F.W. Pavy
1871 The Lancet  
845 had been preceded by the development of a bulla. This ulcer was situated in the middle of a large erythematous patch upon the sole. Her general health appeared to be good. A course of tonic treatment was, however, recommended. It was also advised that the patches should be dressed with pieces of lint spread with mercury plaster. I have had no report of her since. Only one illustration of primary cancer of the skin came under my observation. This was the case of a lady aged about sixty, who
more » ... d about sixty, who was sent to me on July 15th, 1867, by Dr. Francis Henderson, of Helensburgh. She had never been strong, but had had no serious illness. She was of a very spare habit of body, and looked rather weaker, but younger than her age. She complained occasionally of feeling bilious, and her bowels were rather loose and very easily and powerfully affected by aperients. The skin affection, which was of eight months' duration, commenced over the left breast, and gradually extended over the greater portion of the front of the chest and upper part of the abdomen. There were very slight indications of disease on the back and arms, while the face, neck, lower extremities, and lower portion of the trunk were unaffected. The skin affection presented three elements-(l) a rosy erythema, which appeared to be the first stage; (2) purple streaks, the colour of which was not altered by pressure, which were evidently dilated and obliterated cutaneous vessels, and which seemed to be the third stage; and (3) little firm nodules varying in size from pin-heads to split peas, some of them elevated, most of them not, and which were adherent to the cuticle, which was of the natural colour, except over a few of them where it was rosy. The patient complained of slight itching, and for about three weeks previous to my seeing her she had experienced once or twice a day 11 a pain shooting up from the right breast." On the 2nd of March, 1868, Dr. Henderson wrote to me as follows :-" The lady I sent to you in July or August with tuberculous cancer of the skin is still alive. The disease has spread over most of the skin of the chest and abdomen, and there are hard tuberculous nodules on the skin of the arms. She suffers no pain, but is now fast sinking." Only one case of multiple fatty tumours is noted in the present statistics-that of a gentleman, aged about fifty, who resided in the Highlands, whose general health appeared to be good, except that he was the subject of psoriasis, and frequently noticed that his urine was muddy. He had accidentally noticed the tumours a short time previous to my seeing him. They were scattered over the body, especially the extremities ; they were seated in the subcutaneous -cellular tissue, varying in size from a large bean to a small walnut; and were soft, nodulated, and painless. They were non-adherent; and the skin over them was of the natural colour. No cause could be assigned for their appearance. A very similar case, not included in the present statistics, was recently admitted into the medical wards of the infirmary, under my care; but in this case the tumours, which presented all the characters above indicated, were associated with the diffuse development of fatty matter in the subcutaneous cellular tissue in the right hypochondriac and epigastric regions, to such an extent that he was obliged to bring the opposite, sides of his waistcoat and trousers together with the aid of pieces of string. (To be eoncluded.) THE vegetable kingdom forms the primary source of our food. Dumas even at one time affirmed -11 L'animal s'assimile, done, ou detruit des matieres organiques toutes faites; il n'en cree done pas." This, however, as he afterwards admitted, does not strictly hold good. The animal no doubt is incessantly consuming or destroying organic substances, and is incapable of forming them from the in-organic principles; but, if supplied with organic matter, organic compounds of various kinds are constructed. Mulder's discoveries in 183S led up to the doctrine that the albuminous compounds of plants and animals agree in composition and properties; whence it was inferred that the animal simply took the compound of the plant and made it a component part of its own body. Liebig, however, was the first to maintain that animals possessed the power of forming one kind of organic compound out of another. Upon this there arose a controversy, with particular reference to fat. In opposition to Liebig's teaching, that in the animal system fat was producible from sugar, Dumas and Boussingault held that whatever fat was found in an animal being came through its food from without. It is now, however, matter of history that the French authorities have had to abandon their doctrine in favour of the German. One kind of albuminous compound, it is almost needless to say, can be constructed from others. In the young mammal, subsisting on milk, the caseine is the source of fibrin and albumen ; in the animal feeder, when excreting milk, the casein comes from the fibrin and albumen of the food. Gelatin is not found in vegetable food. None of these nitrogenous principles (it is now established) enter the system in the form in which they occur as food. During the digestive process they are all converted into albuminose, which is the principle absorbed and subsequently transformed by the animal's assimilative powers into the various principles met with. The capacity really existing in animals is that of transforming one organic compound into another. All organic matter has its origin in the vegetable kingdom, from which, therefore, all our food is directly or indirectly derived. The vegetable feeder goes at once for its food to the vegetable kingdom. The animal feeder is not less dependent on the products of the vegetable kingdom for its pabulum. But this it obtains, so to speak, in a second-hand way only; its food consisting of the flesh of animals which have themselves been nourished on vegetable products. Plants grow under the action of the sun's rays, to the influence of which we must refer the production of food in the first instance, and the source of all terrestrial life. I have already shown how the energy emitted from the sun, as heat and light, is able, through the medium of the plant, to disengage oxygen from its combination with carbon and hydrogen in carbonic acid and water and lead to the formation of re-oxidisable compounds; and how the energy evolved from the re-oxidation of these compounds, whether by combustion or within the animal system, represents the equivalent of that employed in effecting their construction. We cannot help being struck by the immensity of the amount of power that must have been emitted from, and is still stored up in, the sun, when we come to consider that from the small pencil of rays which has impinged upon our earth at a distance of nearly 95,000,000 miles has been derived all that energy, or source of power, which, under the view now held by philosophers, has been fixed by past and present vegetation, and much besides that has escaped being so utilised. Geology, indeed, teaches us that early in the history of the globe solar influence must have manifested itself in a much stronger degree than it does even at present. The vast coal-beds in the earth's crust are vegetable in their origin, and carry us back to a time when, under solar influence operating on an atmosphere surcharged with carbonic acid and humidity, the most luxuriant vegetation existed, and even so in the arctic regions, as coal-deposits are there to be found. Now, the force of the sun's rays co-operating with the action of the plant leads to the building up of organic compounds, and it is in the green parts of the plant-those containing chlorophyll-that the decomposition of carbonic acid and water occurs, accompanied with the fixation of carbon and hydrogen and the liberation of oxygen. This is the plant's distinctive function, which ceases to be performed when light is absent, or when no chlorophyll exists. Under these latter conditions-absence of light and chlorophyll-oxygen is absorbed, and carbonic acid set free, as in the animal being. I have been informed that it is a fact known to florists that, in the case of the variegated-leaved geranium, a slip that happens to possess white leaves only,
doi:10.1016/s0140-6736(02)64145-5 fatcat:xek5tnlipngdfagf22ifhaobwm