Here again I cannot avoid remarking that, whether from the apparent insignificance of these growths in themselves, or from the regard paid to that affection of the internal organs which gives occasion for the examination of the body, the most accessible of them have received as yet but casual anatomical notice, and the distinctions between them have continued based upon their external characters only.

a. New growths of cellular tissue occur as:

A. Soft Wartlike

Soft Wartlike growths, attached by a pedicle, which constitute what is called the Molluscum simplex: the saccular dilatations of the corium are occupied by some cellular tissue at various stages of its development. They occasionally also contain fat.

ft. Fleshy excrescences on the nose - exuberant or bottlenose: these are composed of a luxuriant growth of corium and of cellular tissue.

£. Condylomata are common about the organs of generation and the anus, especially on the mucous membrane of the former. Some of them are soft, others firm: in their form they may be broad and pointed: sometimes they are attached by a pedicle, and very often their extremities resemble a mulberry, a cauliflower, or a cock's comb. They are composed of an investing layer of epithelium and of newly formed cellular tissue; and they originate in the corium, where their points, which, as is well known, are the more unmanageable part, take deep root (Simon). With these most probably we may connect those out-growing tumors which occur in the Pian of tropical climates, and have by many been regarded as syphiloid; as well as various affections that are met with on the coasts of Europe, for instance, the Radesyge, etc.

B. Fatty Tumors

Fatty Tumors are usually congenital: sometimes only one exists; at other times there are several, which are situated at other parts of the body. They form rounded, globular excrescences, which are, for the most part, truncated and attached by a pedicle, and sometimes grow to a considerable size. They consist of a prolongation of cutis, and enclose some fatty tissue, which seems like a protruded lobule of subcutaneous fat; for at the base or neck of the excrescence it is continuous by a sort of pedicle with the general subcutaneous adipose stratum. The epidermis covering them is sometimes dark-colored, and pigment (Naevus lipo-matodes of Walther), and unnatural hair often grows upon them. When it is a congenital disease, it is often associated with naevus in other parts of the skin. In some few cases, these lipomatous growths are developed in later periods of life.

C. Fibroid Tissue

Fibroid Tissue occurs in skin thickened by repeated, or by chronic, attacks of erythema; in the wheals and knolls of the skin in cases of elephantiasis, etc. It also constitutes cicatrix tissue.

D. The Growth Which Alibert Has Denominated

The Growth Which Alibert Has Denominated cheloid may probably be placed in connection with the last named; for it appears to consist of fibroid callus, and with that appearance its external cicatrix-like aspect corresponds. There are several varieties of cheloid; it may be a simple hardness or callosity of the skin, either flat, somewhat raised, or depressed, and white or pale rosy-colored; or it may be cord-like: in either case it frequently terminates in white or red elevated lines or processes (the spider-like pimple of Warren), and is of considerable extent. It occurs, for the most part, singly at the upper part of the trunk, on the extremities, or on the face; in very few instances does any large number exist.

It very rarely ulcerates; when it does so, the sore may now and then have a malignant (bösartig) character. Some constitutional disorder lies at the root of every case, but the nature of it is unknown; that it is cancerous is altogether problematical.

E. Anomalous Bony Substance

Anomalous Bony Substance is extremely rare in the skin. I once found, in the substance of a scar on the trunk, an oval, yellowish, hard, rugged, osteoid plate, about the size of a thaler.1 It corresponds precisely with the calcareous growths occurring in fibroid exudations upon serous membranes.

F. Teleangiectasis In Skin

Teleangiectasis In Skin is the well-known vascular naevus; it is almost always congenital. Sometimes it forms deep-red, or bluish-red, stains of extremely various size and form (Feuermal, - moles), and sometimes red tumors, which are shaped like cherries, strawberries, mulberries, etc, and are capable, more distinctly than the former kind, of a transient swelling (Dupuytren's erectile tumors, - splenoid tumors of other authors). But they do also commence in after-life, and in themselves are at first quite of a benignant, that is to say, not of a cancerous, nature. Nevertheless, if there be a cancerous cachexia, the teleangiectasis may unquestionably become the seat of a cancerous growth; and, under such circumstances, it has been taken for a special form of cancer - Fungus haematodes cutis: it is not, however, an essential form of that disease, but is merely an accidental complication.

1 [About the size of an English half crown. - Ed].

Teleangiectasis consists of a network of enlarged capillary vessels, imbedded in a delicate, and partly undeveloped cellular tissue.

G. Melasma, (Benignant) Melanosis

Melasma, (Benignant) Melanosis includes both the black coloring which is observed, in some few cases, spread over the whole body, but more frequently limited to certain parts, especially the lower extremities; and also more particularly the accumulation of deep black pigment, in small raised points and berry-like tumors on the trunk and face. The pigment is deposited on the surface of the cutis, and in the latter case in its tissue also. Melasma occurs only in aged, decrepit, and cachectic persons, and must, of course, not be confounded with cancer melanodes.

H. Cysts

Newly formed cysts do not occur in the skin itself; but, instead of them, the sebaceous glands not unfrequently degenerate into cysts of large size, of which I shall speak presently. There are often also cysts in the subcutaneous cellular tissue which become, in various ways, closely connected with the corium. Such cysts very commonly contain cholesterine, which is also quite constant in the morbidly enlarged sebaceous follicles.

I. The Occurrence Of Cholesteatoma

Associated with these is the occurrence of cholesteatoma, as a stratum covering open ulcers of the skin. I have not only met with this upon carcinomatous ulcers, as others have observed it, but have also seen it produced exuberantly, in large masses, on an ulcer of the skin of the right knee, arising from burn.

J. Tubercle

There appears to be no tuberculosis of the skin corresponding to that which occurs in and upon mucous and serous membranes, parenchymatous structures, etc.; at least its existence is altogether problematical. Upon ulcers, however, which arise from various exanthe-matic cutaneous affections of what is called scrofulous character, a product resembling softening tubercle, or puriform tubercular matter is seen, from which the ulcer obtains a character approaching that of the ordi-dary tubercular ulcer upon mucous membrane, particularly the intestinal ulcer.

The skin is subject, also, to ulcerative softening of a less definitely tubercular character during the softening of tuberculous lymphatic glands, and of tubercular depositions in the subcutaneous cellular tissue, as well as when there is ulcerating tubercle in bone.