FIBROMATA OF THE SKIN 
AND 
SUBJACENT TISSUES. 
[fibroma molluscum, cutis fendula, “fibro cellular” tumors.] 
EDWARD'WIGGLESWORTH, JUN., A.M, M.D., 
BY 
Physician to the Boston Dispensary for Skin Diseases ; Lecturer on Syphilis at the 
Harvard Medical School, Boston, etc. 
Reprinted from the Archives of Dermatology, April, 1876. 
G. P. PUTNAM’S SONS, 
182 Fifth Avenue. 
NEW YORK 
1876. FIBROMATA OF THE SKIN 
AND 
SUBJACENT TISSUES. 
[fibroma molluscum, CUTIS PENDULA, “ FIBRO CELLULAR” tumors.] 
BY 
EDWARD WIGGLESWORTH, JR., A.M. M.D. (HARV.) 
PHYSICIAN TO THE BOSTON DISPENSARY FOR SKIN DISEASES ; LECTURER ON SYPHILIS 
AT THE HARVARD MEDICAL SCHOOL, BOSTON, ETC. 
[Reprinted from the “Archives of Dermatology, Vol. 11. No. lII.] 
NEWYORK; 
G. P. PUTNAM’S SONS, 
182 Fifth Avenue. 
1876. FIBROMATA OF THE SKIN AND 
SUBJACENT TISSUES* 
[FIBROMA MOLLUSCUM CUTIS, PENDULA “ FIBRO CELLULAR ” TUMORS.] 
The comprehensive and able little monograph of Dr. Atkinson 
[Observations upon two cases of Fibroma molluscum, New 
York Med. Journal, Dec., 1875] ie description of an excep- 
tionally developed case of Fibroma molluscum, in the July num- 
ber of this Journal, by Dr. Octerlony, have directed attention to 
the group of new formations, classified formerly under the head 
of fibro-cellular tumors, but now, by Virchow, more succinctly des- 
signated as fibromata. I propose, therefore, to give a brief ac- 
count of some interesting; cases of this nature which have oc- 
curred in Boston. 
The inflammatory processes, which, in the internal organs of 
the body, result merely in a fibrous hyperplasia diffused through- 
out these organs, cause, when their action is more superficially ex- 
erted, new formations, of the same histological structure, although 
more or less limited in their extent at different times and under 
varying conditions, and constituting now a general and extended 
hyperplasia, and again more exactly limited and locally defined 
tumors. Such new formations may assume the characteristics of 
Fibroma molluscum [Molluscum simplex, Molluscum fibrosum], of 
Cutis pendula [Dermatolysis, Pachydermatocele], of Elephantiasis 
* Read before the Suffolk District of the Massachusetts Medical Society, 
Feb. 26, 1876. 4 
EDWARD WIGGLES WORTH, Jr. ; 
[Hypersarcosis, Spargosis, Barbacloes Leg, Morbus Herculeus, 
Bucnemia tropica, Pachydermia], or of localized fibrous tumors. 
Of Fibroma molluscum, there have recently occurred here two 
interesting cases. One of these, under the care of Dr. J. C. 
White, will be referred toby him in his “Analysis of 5000 cases 
of Skin Disease,” now publishing in the Boston Medical and 
Surgical Journal. The other case, also seen by Dr. White as well 
as by myself, is the one herein to be described. To illustrate the 
appearance of this patient, I have availed myself of the heliotype 
process of Messrs. Osgood & Co., Franklin St., Boston, in pref- 
erence to other means of pictorial representation, in order to ob- 
tain an image of the disease, which should be as true to nature as 
possible, although a woodcut would have given more prominence 
to many of the smaller, discrete formations which are here lost to 
view from being involved in shadow. 
Of Cutis pendula, two cases were noticeably similar in their 
general anatomical configuration. One, operated upon by Dr. 
Ela/ died from some intercurrent cause, and Dr. Ela’s absence 
from the State, prevents any description of the case here. The 
other, perhaps more remarkable, made a complete recovery after 
an operation for the removal of the growth, performed by Dr. 
R. M. Ffodges, of the Massachusetts General Hospital, by whose 
kindness I am enabled to present his full account of the disease, 
the operation and its results. My original intention was to give 
heliotypic representations of this case also, but the negatives have 
unfortunately, been broken. 
The other three cases here recorded, were kindly copied from 
the records of the Mass. Gen. Hosp., by Mr, M. H. Richardson, 
one of the “ internes,” by the polite permission of Dr. H. J. Bige- 
low, under whose care the patients were while in the Hospital; 
and from Dr. Bigelow’s private records. 
