Page:Archives of dermatology, vol 6.djvu/25

INFLAMMATORY FUNGOID NEOPLASM. 13 the malignant growth is small, firm, and remains confined to its original seat or place of origin." [Samuel, Hanb. d. allg. Path., etc., iii. abth., s. 602, u. iv. abth., s. 903.]

It would seem a priorixdX the change of color, as well as the other phenomena of cachexia, must be due to a blood change rather than to a general tissue change (except so far as general tissue changes necessarily accompany blood alterations), and that the blood change must be one especially affecting its corpuscular elements or the proportion which the white corpuscles bear to the red. It seems a priori probable, also, that if it be true, as Samuel says, that in small, firm, non-metastatic tumors cachexia is 7wt present, and conversely that in soft, cell-rich, malignant growths, giving rise to metastatic knots, cachexia is present, in the one case the blood would be rich in corpuscular elements (derived from the cell-growth of the tumor, its immature cells or nuclei), and in.the other case would be poor in such cells ; and also that such corpuscular elements are the cause, at least in part, of the altered appearance of the cachectic patient.

I have a very few observations in which a marked cachectic appear- ance was coincident with an increase of corpuscular elements in the blood, resembling white corpuscles. In the case here referred to the autopsy proved the existence of a malignant growth, rich in cells, and I have no doubt that nuclei or immature cells of the new growth found their way into the blood-current and gave rise to the increase in number of so-called white blood-corpuscles counted in the blood during life. The cachectic appearance of this patient similarly may have been due to the existence of altered corpuscular proportions of the blood. The rapid increase and the equally rapid diminution of the lesions, and the lymphatic gland enlargement (which had also rapid rises and falls), show conclusively that the blood must have been not only the source of this vast amount of misplaced material composing the skin lesions, but also the recipient of it after the absorption of the lesion and the subsidence of the gland enlargement.

The vast amount of material in the lesions, viewed from a purely anatomico-pathological aspect, would lead us to expect, if this disease were a sarcoma, to find metastatic knots in other parts of the body. A sarcomatous tumor, so succulent, so rich in cells, and with cells so mobile, would almost certainly have had such a result.

In respect to the third one of the characteristic phenomena of this disease, viz., the absence of infection of other organs of the body by metastasis, something still remains to be said. The lesion of the urinary bladder is not to be regarded as a metastatic formation but as an exhibition of the tendency of the morbid process to develop and manifest itself on and about a free "epithelial surface." It is an outburst of the disease at a new surface point, just as occurred on the cutaneous surface at so many points ; surely these skin lesions are not to be spoken of as metastatically related to one another. The occurrence of the lesion of the bladder does not follow the rule concerning the infection of distant organs. The process of meta- stasis consists in the absorption, by lymphatic agency, of the cells or