over the splenius remains enlarged, firm almost to hardness, and adherent to all the tissues except the skin. It gives the impression of its being the seat of a firm deposit similar to that forming the edge of the ulcer; that it is, in fact, cancerous.

With the object chiefly of arresting the progress of the ulceration towards the ear and eye, I gave this man chloroform, and applied the galvanic cautery. The battery was prepared by my colleague, Mr. Heisch, who, with three cells, readily heated a bent platinum wire. By the prolonged touch of this wire, a trench was sunk around nearly the whole ulcer. It was found advisable not to use the wire in an incandescent state, as the high temperature brought on bleeding, which delayed the operation. If the wire were kept in contact with the skin, its temperature remained dull, and when it was drawn slowly along, a black dry trench was immediately formed, which could be carried, without force or pressure, in any direction, and to any depth. The granulations forming the base of the ulcer, all the diseased structure which could be reached near the meatus, and that about the eyelids, were charred with the wire. The granulations bled inconveniently, as it was not possible to expend the heat upon them quickly enough to close the vessels with coagulated blood. When the whole surface had been treated, it was covered with cottonwool, with the view of closing the wound with dry materials. Morphia was injected under the skin before the patient awoke from the chloroform sleep.

He did not sleep, and in an hour there was a little hæmorrhage, but by the evening he was sufficiently at ease to eat and relish his steak.

6. He passed an uneasy night, from pain about the head and from the morphia, which always makes him restless; and to-day he complains of stiffness and heat of the head. The cheek is red near the wound, but the scalp is cool; he is but little feverish.

7. The importance of avoiding hæmorrhage while using the cautery is manifest to-day, as the dressings are soaked with softened blood-clot, and almost all the surface of the ulcer is moist and discharging. The edges are everywhere formed of black eschar. He makes no complaint of pain, and he slept well last night. He is, however, much annoyed by the foetor of the dressings.

10. Doing well. His appetite fails, apparently from the fœtor of the sore during the present hot weather. Some delirium last night seems to have been due to the use of stramonium ointment for the sore, as he feels uncomfortable to-day all over, and has some dilatation of the pupil.

26. The slough has separated, and the whole sore is covered with bright, prominent, healthy, granulations. At the posterior part there does not appear to have been a sufficient destruction of morbid substance, the margin being tumid, of a dusky venous colour, and undermined. The parts in the meatus look healthy, and the bony portion of it is not necrosed. His health is much improved, and his

appetite and healthy appearance have returned. He sleeps well at times, but he complains of pain about the eyebrow and at the back of the sore. The gland over the splenius has diminished to nearly a natural size, and is soft.

August.-There is a distinct diminution of the size of the sore, and its edge is level, soft, and cicatrising, except over the front of the right masseter. There are scattered cicatrising points in six places within the area of the sore. The edge towards the nape is tumid and turgid, but not hard.

Dec. 1865.-The sore has shrunk to four and a half inches horizontally by three inches vertically: its upper edge is thin, flat, and disposed to cicatrise : but no permanent scar advances from it, being no sooner formed than it disappears again. All the lower margin of the ulcer is thick. The base of the sore is covered with few granulations, but is scored in lines radiating in the directions of the fibres of the temporal muscle. These concentrate towards the zygoma, which is prominent and granulating, and are lost under it. The dragging of the lids outwards rather increases, and gives him discomfort. In this part of the sore is the most cicatrix. Over the masseter it is characteristic of the disease, hard, and precipitous. It is firm over the parotid, but bevilled and ready to cicatrise. Towards the occiput and nape its thickness, vascularity, and firmness have lessened, and the skin itself is soft; the margin is here, however, undermined for three-eighths of

an inch, and probably cicatrised on its under surface. There is much complaint of pain and tenderness of the adjoining scalp, where the groove under the skin ends. I can find no bare bone, and there is little tenderness on probing at that part. The gland on the splenius is still not natural.

18. With the galvanic cautery I again destroyed as much as possible of all these diseased parts.

The

May 1866.-The disease has extended within the last few weeks among the deeper textures of the neck, and has exposed the sterno-mastoid muscle, on both its surfaces. Its entire base appears also to have sunk to a slightly lower level, as if the process of destruction were deepening in all directions. most distinct increase of the marginal disease is towards the eyelids, which have rather rapidly ulcerated: the upper part of the edge meanwhile has undergone little change, and still presents an appearance of health in every respect but its failure to cicatrise. With this rather rapid advance of the disease there has concurred a considerable failure of strength, and an amount of pain which the poor fellow speaks of in the strongest language.

May 1867.-During the last twelve months the disease has not extended upwards, the curved margin over the temporal muscle remaining at the same level and of the same form. Occasionally, cicatrisation has advanced from it, and receded again. In other directions some advance of the growth has taken place. The eyelids at one time became gradually

shortened and distorted by the encroaching growth, and so great pain resulted from the consequent exposure of the eye that I removed it for him, together with that part of the disease which had reached the eyelids and orbit. The relief from this operation was great, and he recovered his general health, which had been much impaired by sleeplessness and pain. In the direction downward and backward a slow but continuous increase of the disease occurred, and the parotid space, and upper parts of the sternomastoid and of the splenius muscle were denuded. Some hæmorrhage took place on one occasion from the deepest part of the parotid. It seems to have amounted to several ounces, but after two or three months it had not recurred. The base of the ulcer has withal sunk yet deeper, and most of the substance of the temporal muscle, as well as of the bony zygoma, has disappeared. The aspect of the sore is consequently more healthy, there being less solid substance in any part of it, less rugged inequality, and much less discharge. But these changes are due to infiltration of the solid growth into the even cranium, which is now exposed, and not to any real improvement in the disease. The pain has been sometimes very severe; it is chiefly confined to that part of the sore which is encroaching on the nape of the neck. It sometimes interferes with sleep for a long time, which indeed appears to be taken chiefly either in a half-sitting posture or when he is resting on his elbows and knees. The position of the sore makes