546 TUMOES. 



amputated. Six months later, two enlarged lymph-ganglia were found in the 

 right groin ; one as large as a hazel-nut, the other the size of a pea. Both 

 were extirpated, and, although two years had since elapsed, the patient was 

 perfectly well. The second ganglion came from a male inmate of Charity 

 Hospital, New-York City, aged forty-two. He had a cancer of the throat that 

 bled so freely that it necessitated the ligation of the right carotid. This was 

 followed by excision of the tumor and the removal of an enlarged lymph-gan- 

 glion from the posterior maxillary region. The man died shortly after the 

 operation, and at the post-mortem several abscesses were found in the lungs, 

 and yellowish nodules in the liver and kidneys, which the microscope showed 

 to be secondary cancer in its earliest stage of development. A male of over 

 fifty years furnished the third specimen. About a year before, he was operated 

 on for cancer of the skin on the leg. Shortly after, a number of new tumors 

 arose, and the lymphatics of the groin began to swell. These new growths, 

 as well as the lymphatics, were removed and brought to the laboratory. The 

 fourth case was a woman of unknown age, who was operated on, in 1875, at 

 the German Hospital of New- York City. A few indurated lymph-ganglia were 

 removed from the axilla. The last specimen I removed from the foot of a 

 lady. No enlarged glands were found, and she is now perfectly well. 



The first three of these specimens contained all the stages of invasion, for 

 they not only showed the fully formed cancer-tissue, but also the perfectly 

 healthy adenoid structure. The fourth was composed of completed cancer- 

 tissue. 



The transmission of cancer from a primary focus to the adjacent lymph- 

 ganglia is probably done by a transmission of its epithelia through the 

 lymph-vessels. This, we know, is sometimes done; for in case (1) I saw a 

 few epithelia scattered among the lymph-corpuscles of the cortical substance. 

 Their size and shape distinguished them from all surrounding formations. Of 

 course, this fact will not support us in denying that the fluid portion of the 

 lymph coming from the cancer the so-called cancer juice may also trans- 

 mit the infection. We are sure only that cancer epithelia are lodged in the 

 lymphatic ganglia ; but we are equally certain that we cannot explain why 

 they or the juice can transform normal structures into cancer. 



In the first three specimens I could trace, step by step, the whole of the 

 cancerous metamorphosis. The first stage I found in that part of the ganglion 

 where fibrous trabecula3 separated the healthy from the diseased tissue. This 

 consisted of a melting down or running together of the elements and the for- 

 mation of large multinuclear masses the so-called myeloplaxes. I have not 

 seen these formations in healthy adenoid tissue, but found a few small ones 

 in a hypertrophied tonsil. There is no doubt that they spring from the conflu- 

 ence of the lymph-corpuscles in all their different stages of development, as 

 well as from the myxomatous reticulum. 



In the lymph follicle the corpuscles are connected with each other by deli- 

 cate offshoots of living matter, which pierce the separating layer of liquid. 



We may infer that all that is necessary to the formation of a "myelo- 

 plax " is the fusion of the jelly-like intertrabecular substance. The process 

 of confluence of formerly separated corpuscles is shown in the earliest stages 

 of a growing cancer, and in the invasion of a lymph-ganglion its central por- 

 tion is generally first involved. Frequently I found an interfollicular string 

 completely transformed into a continuous bioplasson mass, but still retaining 

 its original shape. These masses are supplied at regular intervals with large 