The case of Fibroma molluscum is as follows : 
Case I. The patient presented himself for examination at my office in 
November, 1875. C. U., aged 45 years, a Bavarian by birth; has been some 
twenty years in this country. He is by profession an ice-cream maker. 
His physique is sturdy and his frame well-knit, although below the aver- 
age in height. He stands 5 feet and 3 inches high, and weighs 140 
pounds. In shrewdness and intellectual development generally, he is, 
perhaps, rather deficient. His parents were not cousins and were 
always quite healthy until within a few years of their deaths. The father 
died of dropsy, the mother of heart-disease, according to the patient’s 
story. The patient himself had no affection of the skin congenitally or 
in early life, nor does he know of any skin disease in his family, imme- 
diate or distantly connected. The conditions in which he spent his 
youth were good, hygienically speaking. He has always been in good 
health before his present disease, which does not really interfere with 
his health, except that he has suffered from rheumatism. At present FIBROMATA OF THE SKIN 
5 
all his organs appear in good condition, the viscera healthy and the 
special senses unimpaired. He gives the following history of the exist- 
ing disease of the skin : 
About 14 years since, in 1861, and while a member of the 54th Regi- 
ment of Volunteers from New York, he, being at that time in other res- 
pects in good health, noticed, for the first time, upon his breast on the 
right side a small tumor of the size of a pea. His attention was called 
to it by a slight sensation of pain. During the following fortnight he 
noticed others also. They appeared originally upon the breast, next in- 
vaded the neck, then appeared upon the legs, then upon the arms, and 
finally universally over the whole body, the face and the scalp included. 
These nodules increased in number and in size for about three years 
and a half. Since then they have remained nearly stationary, and 
during the last three months some have even disappeared. The largest 
among those which have disappeared was a tumor of the size of a pigeon’s 
egg and situated upon the left breast. It had been also among the first 
to make its appearance. There have thus far disappeared ten tumors in 
all. During this whole period of fourteen years the patient has remain- 
ed in good health, with the exception of attacks of rheumatism at in- 
tervals. 
The subjective sensations of the patient in respect to the tumors have 
been inconsiderable. He reports an original or primary slight pricking 
and itching like that consequent upon a mosquito bite. This is succeed- 
ed by the appearance of a pinkish spot which gradually develops into 
a nodule. The nodule once formed, pain and itching are no longer 
noticed, as the rule, although a few small excrescences upon the neck 
nave itched slightly. The acuteness of sensation of the skin covering 
the tumors is little, if at all impaired. Early in November, about three 
weeks ago, a small nodule of the size of a bean had been snipped from 
the right loin, at the Massachusetts General Hospital. The spot had 
now healed and was marked by a very slight cicatrice. 
The distribution of the tumors at present is most marked upon the 
upper portions of the trunk, which is usually the part most abundantly 
covered. Below the knees their number is small, and the genitals, palms 
and soles are entirely free from them. The arrangement of the tumors 
is not a symmetrical one upon the two sides of the body. There is some 
slight enlargement of the lymphatic glands of the elbows and of the 
groins, more especially of the left groin where an old hernia is present. 
The nails are normal. 
The number of the tumors, ascertained by subdividing the superficial 
area of the body into sections and then counting the number within each 
little separate space, was as follows : Upon the abdomen and chest, 425 ; 
upon the front of the neck, 51 ; upon the forehead, 21 ; upon the scalp, 
19; upon the back of the neck, 43; upon the posterior aspect of the 
body, 385 ; upon the right arm, 39; upon the left arm, 56; upon the 6 
ED WARD WIGGLES WOR TH, Jr.; 
right leg, 57; upon the left leg, 97 ; the left side of the body being gen- 
erally more thickly strewn with the new growth than the right side. In 
all 1193. 
In size the little tumors varied from that of a Guinea pea upwards. 
The largest was rather under half the size of a man’s fist, this one was 
on the back, below the right scapula and nearer the spinal column, and 
was pedunculate. There was never any ulceration or sloughing of' the 
skin covering any of the tumors. 
As to form or shape, the smaller nodules are semi-globular and sessile, 
the larger conical or nipple-shaped and sessile, the largest, pear-shaped 
or round, and pedunculate. 
The smallest have a smooth exterior which may become corrugated 
as the tumors increase in size and the largest were even sacculate. 
Those upon the scalp were, for the most part, smooth and hairless. 
