ABNORMAL GROWTH. TUMOURS 269 



any granulations are formed at all, or if formed are imme- 

 diately destroyed, and the wound assumes the appearance 

 of an ulcer, which remains stationary in size or gradually 

 grows larger. In the latter case there is no bed formed for 

 epithelial new growth. 



Under proper treatment, and in healthy subjects, such 

 wounds heal sooner or later, but as long as healing is delayed 

 we may recognise a theoretical risk of uncontrolled escape 

 from arrest. Theoretically, all that prevents a granulating 

 wound from originating tumour tissue is Control. 



The " proud flesh " of an unhealthy wound is in certain 

 respects abnormal growth ; it is a hyper-production of cells, 

 a release from arrest far greater than is necessary for the 

 healing of the wound ; it is, so to speak, temporary tumour 

 tissue. As a matter of fact, however, we know that the 

 danger is not that granulation tissue, whether excessive or 

 deficient, will become tumour tissue ; it is in the marginal 

 epithelium that this danger arises, and particularly in chronic 

 sores which fail to granulate. It is the epithelium which is 

 specially liable to grow atypically, probably through being 

 deprived of normal connective tissue influences which should 

 locally control its typical development. 



In every living organism there is Equilibrium of Per- 

 sonality ; there is balance of function for the preservation 

 of identity and personality, and this balance reflects itself 

 in the proportionate development of the different somatic 

 tissues and organs. Thus the size of the stomach, the liver, 

 the kidneys, the amount of fat, connective tissue, muscle, 

 or skin in an organism, primarily reflects in each case the 

 degree of development necessary for the preservation of 

 the organism's identity and its equilibrium of personality. 

 In a sense, therefore, one organ, or one tissue, may be said 

 to control the development of another, and we may accept 

 this influence to be exercised indirectly through the central 

 nervous system, and also more directly by means of secre- 

 tions passed into the blood stream. 



The case of epithelial or endothelial tissue is peculiar 

 among the body-tissues in that it always covers surfaces. 

 This is so, whether we are dealing with skin, pleura, peri- 

 toneum, or secreting cells. It is thus always especially 

 subject to damage or wear and tear on what may be called 



