PUSTULE. — CHRONIC CATARRH. 347 



trophy. This is also due to the hyperaemia of the papillaiy body ; 

 at least it is always the papillae which begin by growing at the 

 expense of the embryonic tissue produced at their apices, just as 

 happens in the growth of granulations. We may occasionally 

 observe, even with the naked eye, little red buds sprouting up, 

 which exhibit all the histological characters of granulations, but 

 which are merely the enlarged — or, if the term be preferred — 

 the degenerated papillae of the skin itself.* 



§ 294. As the disease progresses, the state of irritation 

 which was originally confined to the surface, extends to the 

 deeper layers of the skin, to the cutis and subcutaneous areolar 

 tissue. This serves to connect chronic catarrh of the skin with 

 those conditions which are described under the name of Elephan- 

 tiasis in the second part of the present chapter. It is difficult 

 to determine how far this may depend on the catarrhal irrita- 

 tion of the surface, in what measure it may be considered as a 

 reactive hypertrophy; and what share belongs to the predis- 

 posing cause of the eczema itself, to the distm^bance of the 

 circulation of the blood and lymph, and how far therefore the 

 morbid changes deserve to be regarded as an independent 

 disease ; I will therefore break off the thread of my exposition 

 at this point and take it up again when I come to treat of 

 Elephantiasis. 



At present I will only speak about the tendency towards 

 recovery, and the actual process of repair, in chronic catarrh. 

 We have traced a close analogy between the papillary body in 

 its catarrhal state and the surface of a granulating wound ; the 



* This illustrates very strikingly the close connexion between hyper- 

 plastic and heteroplastic evolution. Those who are inclined to dis- 

 tinguish sharply, not merely between hyperplastic and hetcroiDlastic 

 growth, but between inflammatory heteroplasia and heteroplastic 

 tumours, between simple and iniiammatory hypertrophy, will do well to 

 take this lesson, which skin-diseases offer, to heart. We may and ought 

 to avail ourselves of these definitions for the purpose of giving clear- 

 ness to our conceptions of the phenomena, but we must beware of ele- 

 vating them to the rank of rigid formula. Kone such exist in nature, 

 which reconciles all contrasts. In the present case, the development of 

 embryonic tissue at the junction of the epidermis with the connective 

 tissue, belongs, up to a certain point, to the normal plan of evolution of 

 the skin; no sooner however does it overstep this limit, than it at onco 

 converts the cutaneous surface into a granulating sore. 



