Page:Archives of dermatology, vol 6.djvu/27

INFLAMMATORY FUNGOID NEOPLASM. 15 into another; this method of classification was dispensed with, I supposed, when we refused to take scrapings of a tumor and call it cancer, because the microscope showed irregular-shaped cells. There is nothing in the structure, relations, or the mode of production of this disease, which resembles sarcoma. A sarcomatous tumor is decided to be such, not because its cells are spindle-shaped or round, but because the growth, made up of spindle or round cells as a whole, has a certain relation to the tissue in which it is placed. A disease of the intestine is decided to be typhoid fever or tubercle, not according to the kind of cells found, but according to the position of the cells and the relation they bear to the tissue in which they are placed. As already explained, the disease cannot be regarded as one occurring in a connective-tissue structure, and therefore we should not be inclined, from its apparent seat beneath the epithelium, to place it among sarcoma; it occurs in an "epithelial surface," and the connective-tissue part of this surface has its histological 'descent'', not from the same blastodermic layer as the connective-tissue organs of the body, viz., the middle, but from the outer or epithelial layer.

Again, particular stress must be placed on the vast amount of material required in the construction of the lesions. Whether the material has its origin in the blood or in the tissue there is no means of deciding, and, therefore, whether there was a dyscrasia present is undecided. What is probable is that the corpuscular material in the lesions was transferred to the blood on the subsidence of a swelling (we have no observations of the blood in the later stages of the disease to decide this point), and that the cachexia and malignancy (closely connected conditions) are the results of the vast amount of the corpuscular material being thus thrown into the blood-current, attacking and destroying its normal structure.

And again, let us remember the absence of infection of other organs, which, with such monstrous lesions, composed of such highly succulent material, is incompatible with the supposition of a sarcomatous growth.

I do not mean to say that this disease is a simple inflammation; it may have to be placed in an intermediate district between inflammation and new morbid growths or tumors; I do not think it should be placed among sarcomata, until that division of new growths receives the revision it so much needs and is recast. Better let it be unnamed and unclassified than be placed and become fixed wrongly.