Since presenting the case to the Association at the last annual meeting, Dr. Piffard has been kind enough to send me a photograph of his patient supposed to be suffering from the same disease,—the same case to which reference was made in the discussion at the last meeting. From a study of these photographs, together with the history and the statement that the patient had died, I have no hesitation in regarding the case as exhibiting the same disease as that under consideration. I am at present, therefore, familiar with four cases, all of which bore very similar clinical features.
Dr. Longstreth, who has been much interested in the case with me, at my request has kindly expressed his views as to the nature of the disease, which I take pleasure in presenting.
REMARKS BY DR. LONGSTRETH.
The striking phenomena of this unclassed and unnamed disease, found in this patient, viewed in an anatomico-pathological aspect, are the adherence, more or less close, of the lesions to the epithelial surfaces of the body,[1] the vast amount of material concentrated, and the absence of infection of other structures or organs of the body (by means of metastasis or transplantation).
The characteristic of the lesion appears to be the crowding of the connective tissue of the skin with cellular or corpuscular elements. Considered in respect to their form, the cells have nothing characteristic of any new formation or growth, merely resembling those of granulation tissue; in respect to their arrangement the cells do not present anything characteristic of a tumor growth. There is this statement to be made concerning the arrangement or massing of the cells, which seems to me to be conclusive (so far as it is possible to be conclusive) of the pathology of the lesion. The cells are arranged in more or less straight lines (at least this is true of the newly-formed lesions), and this arrangement is the same as I have found in a variety of inflammatory changes, marked by a similar abundant appearance of new cellular or corpuscular elements. As illustrations of this condition, I may refer to what is seen within the alveoli of the lung in croupous pneumonia, examined in the early stage of red hepatization; the exudation-cells are pressed close together in the meshwork of the fibrinous net, and, in the height of this stage of the
- ↑ "Epithelial surfaces" means a tissue or organ covered with epithelium, and of course includes the subjacent tissue or elements which have a histological connection with such a surface. For example, in respect to the skin the term is applied to the cutis and subcutaneous cellular tissue; it includes, therefore, three histologically connected parts, namely, the subcutaneous cellular tissue, the derma, and the epidermis. [See Strieker's Manual of Histology, chap. 26.] In respect to the mucous membrane, the term " epithelial surfaces" includes every structure or form of tissue met with from the surface down to the parts beneath, which are histologically disconnected with such a surface, that is,—from the surface to the fibrous sheath of the muscular layer. The term "epithelial surfaces," as it is used, does not refer, as was incorrectly stated or supposed in the discussion of Dr. Duhring's communication, to a component part of such "epithelial surfaces," namely, to the epithelium or epidermis alone.—M. L.
