The schirrhus of older pathologists, the only new growth designated by them as cancer; other equally and still more malignant formations being by them divided into sarcoma and fungus. It is upon the whole the most compact in texture, and therefore the hardest of cancer-growths. Hence, the expression scirrhous hardness, formerly employed to denote in an organized product a resistance analogous to that of fibro-cartilage.

In a parenchyma like that of the mammary gland, scirrhus commonly appears as a clavate, gibbous, indistinctly lobulated, somewhat branched, not sharply defined, very hard, grayish, or bluish-gray new growth, which has the faculty of dragging down surrounding textures upon itself, is of moderate size, of from a walnut to a duck's egg, is heavy in proportion to its density of texture, and creaks under the knife.

Several deviations, to be hereafter specified, here present themselves. We shall, however, limit ourselves in this place to the statement that the density of the fibrous texture, sufficiently cognizable with the naked eye, as also the hardness, do not always attain the presumed high grade. Under certain conditions, scirrhus becomes tolerably lax and succulent.

On a more minute examination, the principal mass appears to consist of a fibrous texture, imbedded in which are embryonic elements, in the shape of nucleus and cell. The former gives it the impress of fibrous cancer, and determines its density and hardness. The greater the number of the embryonic elements, the more does its fibrous texture serve as a stroma for a constituent, whose preponderating mass alters and determines its characters.

The fibrous groundwork presents manifold differences with respect to the form and the arrangement of the fibres.

1. Very commonly it is a fibre resembling an areolar tissue-fibre or fibril, or that of the organic muscles.

2. Sometimes it is a consolidated, tolerably transparent blastema, in the act of splitting into fibres and fibrils, and presenting a fibrous torn surface. In both instances there is an accession of granule- and nucleus-fibres in various numbers.

3. In a case of stomach-cancer it was a dense felt of black, branched, anastomosing fibrils, similar to the fibrils of fibrin.

With respect to arrangement:

1. The fibres for the most part point in one direction parallel to each other.

2. They radiate from different centres.

3. Considerable columns of fibres traverse each other at various angles, so that upon a parallel-fibred section we find displayed, here and there, the stumps of transversely and obliquely divided fasciculi.

4. The alveolar fibre arrangement is very frequent.

The embryonic elements consist of nucleus and cell. The former are often very numerous, as spherical, shining nuclei, furnished with black contours. Not rarely, indeed, the transparent nature of crude, cancer blastema makes it appear as if the cancer consisted exclusively of these nuclei.

The cells present many points of difference.

They are round, or angular, ganglion-globule-like, or again wedge-shaped, caudate, etc.

There are often present parent-cells, which become developed into alveoli; and upon a cut surface we meet with these, visible to the naked eye, in the shape of prominent, transparent vesicles, imparting to fibrocarcinoma the aspect of a glandular structure. Bloodvessels are not wanting in scirrhus, although their abundance is not very great. Lob-stein is wrong in asserting these growths to be non-vascular.

Although the mass of fibro-carcinoma is not altogether dissolved by boiling, it yields, nevertheless, a notable amount of gluten. Compared with medullary cancer, it contains a smaller proportion of fat (according to Martigny, a soft fat; according to Breschet, cholesterine).

Acetic acid certainly does (although denied by Muller) render the cells more limpid, throwing nuclei and nucleus corpuscles with black contours and some little shrivelling, more into relief.

No other cancer possesses, in so high a degree as the fibrous, the tendency to condense and corrugate the textures, in which it has taken up its seat, or to drag down upon itself contiguous, especially if they be membranous, parts. The invariable consequence is the wasting of the cancerous organs, and the shortening, with consolidation, of implicated membranous formations. Fibro-carcinoma is slow of growth, and slower in proportion as the fibrous character predominates in its fabric. It will thus vegetate long, without producing any visible cachexia, provided it do not interfere with the function of any vital organ, and provided it remain solitary. A more rapid growth is always conditional upon an overpowering development of embryonic elements out of fluid blastema; which latter, in the inverse ratio of its plasticity, relaxes the texture of the scirrhus, drenches it, and causes it to swell. It is often of a medullary (encephaloid) character, giving rise to a combination of fibrous with medullary cancer, in the shape of a more or less intimate blending of the two. With this, there is always a simultaneous increase of vascularity in the cancer-parenchyma, hypersemious tumefaction, and inflammation; frequently, also, the development of a reticulum.

