PAPILLARY TUMORS. 517 



and cancroid formations which may assume this form, 

 and others again, which do not do so. 



With reference to the relation of form and nature, there 

 is a question of really cardinal importance, concerning 

 which, in the interest of mankind, a certain degree of 

 unanimity ought soon to be arrived at, namely, what is 

 properly to be understood by the term tubercle. The 

 same difficulties which I have just described to you, are 

 again encountered in the case of tubercle in a still higher 

 degree. The old writers introduced the name tubercle 

 merely to express an external form. Everything was 

 called a tubercle which manifested itself in the shape of 

 a small knot. It is, as you are no doubt aware, by no 

 means so very long since this term was employed in the 

 most loose manner. Carcinomatous and scirrhous tuber- 

 cles were talked about, scrofulous and syphilitic tubercles 

 were distinguished from one another, and these terms are 

 still preserved in France. Cancer too, you know, in old 

 times was not by any means exclusively employed to 

 designate a real tumour, but noma (cancer aquaticus) was 

 considered to have as much right to the appellation as a 

 chancre (cancer syphiliticus). 



Now in the course of the present century endeavours 

 have been made gradually to exchange these somewhat 

 superficial views for more accurate conceptions, and here 

 also it is to Laennec especially that credit is due for hav- 

 ing sought for precise denominations. Still he himself 

 in his turn has been the cause of this matter's having 

 fallen into a state of nearly irremediable confusion. For, 

 as you no doubt recollect, he asserted that tubercle pre- 

 sented itself in the lungs under two different aspects, the 

 so-called tubercular infiltration, and tubercular granula- 

 tion. Now, inasmuch as infiltration signifies something 

 completely at variance with the old notion of tubercle, 

 since it does not at all imply the presence of small knots 



