not en- 
larged. 
The past history of these cases varies greatly. Here is a 
patient who had suffered from elephantoid fever for at least 
fifteen years, and whose scrotum had only during the last year 
become a lymph scrotum. Here is another patient who, within 
six months of his first appearance of trouble due to the filaria, 
had developed a very marked condition of lymph scrotum; but 
as a rule a marked condition of lymph scrotum takes about a year 
to develop, and every degree of varicosity is produced. The 
largest varices are generally found near the root of the penis. 
Occasionally the testicles are a little thickened, especially if 
there has been an attack of filiarial orchitis. Also, single or 
double hydrocele may or may not be present. 