The skin of the body was normal in color. That over the tumors 
darker and its mucous layer was shown by the Microscope to be more 
rich than usual in pigment granules. The skin over the very largest 
tumors had quite a cyanotic tint. All the growths became somewhat 
paler upon pressure. The largest were slightly cooler than the rest of 
the body and firmer to the touch than the smaller ones. All were non- 
pulsating, compressible, soft but not fluctuating, and the conical ones 
gave to the finger a very peculiar sensation as if the finger were passing 
down through the skin and pushing the conical nodule before it, invert- 
ing it also at the same time, as when one pushes in the end of the finger 
of a glove. 
The site of the nodules was mostly in the subcutaneous cellular tis- 
sue and though a few small ones were apparently movable with the skin, 
the larger ones, more deeply planted and on a broader base, allowed the 
skin to slip away freely over them. 
One quite marked feature in this case was the close resemblance of 
several of the conical tumors to nipples. Thus below the right true 
nipple there existed a very good molluscous imitation of it, and both 
above and below the left nipple were imitations, one of which was so 
life-like as to suggest an explanation of some of the cases of super- 
numerary nipples which have been reported. 
There were also present, as in Dr. Atkinson’s case, several naevi 
verrucosi. Of these there were three upon the left posterior aspect of 
the neck and one in the bend of the left elbow joint, dark brown, flabby, 
shrivelled, superficial, saccular formations, somewhat pedunculate, pos- 
sessing a few hairs, congenital, stationary in growth and having their 
bases immovably attached to the skin around. 
In opposition to the views of the patient, and though he has been 
under observation but a short time, I am yet inclined to believe that the 
tumors are increasing in extent rather than diminishing. On Friday, 
Dec. 10th, a little tumor was removed by the ecraseur, and the next day FIBROMATA OF THE SKIN. 
7 
it was as large as ever. The cellular tissue had supplied the loss very 
rapidly. As there was no skin, however, to protect it, it scabbed over, 
shrank and withered away, and by the 13th of the month, i.e, two days 
later, the crust was ready to fall and leave a smooth cicatrice. On Mon- 
day, Feb. 14th, the patient was again seen, and at that date it was noticed 
that a fresh nodule, normal to all appearance, had been redeveloped 
exactly upon the site of what for a time had been a natural cicatrice. 
The orifices of the sebaceous glands in the skin covering the growths 
were everywhere well marked, dilated and filled by plugs of moderately 
thickened, sebaceous material. 
A couple of little nodules of the size of cherry stones were removed by 
Dr. J. C. Warren and myself, and hardened in alcohol, and some excel- 
lent sections, both horizontal and vertical, were made and colored with 
hoematoxylin by Dr. H. P. Quincy. I now regret that these growths 
were not injected prior to removal, in order to display any lymphatic ves- 
sels which might have been present. 
The microscopical examination of these sections showed the usual ap- 
pearances found in cases of Fibroma molluscum. There were well 
marked trabeculae with a fine interlacing meshwork of fibrillated, inter- 
cellular substance. Within this meshwork lay the constituent material 
of the growth, a young connective tissue very rich in cells, with many 
nuclei interspersed without any cell wall. In some parts the blood vessels 
were numerous, in others not so abundant. The papillae were well 
marked and of various sizes and shapes. In the walls of the sweat 
ducts nuclei were observed, and around these walls there appeared to be 
a well defined amount of new cell growth. The structure of the tumors 
varied somewhat in character, being in places quite dense though 
usually loose. The loose areolar tissue probably contained formerly 
much fluid, as in some parts empty spaces were apparent, scattered ir- 
regularly throughout the structure of the growths, and separated by deli- 
cate fibres of connective tissue. The shrunken condition of the fibrous 
bands (in Canada balsam) pointed in the same direction. The growth 
was apparently the result of a thickening of the subcutaneous cellular 
tissue, which had pushed the skin up before it and caused an atrophy of 
this last, although the papillae, as above stated, were still well marked. 
Allied to Fibroma molluscum and to Elephantiasis, stands the 
very loosely defined Dermatolysis of English authors, consisting 
of loose folds of skin often “ in layers like the folds of a tippet,” 
but in which there is also found “ a great increase of fibro-cellular 
elements.” This term includes, according to Fox, all forms of 
pendulous obesity, which breadth of definition would permit us 
to class as Dermatolysis the massive pendulous growth depicted 
in the vignette of Virchow’s Krankhaften Gesehwiilste, and really 
portraying a marked example of the molluscous form of the 
Fibromata. In preference to the term Dermatolysis I have made 8 
EDWARD WIGGLESWORTH, Jr.; 
use therefore of the title Cutis pendula, which, at least, empha- 
sises the at best but slight histological distinction between this 
disease and Elephantiasis. 
