may be which occurs in the vascular tissue itself is not clear, nor can it be made out so long as we are in ignorance of the original condition of the vessels. Is there at first simple increase in the amount and size of the proper vessels? or are there lacunæ left in the growing tissue with which the vessels communicate? Mr. Paget inclines to the former view, and supposes that the walls of the mutually apposed vessels ultimately thin and give way, forming blood-spaces. This, probably, is the case in the active arterial vascular growths. In the tissue of the tumours now described there is no evidence of such a transition from simple increase of the vessels to the formation of blood-spaces, no enlarged or tortuous vessels, and no lining to the cavities. The blood is not driven into the tumour through one or two large and active vessels creating pressure on its contents and walls such as is seen in an aneurysm; on the contrary, the most remarkable point in the operation of removal of these tumours is the entire absence of hæmorrhage from any vessel feeding them. If cut into, no doubt the bleeding from them would be very abundant, but the supply of blood is evidently derived from the general vascularity in the neighbourhood, and no single vessel is large enough to give rise to hæmorrhage. It is possible still that the presence of blood-spaces may be due to pressure and absorption, but the mere physical cause of their formation is of secondary importance. The essence of the disease is the new condition of growth, which, having its starting-point perhaps in some abnormally developed tissue, determines a similar condition in all parts within its reach. Hence, the term tumour may fairly be applied to all these growths, whether they become in the end isolated by the formation of an investing capsule of cellular tissue, or spread without limitation in the plain of a muscle or other tissue which they involve. They are not mere hypertrophies-their whole history is opposed to that view-they are of the nature of new growths, possessing their own peculiar and distinctive character. In using this term it is not of course implied that the structure possesses any new or peculiar elementary tissue which could not be discovered in some form or under some arrangement in the normal structure; so limited, perhaps, there is in reality no such thing as new growth, except in the case of parasites. Nor is it implied that there is such a wide deviation from the normal structure as is found in true cancer; but, at any rate, there is as good reason for classing these diseases amongst new growths as there is for placing adenoïd or cystic tumours in that category. The structures may be histologically the same, but their mode of development and the relative amounts and general arrangement of the elements which enter into them differ so greatly from what is seen in the normal condition of the parts involved that they may fairly be considered as tumours. As in Cruveilhier's case, already mentioned, there is at times a disposition to the development of the disease in a number of different places, reminding one of the tendencies of cancer, and this is more remarkably seen in another instance figured by him (Livraison 27, Planches 3 and 4), where the hand and arm were studded with innumerable small tumours, varying in size from that of a small shot to

that of a large bean, lying, some in the skin, some under it, and some below the fascia and in the midst of the muscles. They all consisted of erectile tissue. Cruveilhier seems, indeed, to consider that there is a relation between erectile tumour and cancer, and that in their stroma the two are much alike, their differences being that in one case the spaces are filled with blood, and in the other with cells. Though one may be indisposed to go this length, yet it is a fact which has been long recognised, that of all forms of abnormal growth none are more prone to degenerate into cancer than those which fall generally under the name of vascular tumours. I may here mention another remarkable case of this kind, in which there appeared little doubt as to the tumours, numerous as they were, having a congenital origin. A man, aged sixty-three, was admitted into the medical wards of the Middlesex Hospital, in 1854, for hæmatemesis. He presented over many parts of the body venous nævi-some in the skin, some subcutaneous. They existed in large numbers on the forehead, face, and neck; in the latter situation they formed a large mass on each side. Similar tumours were found studding the shoulders, arms, hands, and legs. Some of these appeared to be dilated veins simply-some had merely the characters of mother's marks. None of them were much affected by steady pressure. On the left side of the tongue was a large vascular tumour. He said that he had had them all for as long as he could remember. This patient was admitted again in 1855 for hæmorrhage from the urethra, caused by the abrasion of a small vascular tumour in that situation. general health had always been very good.

His

The diagnosis of these vascular tumours is not always so easy as is generally supposed. In the first case, that of Ruth Edwards, there was no difficulty; the emptying and filling of the tumour under the circumstances described, left no room for doubt as to its true nature, but in the second case such a diagnosis was impossible; the tumour was so small and so deeply seated that the changes of bulk which might have taken place in it could not be recognised. In Mr. Shaw's case, again, there were no characters in the tumour itself by which its nature could be determined; the fact of its having existed from the time of birth was the great ground for regarding it as possibly a deep-seated nævus.

