12 LOUIS A. DUHRING;
disease, these cells are seen arranged in straight lines conformable in direction to the fibrous mesh, the cells, as it were, are strung in lines along the fibrin spanning the alveoli. The appearance of a Peyer's patch, when it has just reached the stage of most marked enlargement, presents a striated arrangement of the cellular elements very strikingly similar to that seen in the lung and in the lesions of this skin. The explanation of this arrangement of cells is to be found in the changes brought about in the normal tissue by the dis- tention caused by the influx of the new elements. The distending force of the cells stretch out, elongate, and render straight the con- nective tissue and other fibres, which under normal conditions have a tortuous arrangement. The cells naturally are confined within the limits formed by the fibres, and thus present a distinct striation. The arrangement of the cells, in relation to one another, is not a characteristic of pneumonia or of typhoid fever ; neither is it a characteristic of this disease, but it is an essential feature of the process by which the lesions of this skin were produced, and closely allies the processes of these morbid changes to each other.
The presence of the cellular or corpuscular elements in the tissues beneath the skin is comparable to the condition found in the sur- roundings of every inflammatory or other centre of infiltration, and the presence of these cellular elements in the adipose, muscular, arterial, or nervous tissues must not be viewed as a tendency of these tissues to degenerate into or to be involved in this lesion, — certainly not in the same sense as in the cancerous invasion of adjacent tissues. The muscular and fibrous coats of the intestine in typhoid fever be- neath an involved Peyer's patch, and the alveolar walls of the lung in pneumonia, show similar dissemination of cells as is found here in the tissues beneath the involved skin.
The second characteristic, viz., the amount of new material present in the lesion, has a twofold aspect of importance. In a clinical aspect, we have the malignant course of the disease and the cachectic appearance presented by the patient; in an anatomico-pathological aspect, we would expect to find systemic infection by metastasis.
Malignancy, used as a clinical expression, means that the disease or the lesion leads to death, and the degree of malignancy is more or less proportioned to the extent of the disease or lesion and of the accompanying blood alterations. The malignant course of the disease in this patient is to be accounted for by the vast amount of cellular constituents used in forming the lesions and the consequent alterations in the blood due to the withdrawal of the corpuscular elements from its current.
Cachexia, or the cachectic look of patients suffering from malig- nant disease, is a change by no means invariable or uniform. The cause of the cachexia is " the alteration or corruption of the blood and fluids" of the body, "bringing with it emaciation with anaemia and hydraemia, increased by ulceration and its consequences (loss of blood and fluids), as well as previous occupation of organs im- portant in the new formation of blood ; cachexia may be absent if
