Page:Archives of dermatology, vol 6.djvu/21

INFLAMMATORY FUNGOID NEOPLASM. 9 in the densest portions were fused. The epithelium on the free surface of the lesion was absent, the border displaying a frayed con- dition, from which the cells had apparently been washed out. In the submucous connective tissue and between the muscular bands the cells were found in abundance, especially beneath the circumscribed swelling. Beyond the borders of this swelling they also existed, but in fewer numbers.*

From the foregoing notes of the autopsy we observe that certain glandular structures were involved in the morbid process, a point of interest in considering the pathology of the disease. The nature of this alteration, however, is capable of more than one explanation. We have, moreover, seen that of the internal organs the bladder alone exhibited positive signs of disease. That the formation on the internal surface of this organ was of the same character as those on the integumentary surface can, I think, admit of no question; and its occurrence here goes to show the tendency of the disease to attack free surfaces rather than deep-seated tissues. This observa- tion is also corroborated by the lesions which were noted to occur in the mouth and vagina. The character of the growth of the parotid glands, as stated, may be differently construed. — that is, as being due either to simple inflammatory changes, giving rise to simple hyperplasy, or, on the other hand, to a direct involvement of these glandular structures by the same morbid process as existed on the skin, mucous membrane, and wall of the bladder. I strongly incline to the latter view. The clinical features certainly point to this conclusion, while their microscopic appearances likewise leave no doubt in my mind as to the identity of the process at work in all of the structures invaded.

The notes of the case have been so fully recorded that but little remains to be remarked upon. The symptoms throughout the course of the disease were so peculiar that it was deemed a matter of im- portance that they should be noted in extenso. They certainly are of the greatest interest. Such an array of curious symptoms cannot, it seems to me, be regarded as peculiar to the case but rather as characteristic of the disease. I know of no disease where similar objective and subjective symptoms are encountered ; certainly not in the recognized forms of sarcoma, as we know this disease and as it is described by authorities, nor in the several varieties of carcinoma, the only known maladies which one would be inclined to call to mind.

A point of great interest exists in the action of the morbid process to the influence of internal remedies. As will be recalled, among the numerous and varied medicines employed in the early stages of the disease with the hope of arresting or modifying the process, there was not one which exerted the least beneficial effect;

that portions of perfectly healthy tissue from various regions of the integument, as well as portions from all the internal organs and glands, were not removed and examined.
 * In thelight of the results of the microscopical examination, it is to be regretted