Dr. Hodges gives the following report of his case. 
Case 11. The subject of this tumor was a farmer, ast. 30, who was born 
and has always resided in Massachusetts. 
He had been told by the attending physician that at his birth his skin 
was “ mottled,” the discoloration being most marked on his left arm. His 
mother has said that when two years old the integument of this arm was 
quite coarse. 
At the time when this patient entered the Massachusetts General 
Hospital the entire surface of the body was studded with minute sub- 
cutaneous growths, some of them presenting a central orifice like those 
of a molluscum from which a slight excretion could be pressed. 
At the side of the spine, beneath the left scapula, there was a large 
projection, giving to the back the appearance of a lateral curvature. This 
it evidently was not, as the line of spinous processes was straight, and 
there was no distortion of the thorax. 
His most conspicuous deformity was, however, the condition of his left 
arm, consisting of a hypertrophy of the subcutaneous cellular tissue, 
and of the subjacent integument upon the anterior and external aspects 
of the limb. Upon the inner side of the arm the integument and tissue 
beneath were unchanged. The disease extended from the middle of the 
deltoid muscle, upon which was a remarkable growth of hair, to the 
middle of the fore arm. It did not involve the whole circumference, but 
had left a strip of varying width along the back of the arm, where 
neither the skin nor subcutaneous cellular tissue was included in the 
disease-process. The thickened skin hung in heavy, oedematous, and 
over-lapping folds, movable upon the fascia beneath, increasing in size 
from above downwards, reminding one of what were once called 
“ drapery sleeves.” The lowermost fold depended from the arm seven 
inches, and constituted a large and brawny mass so pendulous as to 
admit of hanging from either side of the fore arm. The whole of this 
thickened integument was dark and discolored, and the hair follicles 
were widely separated, enlarged and prominent, giving the surface a “ pig 
skin” look. It was not the seat of any pain, tenderness, or inflamma- 
tion. Its present size had been attained within the last few years, and 
it had grown pendulous to the extent of several inches within two years. 
There were various smaller growths of a similar character in different 
parts of the body, the most prominent being one on the right fore arm, 
and two or three on the left leg and thigh. The most noticeable one was 
situated above the right moustache, over which it hung like a super- 
numerary lip. The gum and mucous membrane of the upper jaw at the 
point corresponding to the last described tumor were hypertrophied in a 
similar manner, though to a less extent. In spite of all these various FIBROMATA OF THE SKIN. 
9 
manifestations of disease the patient had been and was a healthy, hard 
working man, nor did the size of the tumor of the arm give rise to the 
inconvenience which might be supposed. 
The removal of the growth, Oct. 19th, 1867, upon the fore arm, was 
easily accomplished, but was attended by a great amount of venous 
bleeding. About twenty ligatures were required. Except at the el- 
bow, enough sound integument was obtained to make a good covering. 
The tumor weighed, after much of the serous infiltration had drained 
away, four pounds and a half. 
In March, 1868, a surface one inch square still remained unhealed, 
but the patient was able to “ bring in all the wood for two or three fires, 
carrying it on that arm.” In April the cicatrization was complete. In 
November, 1868, when the photograph of his present condition was taken, 
the patient wrote, “the arm is so little crooked that I seldom notice it. 
By placing the palms of my hands together and extending my arms, the 
left is only about half an inch shorter than the right.” A section of the 
mass removed presented the appearance of an infiltrated cellular tissue, 
similar, as Mr. Paget says, to the “ sub-cutaneous cellular tissue of the 
back, as one sees it dissected in a dropsical body.” Under the micros- 
cope it exhibited an imperfectly formed cellular tissue indistinctly 
fibrillated, with much granular and oily matter. 
This is by no means the most remarkable of a number of instances 
of rare forms of tumors which have presented themselves at the Mass. 
Gen. Hosp. within the last ten years. One of the buttock, so large that 
the patient, when standing, was in the habit of resting it on a table, and 
another of the scrotum, also very large, were removed by Dr. H. J. Bige- 
low several years ago, [Med. Imp. Soc. vol. V., supplement, p. 91.] In 
both instances there was a recurrence of the disease. In the present 
instance, a tendency to the development of this disease seeming to pre- 
vail throughout the body, it cannot be expected that its eradication will 
prevent a return, at least to a certain extent. 
