The appearances of these tumours are represented in the foregoing engravings, and the microscopical characters of vascular tumours is well seen in the following section, after Paget. They are usually soft, emptying and becoming pale by pressure; filling and becoming turgid, like erectile tissue, when the circulation is excited-but they may harden with clots of blood, phlebolites, &c. They are usually congenital; but, besides the instance I have mentioned, Warren describes one which grew about the eyelids in a girl 17 years old. Sir R. Carswell believed they often depended on atony of the vessels throughout the system, for he has found large arteries, as the iliacs, tortuous and distended in many of these cases.

Neuroma, or a swelling on a nerve, may be alluded to. We owe nearly all our knowledge on the subject to the treatise of Prof. R. W. Smith, which is the most exhaustive and most splendidly illustrated monograph ever published upon any disease. One form, "the painful sub-cutaneous tumour," was described and so named by Wood, in 1812.

Before commencing the next division of morbid growths, there is a class of tumours which are supposed to hold an intermediate place between innocent and malignant diseases, as the terms "semi-malignant" and "recurrent" indicate. There is a growing tendency, however, among pathologists to consider cancer as something not entirely distinct from the normal constituents of the body. This view is expressed by Mr. M. H. Collis, of the Meath Hospital, in the following formula: "The nearer in form and power of development that the constituent cells of a tumour are to the healthy lymph-cell, • the more innocent is the tumour; the further removed, the more destructive."—(" Dub. Quart. Journ.," Nov., 1860).

The tumours which are most apt to return are those which combine the characters of the fibrous and fibrocellular hence they are described by Paget as recur

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ring fibroid;" but any class of tumour may possess this character, in which alone they differ from more innocent examples of the same type. This unrivalled pathologist, in his latest work ("Tumours-Holmes' System of Surgery"), says: "The general appearance of recurrent tumours is, in their first growth, often not distinguishable from that of tumours of the same structure that are not likely to recur; they may look like ordinary fibro-cellular, fibrous, or other tumours. More often, however, they differ from these ordinary tumours in that they are softer, more succulent or glutinous, glistening or translucent, brittle or easily torn, with a kind of fibrous grain. Commonly all these peculiarities become more marked in the successive recurrences of the tumour; and the later growths are generally like masses of yellow or ruddy soft gelatine, with blood-vessels. The later are,

also, usually much more rapid in their progress than the earlier growths, and are generally less well-defined, penetrating further and more vaguely among the interstices of adjacent parts, and more quickly protruding through the skin or scars over them. The likeness of recurrent tumours to cancers, in many of these points, is evident. But their unlikeness is as distinct. They rarely look like cancers to the naked eye-never to that assisted with the microscope; their homology with the natural structures, though in a rudimental, and, it may be, degenerate state, is clear. They do not affect the lymphatics; their recurrence is in loco; and in the few cases in which, late in the disease, similar growths have occurred in the lungs, it may be suspected that the propagation was by direct carrying of germs with the blood from vessels into which a tumour had grown-as in the case of cartilaginous growth in the testicle. Moreover, after repeated recurrences, the patient commonly retains apparently good health, and shows none of that cachexia which would almost certainly exist in a patient who had suffered repeated recurrences of cancer."

In the same debatable ground may be placed the morbid growths named Epithelioma by Hannover. The cells of epithelium and epidermis are constantly being shed and replaced by new ones; but, if generated in increased numbers by some morbid physiological stimulus, or if their exuviation be prevented, they give rise to

Warts and condylomata, which grow from mucous surfaces, or where sebaceous follicles abound in skin, are also, however, papilla-like masses of such cells, with a capillary looping into each projection. Those which occur round the anus, the mucous tubercle, or "plaque muqueuse" of Ricord, are syphilitic, and some believe contagious.

The common epithelial tumour of the lower lip, or that of the cervix uteri, mainly consists of epithelial cells of various sizes and degrees of formation. Sometimes,

deep in the mass, large circular spaces filled with cells may be found, and they are termed "cell-nests." Some may measure, and as they seem to generate other cells by endogenous growth, are named "brood-cells." In others the cells are more intimately infiltrated into the tissues. It is remarkable that men are more subject to this disease in the proportion of 86 to 19. The foregoing representations of the cells of Epithelioma are from Mr. Richardson's paper in "The Dublin Hospital Gazette.' Some growths from mucous surfaces, often termed "villous cancer," are of this papillary nature, as also is the "cauliflower" excrescence of obstetric writers. Paget, who regards epithelial tumors as cancerous, sums up his reasons for that view as follows; and from their consideration, and a careful microscopical examination of one which grew on the left tonsil of a patient of mine, I am inclined to coincide in them to the fullest extent:

"1. The interstitial formation of structures like those of epithelium is not an imitation of any natural tissue; it constitutes an heterologous structure-for superficial position is more essential to the type of epithelial structures than any shape of elemental cells or scales is. 2. Even that delusive appearance of homology which exists when the structures like those of epithelium are formed in the dermal tissues, and therefore near the surface, is lost in nearly all the cases of deep-seated epithelial cancers, and in all the similar affections of the lymphatic glands and internal organs. 3. The interstitial formation of cells in epithelial cancer is conformed with the characteristic plan of all cancerous infiltrations, and leads to a similar substitution of new structures in the place of the original tissues of the affected part. 4. The interstitially formed cells often deviate very widely from the type of any natural epithelial cell, in

shape, in general aspect, in method of arrangement, and in endogenous formation. The difference between them and any natural elemental structures is, indeed, much greater than that between many medullary and schirrhous cancer-cells and the cells of the organ in which they grow: e. g. it is sometimes difficult to distinguish the cells of a medullary cancer in the liver from those of the liver itself. 5. The pathology of epithelial cancers is scarcely less conformed than is their anatomy to the type represented by the schirrhous and medullary cancers; for, not only are they prone to incurable ulceration, and to repeated recurrence after removal, but (which is much more characteristic) they usually lead to the formation of structures like themselves in the lymphatic glands connected with their primary seat, and they lead sometimes to similar formations in more distant organs. 6. In their growth, and in their recurrence, there is no tissue which the epithelial cancers do not invade and destroy. 7. A peculiar liability to them seems to exist in certain members of those families in which schirrhous or medullary cancers also occur."

CANCER,

Is a term which properly includes the following varieties of malignant disease, for they are all distinguished by the character from which this ancient name is derivednamely, that of spreading and infiltrating into all tissues:

I. Scirrhus, of which the disease affecting the mamma may be taken as the type. It is a heavy, hard, inelastic mass, often as firm as fibro-cartilage, and in size never exceeds the normal size of the portion of the breast it attacks. It is infiltrated as intimately into the organ as lymph is in pneumonia, and has no capsule. When firmly pressed, a "juice" exudes; and the dry fibrous matter which is left is termed the "stroma"-a structure not proper to the cancer, being only the areolar tissue of the part; thus, for instance, if schirrus is de