The presence of this reticulum changes fibrous cancer to that form which Johannes Muller has designated carcinoma reticulare or reticula-tum. That is to say, we conceive ourselves to be warranted by experiment in assuming the latter to be fibrous cancer, plus the reticulum, - fibrous cancer in the aforesaid progress of rapid and redundant growth, and incontinently passing into congestion and inflammation. Its form-elements are identical with those of pure, fibrous cancer; although the embryonic elements and bloodvessels predominate. The capacious cells and membrane-clad cavities met with occasionally in carcinoma reticu-latum by Johannes Muller, are probably nothing more than the follicles of an alveolar texture that has invaded the fibro-carcinoma; such follicles being replete with the substance of the reticulum as a product of inflammation. This so modified fibro-carcinoma frequently occurs in the mammary gland, attaining, for the reasons stated, a greater volume than pure, fibrous cancer.

Fibrous Cancer

Fibrous Cancer occurs (primitively and in a developed form), in the mammary gland; in the stomach, perhaps, still more frequently; in the colon; in the submucous areolar tissue; - more rarely in the vaginal portion of the uterus, upon serous membranes, and in the subserous areolar tissue. Again, as an expansive degeneration of the omentum and of the mesentery; in the salivary glands; in the fibrous tunic of the bronchia. In several of these, as well as in other structures, - for example, the ovaries, the brain, - there occur cancerous growths of embryonic composition, and in all likelihood of fibro-cancerous nature.

With respect to shape, fibrous cancer in and upon membranous structures deviates from the clavate form before described. In the stomach, for instance, it represents degenerations, spreading along the course of the submucous, areolar stratum, and only here and there swelling into knobbed projections; whilst in the intestine it assumes the annular shape. Upon serous membranes, the pleura for example, it sometimes occurs as a fibroid exudate, that is, as a densely fibrous, whitish, sha-greened mass of unequal thickness, branching, as if outpoured, or dropped here and there, over the surface.

In the bones it appears in the shape of roundish knobs, imbedded in the diploe of the cylindrical bones, over which the compact covering plate becomes wasted by compression, giving occasion to spontaneous bone fractures.

In the frequent cases of cancer of the stomach we have the best opportunities for studying the character of the cancerous degeneration of muscular tissues. It consists in a development of white interfascicular striae, imparting to the fleshy tunic a white-celled aspect. The white striae consists of accumulations of nuclei, cells, and lastly, fibres, which receive and so to speak encapsule the swollen, reddish, or yellowish red, exsanguine muscle-substance. The formation of these septa multiplies, and they increase in volume until the muscle has entirely given way and perished.

Fibro-Carcinoma

Fibro-Carcinoma is, for the most part, the primitive cancer in the organism, and very rarely indeed the secondary. The cancer-growths consecutive to it have, in proportion as they multiply, more and more the character of the medullary form. Even the occasionally more rapid development of fibro-carcinoma takes place under the supervention of medullary carcinoma, and the affection of the implicated lymphatic glands occurring in the consecutive series is of the same medullary character. In like manner the extirpation of fibrous cancer is generally followed by medullary growth.

In conclusion, we would advert to certain malignant accumulations, proved by antecedent circumstances to be undoubtedly cancerous. These infest bone, the ovaries, again the mediastina, the retro-peritoneal space, lastly, the intermuscular areolar tissue; and they are distinguished for the great bulk to which they attain. As regards their elementary fabric, they are almost always embryonic structures, that is to say, they consist of nuclei and spindle-shaped or caudate cells, which last, by their arrangement, impart to the whole the semblance of fibrillation. The intercellular substance (blastema) is very scant; and the heterologous mass is consequently very dense and firm. They are to be regarded on the one hand as embryonic fibre-cancers; on the other, as kindred with the firmer varieties of medullary cancer.