The notes of Dr. Bigelow’s cases are as follows : 
Case 111. Fibro Cellular Tumor Growing in the Skin.—This case was 
of a patient 42 years of age, and the disease was of one year’s duration. 
The general aspect of the tumor was that of a very large hydrocele, but fur- 
ther examination showed the testicles to occupy nearly a normal position 
high up on each side near the pubes. There was no probability that the tu- 
mor was of hernial origin, as the inguinal rings were normal in size and 
clearly defined. The tumor consisted chiefly of slippery lobes that eluded 
the grasp, and was supposed before the operation to be either fatty or fibro- 
cellular. It may be remarked that behind and near the anus the inser- 
tion of the scrotum had a brawny feel, and the termination of the tumor 
was noticed to be there undefined. Upon cutting down, the first lobe 
that was exposed declared the fibro-cellular character of the tissue; and 
after a dissection, which was rendered tedious by adhesions, the tumor EDWARD WIGGLES WORTH, Jr. : 
resolved itself into two principal masses. Each of these was somewhat 
lobulated, six or more inches in length, three or four inches in diameter, 
and smallest at the neck. The dissection was carried downwards and 
backwards between the bulb of the urethra and the rectum, each of 
which was exposed, and through the triangular ligament. 
Their insertion was discovered to be fan-shaped and expanded, high 
up somewhere between the prostate gland and the rectum, where liga- 
tures were passed around the two pedicles, and the masses were cut 
away. The microscope showed them to consist of a fibroid structure, 
with some attempt at an elongated cell growth; and, lying free within 
the skin and not involving it. They differ from a similar structure 
which is occasionally found attached to and corrugating the skin itself. 
Examples of the latter kind exist in Elephantiasis of the scrotum, and 
also in some other outgrowths, of which the following is an example ; 
Case IV. Fibro Cellular Tumor Growing in the Skin. The 
patient was a young woman 25 years of age, and the tumor was 
of six years’ duration when it was removed in August, 1856. She was 
troubled only by the weight of the mass, which was suspended from the 
upper part of the left buttock by a large pedicle, the whole weighing 
after removal 131 lbs., and being discolored in its surface as in Elephan- 
tiasis, wrinkled and lobulated, but entirely flaccid. 
A few days confinement to the bed reduced the size of the tumor and 
rendered the whole mass softer, so that it was evident that the growth 
owed something of its size and induration to oedema when suspended as 
usual in the vertical position. The discolored and lobulated investments 
of the tumor terminated abruptly at their margin in healthy skin. The 
wound after excision measured 13 X V inches, and the patient after 
having been much prostrated, finally recovered. 
In 1863-4 the patient was again examined, and the tumor found be- 
ginning to re-appear. 
The microscopic appearances were as in the preceding case. 
This case is noticed in the records of the Mass. Gen. Hosp. 
(Vol. 73, p. 2) as “a patient of Dr. Bigelow,” without any further 
records, but is evidently a well-marked example of the disease 
process which is bounded upon one side by Fibroma molluscum 
and upon the other by Elephantiasis, and it represents exactly the 
same pathological condition which is present upon the left lumbar 
region of the patient shown by Virchow in the frontispiece to his 
work upon tumors; in other words it is a case of what Virchow 
calls Elephantiasis Molluscum, since it is a broad-based, connec- 
tive tissue tumor of immense size and soft contents. It is not 
known whether inflammatory attacks preceded the present formation 
or not. From Cutis pendula it is more readily distinguished as the 
former is a hyperplasia of skin development of fibrous 
tissue, the latter a hyperplasia of fibrous tissue elements with a skin 
necessarily increased in size by irritation and increased nutrition. FIBROMATA OF THE SKIN 
11 
Dr. Bigelow’s first case represents a Fibroma intermediate between 
the small hard fibromata and the large, soft forms to which the term 
Elephantiasis is applied. The fasciae are favorite sites of origin 
of the fibromata, which may thence develop to a large size, at- 
tached partially to such faciae as their bases, but with the largest 
part lying loose in the surrounding connective tissue. Such tu- 
mors are usually roundish and lobulated, the lobulus being com- 
posed of fascicular fibrils radiating towards the periphery of the 
tumor and being separated by tough, whitish fibres of connective 
tissue. Such fibromata rarely reach the surface as in this case. 
To this case is appended a similar one occurring upon a woman. 