A somewhat curious case of blood-tumour came under my care a short time since, in which, though it was subcutaneous, none of the diagnostic signs of such tumours were present. A man, aged fortyone, came to the Middlesex Hospital to have an operation done for the removal of some necrosed bone in the radius. He pointed out a small tumour on the other forearm, which had never given him any trouble, but which he thought might as well be removed at the same time. The tumour was about the size of a large marble; it rolled freely under the skin, which presented a network of fine veins on its surface. It was suspected to be a vascular tumour; but neither pressure upon it, nor upon the veins above it, nor change in the position of the arm, made any alteration whatever in its size and consistence, which was that of a somewhat condensed fatty tumour. Hence it was believed to be really a simple fatty tumour, and the more

so, as the man was positive in his statement that it had not existed for more than ten years, and that when first seen it was not so large as a very small pea. I therefore cut down directly upon it and into it, when its true nature was at once seen. The texture looked like that of spleen, and the blood oozed from it as if squeezed from a sponge. It was very readily turned out, however, and there was a good deal of venous bleeding, which was easily stopped by a compress. The wound healed by the first intention.

For an examination of the structure of the tumour I am again indebted to Mr. Hulke, who reports that "it is composed of cavernous tissue, and does not contain any muscular element, neither did I meet with any yellow elastic tissue. The cavernous structure was enclosed in a capsule of connective tissue, and its connexion with the veins outside was not obvious." The specimen is in the museum of the hospital.

The term erectile is not then universally applicable to vascular tumours. Here, for example, we find a growth which was not undergoing any process of degeneration, and was as active probably as at any period of its existence, yet was totally devoid of any recognisable erectile character.

Neither probably could the term be applied to the first form of deepseated blood-tumour which I have mentioned, in which, to all appearance, there is a simple varicose state of the veins. Still less is known of the real nature of these than of the other forms. Probably they are not in reality mere dilatations of the veins, but are true bloodcysts, such as exist sometimes as secondary formations in the erectile tumours, and sometimes are found as isolated tumours, unconnected with any venous trunks. Of such a nature was the blood-cyst before alluded to, a report of which, by Dr. Buchanan, appears in the eighth volume of the Pathological Society's Transactions, p. 363. It was situated in the gastrocnemius muscle, which, in fact, was converted into a cyst that contained about ten ounces of viscid fluid, homogeneous, and of a brownish-red colour, not unlike bile." There were also a few loose shreds, the remains apparently of old coagulum. There was very little of the muscular tissue of the gastrocnemius left. The walls of the cyst were formed of tough membrane, which appeared composed of condensed and altered muscular tissue. On microscopical examination, the walls presented little beyond fat, though in some parts muscular fibres, with the transverse striæ hardly recognisable, were to be seen. The tumour was only discovered after death, and no previous history could be obtained.

I cannot help suspecting that the following case had its origin in some form of cutaneous nævus:

Some years ago I removed a tumour about the size of a large orange from the back of a gentleman where it had been growing for eight years, and who wanted to get rid of it merely because it got chafed at times. It was situated over the left scapula. It was somewhat dark-coloured and rather flaccid: it could not be diminished in size by pressure; no vessels could be seen running upon or near it.

It was clearly a cyst with thin walls, and I removed it by elliptical incisions round its base. I was certainly astonished at the active hæmorrhage which took place from five or six arteries-the blood spirted out round the tumour as if from the rose of a watering-pot. As soon as the tumour was removed all the bleeding stopped, and we could not find any vessel to take up. On cutting through the tumour it was found to contain nothing but blood, with smooth, thin, old fibrous layers lining the walls, which were otherwise not thicker than ordinary cardboard. The base was more solid, but nothing could be found in it save condensed fibrous tissue. No vessel could be discovered entering into the tumour. The wound made for its removal healed almost entirely by the first intention, and there has not been any return of it. It may be questioned, of course, whether this was truly a blood-cyst, and not an ordinary cyst which, from friction or injury, had had blood effused into it; but the remarkable vascular activity in the skin around it, which ceased so rapidly on its removal, indicates that its original connexion was with the blood vessels. The case is reported by Mr. Flower, and a drawing of it given in the eleventh volume of the Pathological Society's Transactions, p. 237. The preparation is in the Museum of the Middlesex Hospital.

