[Illustration:  FIG. 97.—­Elephantiasis in a woman aet. 45.]

A similar type of elephantiasis may occur after extirpation of the lymph glands in the axilla or groin; in the leg in long-standing standing varix and phlebitis with chronic ulcer; in the arm as a result of extensive cancerous disease of the lymphatics in the axilla secondarily to cancer of the breast; and in extensive tuberculous disease of the lymphatics.  The last-named is chiefly observed in the lower limb in young adult women, and from its following upon lupus of the toes or foot it has been called lupus elephantiasis.  The tuberculous infection spreads slowly up the limb by way of the lymph vessels, and as these are obliterated the skin and cellular tissues become hypertrophied, and the surface is studded over with fungating tuberculous masses of a livid blue colour.  As the more severe forms of the disease may prove dangerous to life by pyogenic complications inducing gangrene of the limb, the question of amputation may have to be considered.

[Illustration:  FIG. 98.—­Elephantiasis of Penis and Scrotum in native of Demerara.

(Mr. Annandale’s case.)]

Belonging to this group also is a form of congenital elephantiasis resulting from the circular constriction of a limb in utero by amniotic bands.

Elephantiasis occurring apart from lymphatic or venous obstruction is illustrated by elephantiasis nervorum, in which there is an overgrowth of the skin and cellular tissue of an extremity in association with neuro-fibromatosis of the cutaneous nerves (Fig. 89); and by elephantiasis Graecorum—­a form of leprosy in which the skin of the face becomes the seat of tumour-like masses consisting of leprous nodules.  It is also illustrated by elephantiasis involving the scrotum as a result of prolonged irritation by the urine in cases in which the penis has been amputated and the urine has infiltrated the scrotal tissues over a period of years.

#Sebaceous Cysts.#—­Atheromatous cysts or wens are formed in relation to the sebaceous glands and hair follicles.  They are commonly met with in adults, on the scalp (Fig. 99), face, neck, back, and external genitals.  Sometimes they are multiple, and they may be met with in several members of the same family.  They are smooth, rounded, or discoid cysts, varying in size from a split-pea to a Tangerine orange.  In consistence they are firm and elastic, or fluctuating, and are incorporated with the overlying skin, but movable on the deeper structures.  The orifice of the partly blocked sebaceous follicle is sometimes visible, and the contents of the cyst can be squeezed through the opening.  The wall of the cyst is composed of a connective-tissue capsule lined by stratified squamous epithelium.  The contents consist of accumulated epithelial cells, and are at first dry and pearly white in appearance, but as a result of fatty degeneration they break down into