Page:Archives of dermatology, vol 6.djvu/399

 PAPILLOMA CUTIS. 387

pation of cancer of the throat (Dr. L. Elsberg's case), and satisfied myself about the presence of epithelial emboli within the capillaries of the liver. Clinically, therefore, it is of the greatest importance to determine in each case whether the cancer be a primary or a secondary formation, all operative interference being prohibited in the latter instance. The relatively mildest forms of cancer are those occurring in the face, especially in its upper half; the rela- tively worst are those of the rare melanotic variety. A ll observers agree to-day as to the local origin of cancer, and the idea of a primary cancerous dyscrasia, or cachexia, or blood- disease, is abandoned. The cause of cancer is unknown. What we do know is that a relatively strong constitution is required for the production of cancer; hence persons afflicted with severe syph- ilis or tuberculosis are exempt from cancer. Secondly, a long-con- tinued local irritation is the main source of the formation of can- cer. Warts on the face or lips irritated by rough mouth-pieces of pipes, phimotic prepuces, the scrotum of chimney-sweeps, long- lasting ulcers of the legs, callosities of the feet, etc., often become the starting-points of cancer. Contrary to myeloma, cancer is a disease of adults in most instances, and is very rare under the thir- tieth year of life.

Lastly, I would draw attention to the fact that the structure of cancer not quite infrequently changes into that of myeloma when- ever a rapid growth takes place. In the worst kinds of cancer we can trace a gradual change of the epithelia into medullary elements, lastly to such a degree that the latest formations are devoid of epithelia altogether, and only exhibit the features of a very malig- nant myeloma.

UNDER the general designation of papilloma cutis, writers on dermatology have described the most various forms of cuta- neous disease, widely differing in their etiological and clinical sig- nificance, although possessing, perhaps, certain broad anatomical features in common.

In the following paper I have endeavored to make a short clinical study of the numerous pathological conditions to which the term papilloma has been applied, in the hope that by this effort to clear up the confusion in which the subject is involved, a more precise significance may hereafter be attached to the word. I have, there-

tion, Newport, R. I., Sept. i, 1880. For discussion, see p. 435.
 * Read at the fourth annual meeting of the American Dermatological Associa-