In the same Museum is also a preparation presented to it by Mr. Hulke, of a vascular tumour which he removed after death from the neck of an infant a few months old. It had been considered during life to be a deep-seated venous nævus. It was covered by the trapezius, which adhered intimately to it, and by the sterno-mastoïdeus. Reaching from the occiput to the upper border of the scapula, and passing forwards under the sterno-mastoïdeus, it communicated by a short wide trunk with the internal jugular vein. It has an irregular tuberous form, and consists of freely communicating blood-spaces varying from the size of a large filbert downwards. These are lined by a smooth, continuous membrane, which structurally resembles the inner coat of a large vein, and is distinctly separable from the septa, which imperfectly divide the spaces, and which consist of connective and elastic tissues. No muscular tissue exists in these septa. This latter point, which Mr. Hulke has clearly made out, and the fact of the free communication with the internal jugular, indicate that the tumour was not primarily seated in muscle, though its close investment by the muscular fibre seemed to point to such an origin. It is, however, a remarkably fine specimen of the cystic vascular tumour.

In Cruveilhier's plates, and especially in the one before referred to, these blood-cysts are seen in various situations and states. In some places they appear to be undergoing a change towards the erectile form; in some they lie on, and are connected with, large venous trunks; in others they are unconnected with any large vessel, and lie as isolated masses in the midst of the cutaneous and muscular tissues. Here and there are small single cysts; at other parts they form clusters like berries. The "black-currant-like cysts" observed in Mr. Shaw's case were probably of the same nature.

These formations, however, require investigation as to their mode of

origin and growth, and their connexion with the other forms of blood

tumour.

The terms erectile tumour and blood or vascular tumour have been used in preference to the more lofty-sounding one of " telangeiectasis," inasmuch as they are far more easy to read and write, and as they convey quite as correct a notion of the character of the disease. The term erectile simply points to a fact that these tumours under certain circumstances become turgid, and again empty themselves: it does not imply that they possess the peculiar nervous endowments and vascular arrangement of the normal erectile tissue.

ART. III.

On the Phytopathology of the Skin, and Nosophytodermata, the so-called Parasitic Affections of the Skin. By ERASMUS WILSON, F.R.S. SHORTLY after the first discovery by Remak, in 1836, of the phytiform structure of the yellow matter composing the cups of Favus, and their further illustration by Schoenlein of Zurich in 1839, Gruby of Vienna proposed that the diseases in which this structure had been observed, which were then two in number-namely, Favus and Aptha— should be placed in a group, to be termed Nosophyta, with the distinctive titles, Porrigophyton and Apthophyton. And, subsequently, having discovered a similar organism in mentagra, Gruby further proposed to add that disease to the same group under the name of Mentagrophyton. No better term than Nosophyta has been suggested by any of the phytopathologists who have succeeded Gruby; it expresses the bare scientific fact of the association of a plant-like organism with certain diseases; it commits those who make use of it to no theory; and therefore we adopt it as the title of our present essay.

The Nosophytodermata are five in number, namely:-Favus, vel Tinea favosa; Trichosis, vel Porrigo tonsurans; Mentagra, vel Sycosis; Alopecia areata, vel Porrigo decalvans; Chloasma, vel Pityriasis versicolor. These diseases form a natural group, which is distinguished by a morbid alteration of the epidermis and hairs, rendering them friable and brittle, changing their appearance and colour, and causing their exfoliation and fall. The epidermis loses its smoothness, the hairs lose their polish; the former becomes spongy and furfuraceous, the latter become faded, discoloured, and shrivelled, and break off close to the skin, suggesting the idea of being cropped by artificial means; hence the terms, tonsurans, tondens, tonsoria, &c., applied to one of these diseases.

Closer observation detects certain differences between them—for example, favus and mentagra affect chiefly the hair-follicles; trichosis and area chiefly the hairs; and chloasma chiefly the epidermis. Favus has the appearance of a yellow flat pustule, often of considerable breadth (two or three lines), surrounding the mouth of the hair-follicle and hair; trichosis is known by the broken state of the hair, which gives an aspect of bareness or seeming baldness to the diseased parts;