EPITHELIAL CANCER OF THE BLADDER. 
317 
tion is in progress, a greater uniformity of external appearance is found ; 
for, in general, while all that was superficial or exuberant is in process of 
destruction, the base of the cancer is constantly extending both widely and 
deeply into the subintegumental tissues/’ 
He goes on to remark that — 
“ In other instances, or in other parts, a large mass is formed, the surface 
of which, when exposed by washing away the loose epidermoid cells which 
fill up its inequalities, is largely granulated or tuberculated, and is planned 
out into lobes by deeper clefts. Such growths are up-raised, cauliflower- 
like; and, with this likeness, may be broken through the clefts, into 
narrow-stemmed masses, formed each of one or more close-packed groups of 
enlarged, tuberous, and clavate papillae. The surface of such a growth 
shows, usually, its full vascularity; for if it be washed, it appears bare, and, 
like the surface of common granulations, has no covering layer of cuticle. 
It may be florid, bleeding on slight contact, but, more often, it presents a 
dull or rusty vermilion tint, rather than the brighter crimson or pink of 
common granulations, or of such warts as one commonly sees on the 
prepuce or glans penis. * * * * * 
But the same general plan of construction exists in all ; namely a certain 
portion of the skin or mucous membrane is infiltrated with epithelial cancer- 
structures : on this, as on a base more or less elevated and imbedded, the 
papillae, variously changed in shape, size, and grouping, are also cancerous ; 
their natural structures, if we except their blood-vessels, which appear 
enlarged, are replaced by epithelial cancer-cells. And herein is the essential 
distinction between a simple or common warty or papillary growth, and a 
cancerous one or warty cancer.” 
With a further view of showing the identity of this ease 
w r ith what is now known of this disease in man, we venture 
to give another quotation from Mr. Paget’s valuable 
work : 
“The grey substance,” says he, “ of epithelial cancers commonly yields to 
pressure only a small quantity of turbid yellowish or greyish fluid ; but, with 
rare exceptions, one may squeeze or scrape from certain parts of the cut 
surface, as if from small cavities or canals, a peculiar opaque-white or 
yellowish material. It is like the comedones, or accumulated epithelial and 
sebaceous contents of hair-follicles ; or even more like what one may 
scrape from the epidermis of the palm or sole after long maceration or 
putrefaction. This material, which is composed of structures essentially 
similar to those of the firmer substance of the cancer, but differently 
aggregated, supplies one of the best characteristics of the disease. It may 
be thickly liquid, but more often is like a soft, half-dry, crumbling, curdy 
substance : pressed on a smooth surface, it does not become pulpy or 
creamy, but smears the surface, as if it were greasy: mixed with water, it 
does not at once diffuse itself, so as to make the water uniformly turbid, but 
divides into minute visible particles. 
“ The quantity of this softer material is extremely various in different 
instances of epithelial cancer. According to its abundance and arrangement, 
the grey basis-substance may appear differently variegated ; and the more 
abundant it is the more does the cancer lose firmness, and acquire a soft, 
friable, and crumbling texture. In many cases the soft substance appears, 
on the cut surface, like imbedded scattered dots, or small grains : these 
being sections of portions contained in small cavities. But, as the quantity 
xxviii. 41 
