Some comments and discussion on the paper "The etiology of tumors", read before the Pathological Society of Philadelphia, April 28, 1881 / by H.F. Formad.

  • Formad, H. F. (Henry F.), 1847-1892.
Date:
[1881?]
Catalogue details

Licence: Public Domain Mark

Credit: Some comments and discussion on the paper "The etiology of tumors", read before the Pathological Society of Philadelphia, April 28, 1881 / by H.F. Formad. Source: Wellcome Collection.

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    9 Though in my own research I did not succeed as yet to confirm the observations of Woodward and Classen, they are pos¬ sibly correct, and I utilize them as coming from such high authority. Besides, they correspond so remarkably to what I be¬ lieve to have established for fibroma. My view of the histogenesis of fibroma holds good also for primary glandular car¬ cinoma. The glandilemma or basement mem¬ brane in glands (wherever such exists), upon which the epithelial cells rest, may be destroyed in precisely the same manner as the endothelial sheaths of the fibrillar bundles. This is demonstrable in car¬ cinoma beginning to develop in a gland, or in the transformation of an adenoma into cancer. Here, as in fibroma, only an inflammatory process can accomplish this destruction of the normal boundaries. These boundaries, if not re-established after an injury by perfect healing, there is nothing to prevent the epithelial cells from travelling into surrounding connective- tissue spaces and to thus form a cancer. I have here reference to the destruction of the endothelial boundaries which forms the basement membrane of the epithelium alone. The endothelial ensheathment of the connective-tissue alveoli remains per¬ fect in the cancers unless it becomes in¬ flamed. It is not the want of resistance of the surrounding tissue (as is generally held), but simply the getting loose of the normal cells from their place of attachment, which constitutes the formation of a malignant tumor. It is the mobility of the cells, I think, that conditions the malignancy of a tumor. Any tumor, even the most benign one, would be eminently malignant if the cells composing it could get loose and travel through the widely open paths of the system of juice-channels. In benign tumors the cells are more or less fixed, hence no metastasis. The en¬ dothelial basement membranes and en- sheathments are, however, here also defect¬ ive. The-physiological boundaries which maintain the equilibrium and keep the cells in position and in harmony with one another are found absent in that tissue which gave rise to tumor-formation. As it is not proven so far that any other pathological process besides inflammation is capable of destroying the endothelial ensheathments and basement membranes, I am driven to the conclusion that all. true tumors are direct products of the inflam¬ matory process, and that true tumors should be considered as one of the terminations of inflammation. DISCUSSION. Dr. S. W. Gross said that the main prop¬ ositions propounded by Dr. Formad were, first, that all tumors are the products of the inflammatory process, and, secondly, that in the development of tumors there is a de¬ struction of normal boundaries. Gumma and tubercle are regarded by the author as tu¬ mors ; but Dr. Gross thought that the term should not be applied to the temporary pro¬ ducts of specific inflammations, but that it should be restricted to permanent additions to the normal tissues. Dermoid cysts ought certainly to be included, as should also an- geioma and lymphangeioma. The former nat¬ urally comes under the classification of cystic growths, while the latter — in regard to the causation of which Dr. Formad confesses that he has strained a point—are not merely con¬ genital enlargements of pre-existing vessels, but are composed partly of newly-formed ves¬ sels, and should, therefore, be retained among the neoplasms. While it is true that in carci¬ noma of the breast the membrana limitans, or glandilemma, of the acini and ducts is destroyed, it is equally true that it remains intact in adenoma of that organ : so that, in the formation of tumors, normal boundaries are by no means always destroyed. Dr. Gross was convinced that inflammation, or a process nearly related to it, plays an important part in the etiology of many tumors, but he thought that Dr. Formad was too exclusive in his theory. He, moreover, believed that Dr. For¬ mad was too sweeping in his assertion that inoculation with the juice of neoplasms was incapable of begetting similar growths. Dr. Formad, indeed, quotes several experiments which disprove his own positive assertions ; and Dr. Gross related the following cases, which he thought supported the doctrine of the inoculability of tumor-juices. The first case shows that sarcoma may be transmitted to man from an animal, and the second and third demonstrate infection in the same individual other than by metastasis. Case /.—An ox was affected with a subcu¬ taneous tumor behind the scapula, which proved, on removal, to be a medullary sar¬ coma. A few days before the operation the owner made an incision into the swelling on account of pseudo-fluctuation, and there was a sanious discharge for some days. The wife, aet. 23 years, was in the habit of cleansing the part, and had at the time a small wound on the outer side of the fourth finger of the right hand. In a few days a small warty excres¬ cence was noticed on the finger, which soon