Case V. Fihro Cellular Tumor of Vagina.—J. G., aged 31, entered 
the hospital 27th, 1875. About a year and a-half ago she noticed 
a swelling on the left buttock, near the labium. Several physicians sup- 
posed it to be a hernia. The tumor was painless and projected into the 
vagina. Its shape was oval, it did not adhere to the skin but was lobulated 
and slipped about, eluding the grasp. Moderately compressible, it attain- 
ed in the erect posture the size of a cocoanut.. No pedicle was discovered. 
Upon further careful examination percussion was flat, and fluctuation 
very doubtful. To settle this question, however, an aspirator was intro- 
duced, but without result. 
Feb. 21 st.—An incision eight inches in length, outside the labium, 
exposed the tumor. The latter, although hard at certain points, consist- 
ed mostly of a juicy fibrous tissue, that was also quite vascular. As its 
substance was torn open regular layers of wavy vessels appeared in the 
interstices. The tumor was intimately interwoven with the surrounding 
tissues, except the skin. As the dissection went on there was a great 
deal of haemorrhage and many vessels were tied. When the neck of the 
tumor had been traced high up between the rectum and the vagina, the 
haemorrhage made it advisable to strangulate it, which was done with a 
double ligature transfixing the base. The oedema allowed this to be- 
come loose, and an ecraseur was applied and left in place; sponges 
were placed in the wound to check the oozing of blood. From day to 
day the ecraseur was tightened. On the 27th of February the patient 
died of pyaemia, the symptoms of which had been gradually superven- 
ing. At the autopsy pus was found in the right knee-joint and in the 
substance of the rectus muscle near the navel. 
On examination, more of the tumor remained. It had its origin in a 
slightly thickened connective tissue between the vagina and rectum, and 
behind the rectum. The tumor was hardened in alchohol and chromic 
acid, and was found mainly composed of imperfectly formed fibroid 
tissue. 
The histological substructure of all the pathological appearances 
to which we have called attention, is practically the same, namely 
fibrous tissue, and we need not allow ourselves to be bewildered EDWARD WIGGLES WORTH, Jr. 
12 
by the use of long names. The distinctions, made for con- 
venience sake and which alone concern us, are clinical, not histo- 
logical. A small, solitary, hardish and pedunculate fibroma we may 
call a fibrous tumor, whereas a gigantic, continuously diffused, soft 
formation, sessile or very broadly pedunculate, and causing disfigur- 
ation of the body itself, rather than being merely an attachment to 
the body, would be properly characterized as Elephantiasis. 
The predominate component structure in true Elephantiasis, is 
connective tissue, and Fibroma molluscum might be regarded as 
an Elephantiasis mollusca, except that the former process is less 
diffused and runs its course without fever or inflammation, chronic- 
ally and almost without attracting attention, while the latter be- 
gins, as a rule, with an inflammatory process of the character of 
erysipelas, accompanied usually by marked fever, the channels of 
the lymphatic vascular symptom being, for the most part, very early 
participants in the process, and to the stasis in these is largely 
due the swelling and the fibrinogenous fluid which exudes when 
the tumor is cut. So also the adenitis. Elephantiasis is an ex- 
tensively diffused and continuous process, though limited in ex- 
tent to parts of the body; Fibroma molluscum occurs as discrete 
formations of smaller size, scattered over any, or the whole extent 
of the body in great numbers, and selects by preference the trunk 
and the face, the very parts usually spared by Elephantiasis. Fi- 
bromata mollusca are also always soft, and are due to progressive 
hyperplasia of the subcutaneous tissue. 
As regards Elephantiasis, it is perhaps, hardly necessary here 
to more than reiterate the necessity of bearing in mind the 
marked distinction between true Elephantiasis, the E. Arabum, 
which belongs to the group of cellular or connective tissue tumors, 
tumores fibrosi, and the E. Grascorum, or true Leprosy, belonging 
to the granulation group of tumors, which group includes also 
lupus and syphilitic gummata. The Lepra Arabum is, however, 
identical with the Elephantiasis of the Greeks, while the Lepra of 
the Greeks, and of Willan, is the disease at present known as 
psoriasis. Cases have been reported where true elephantiasis has 
occurred, as a separate disease, upon persons affected with lep- 
rosy, but such are very rare. Elephantiasis is a purely local and 
limited disease occurring principally upon the limbs, a definitely 
defined increase of tissue growth ; Leprosy on the contrary, is a 
constitutional and universally diffused disease process. ARCHIVES OF DERMATOLOGY; 
A QUARTERLY JOURNAL OF 
SKIN AND VENEREAL DISEASES. 
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•,* Volume 11. begins October, 1875.