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.

H. F. Formad

Date:: [1881?]

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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general law concerning the etiology of tumors, let him and those who seem inclined to ac¬ cept his hypothesis for one moment consider its application to syphilitic and tuberculous growths. Dr. Mills has related, in the course of the debate, a number of cases of brain tumor, the histories of which showed that they followed a severe blow or other traumatism. In some instances the tumor proved to be sarcoma¬ tous, in others tuberculous, in others gumma¬ tous. Dr. Shakespeare referred to these par¬ ticular cases because Dr. Mills had related them as perhaps offering some support to the hypothesis advanced in the paper, and had incidentally referred to him as personally cognizant of several of them. These cases are no more, perhaps no less, typical than others of that large class from which the essay has been made to deduce the general law enunciated this evening. Will the lecturer , take the position (seem¬ ingly absurd in the light of our present knowl¬ edge of syphilis and tuberculosis) that the tuberculous and the syphilitic tumors, no less than the sarcomata, are simply the natural terminations of an ordinary inflammation es¬ tablished by a traumatism ? Or will he rather prefer to further curtail the list of tumors for the purposes of his theory, and erase the names of tubercle and gumma? If the latter horn of the dilemma be elected, he would suggest the propriety of placing true carcinoma in a category very near to that of tubercle and gumma, for there are very many parallels and similarities in their clini¬ cal and pathological aspects. He declared that he could see no cogent reason why some authors, in drawing the line of demarcation between abnormities which are and those which are not to be regarded as tumors, have placed upon the one side cancerous growths and upon the other side have ranged the permanent products of syphi¬ lis and tuberculosis. He did not recognize mere relative size as an adequate distinction between one morbid product which must, per¬ force, be a tumor, and another which must not be so classified. Carcinoma sometimes presents in its history the phase of miliary eruptions, and, on the other hand, tubercles oftentimes form a confluent tumor-mass of very considerable size and delimitation. All that is at present known of carcinomatosis and of tuberculosis would seem to warrant the belief that in both there is frequently a strong hereditary predisposition. In both* from the locus of primary manifestation of disease the system may become infected by way of the lymphatics; in both the chain of lymphatic glands along the course of the lymph-vessels which lead from the primary growth may, and often does, form a cordon to prevent, at least for a time, the contamination of the general system ; in both, when the morbid influence passes these natural barriers and reaches the circulating blood, metastases in various situa¬ tions usually occur. Notwithstanding the research and the ob¬ servation and the ingenuity of the lecturer, Dr. Shakespeare thought that, as yet, we have no satisfactory reasons for attributing to an ordinary traumatic inflammation any agency in the development of a tumor beyond that of a simple exciting cause. Dr. Formad, in closing the discussion, said, in reference to Dr. S. W. Gross’s remarks, that he did not think it probable that tumors could arise from inoculation with tumor-juices unless the latter were the carriers of living tumor-particles. He believed that even in the three cases of apparent inoculation with tumor-juices just referred to by Dr. Gross there was no evidence at all that such small tumor - particles were not suspended in the juice and did not effect the transplantation of the new formations. In reference to Dr. Tyson’s remarks that the similarity between inflammatory products and tumors was limited to only a few in¬ stances, Dr. Formad maintained that this similarity was applicable to the majority of tumors, and, contrary to Dr. Tyson’s view, was easily demonstrable,—e.g.y in carcinoma. Dr. Formad dwelt upon the gradual transi¬ tion of inflamed skin into a cancroid, and of a catarrhal inflammation of the stomach or gall-bladder into cancerous growth,—the mi¬ croscopic picture showing the direct merging of the primary inflammatory changes into cancer, and that it is impossible to point out where the one ends and the other commences. Dr. Formad could not agree with Dr. Henry that there was necessary “ a fibroma- tous, a lipomatous, an enchondromatous, and other unheard-of forms of inflammation” in accepting the view of an inflammatory origin of tumors. Dr. Formad thought that the ordinary process of interstitial and parenchy¬ matous inflammation and the laws which gov¬ ern the new formation of tissues are sufficient to explain the histogenesis of the various tumors. Fibroma, he thought, should be regarded as one of the products of a chronic interstitial inflammation ; lipoma is nothing else than a uniform fatty infiltration of a ffi broma, and a myxoma a mucoid degeneration of the latter. Before we can have adipose tissue we must have connective tissue; and probably all pathological mucous tissue has its origin in a mucoid degeneration of simple connective tisue. The direct transformation of fibrillar connective tissue into cartilage has been proven by several reliable observers. Thus the chondroma is formed. A parallel to this we have in the process of ossification and in the formation of osteoma, etc. Dr. For¬ mad stated that he was acquainted with no real facts that could be brought forward against the view of an inflammatory origin of tumors. Dr. formad agreed with Dr. Nancrede

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.

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