the malar has also re-opened. At the lower part of the larger one there has been a little sloughing within the very hard thick tissue between the jaw and the mastoid process.

May 1.-The skin last spoken of is now perfectly soft.

July 9.-The three openings have remained in nearly the same state for many weeks. They appear perfectly indolent, being pale without granulations, excavated and concave, sharp edged, and without surrounding vascularity. Sometimes the margin

towards the tissues of the neck becomes hard and thick, and again, without perceptible reason, it softens. It has been necessary to discharge him today; I have desired him, however, to return.

Mr. Holthouse informed me that the man was admitted into the Westminster Hospital and died of hæmorrhage from the wound in the parotid region, in the latter part of 1866.

CASE VIII.-Rodent Cancer of twenty years' duration in the left Eyelids, Orbit and Temple.

JAMES B., æt. 81, was sent to me by Mr. W. G. Lee, of St. John's, Fulham. He is a tall, fairly muscular, clear-skinned, hale old man; retains sight for reading his Bible without glasses, and till five years ago he had good sight with the left eye. He has also had excellent health throughout life, with the exception of an abscess under the left shoulder blade, probably

after pricking his finger. He was born in Surrey; was the eighth of ten children, and born in the same year as the seventh. After working as an agriculturist, he came to London in the same year as Lord Nelson' (1804), and was a butcher over fifty years.

More than twenty years ago he found blood on the edge of the upper lid, and a small crack, which thickened, ulcerated, and spread, never ceasing, never better, until it reached its present size. Five years ago he lost the eye, but without particular pain.

There is now a cavity on the left side of his face, having thick sinuous cutaneous edges, and occupying the place of nearly all of both eyelids, the adjoining part of the temple, and the outer part of the orbit. At the inner side is the stump of the eye. It is doubtful if any part of the base adhere to the external angular process; elsewhere there is no tissue affected but the lids, the globe, and the orbital cellular structure, all of which could be easily removed. No glandular disease on the masseter or in the neck.

He suffers pain in the scalp on that side of the head, and is sometimes very low; but he decidedly objected to have the disease removed by any operation.

CASE IX. Rodent of the Cheek.

MR. FLOWER, of Codford, St. Peter's, sent me a patient of about 63, November 1865, with an excava

tion in the front of the left cheek, side of the ala nasi, and upper lip. It had begun some years previously in a pimple on the cheek, which scabbed, and she frequently rubbed off the scab in washing. The progress of the ulceration was at first very slow, but since May last it has advanced more quickly. The whole gap in the integument, though not circular, occupies a larger area than a half-crown piece. The edge of the ulcer is a firm, rather red, raised rim, less than an eighth of an inch in thickness, irregular in outline, and continuous externally with perfectly healthy integument. The adjoining features are not in the least displaced. Half the lip is destroyed, yet the line of the mouth is not altered.

The case is a promising one for extirpation; but she declines any operation.

Operation.

CASE X.-Rodent Cancer of the left Orbit, Forehead, and Cheek, exposing the Dura Mater. Temporary improvement.

Published by favour of Mr. De Morgan.

ANN F., aged 67, an emaciated and feeble woman, was in the Middlesex Hospital under the care of Mr. De Morgan for a very extensive ulcer of the forehead, left cheek, and left eyelids. The ulcer was everywhere set upon a solid base of new growth, which permeated the textures beneath the ulcer. The natural parts were to a considerable extent destroyed

by it: the whole thickness of the scalp and frontal bone was 'gone, and the dura mater of that part, thickened with the morbid granulation, pulsated on the face of the great cavity. The eye was painful and sightless, and it appeared to contain pus.

After extirpating the globe, Mr. De Morgan removed the greater part of the diseased substance by incision and cautery, and then laid the chloride of zinc paste over the entire surface. The paste was laid upon the exposed dura mater in small quantity, and without previous incision of that part.

The patient had the usual epileptiform fits after the operation, but they were transient and not severe. They were indeed neither so prolonged nor so frequent as those which sometimes occurred when the caustic was not applied to the dura mater, but only to exposed bone. On the separation of the sloughs, the wound in great part healed, and the patient was restored to much comfort and recovered some of her strength. She lived altogether in the Hospital from June 1864 to April 1866, and died at length without renewed cerebral symptoms, on a return and increase of general feebleness.

At the time of death, the gap in the face extended from a little below the hairy scalp nearly to the tip of the nose. The left cheek was gone, with the inner part of the left eyelids, the contents of the left orbit, and the nasal bones. The interior of the nose and the left frontal sinus were exposed; and the aperture in the frontal bone, still closed by dura mater

and covered with a thick layer of granulations, measured an inch and a half in diameter. The edge of the ulcer was generally cicatrised, and nowhere thickened; on the left eyelids and left side of the nose it was sharp and appeared to have been extending. There was no enlargement of the glands in the neck or face. The brain was normal, but adherent to the dura mater within the aperture in the frontal bone. No cancerous elements were detected with the microscope. The kidneys were contracted and granular; their cortices much wasted, and the capsules adherent.

CASE XI.-Fatal Rodent Cancer of the Face at an early age.

Published by favour of Mr. De Morgan.

A MAN, aged 48, died in the Middlesex Hospital, under the care of Mr. De Morgan, in July 1863.

He was extremely emaciated. An ulcer, having a somewhat thickened edge, on the left of the face, occupied the place of the left eye, the whole of the nose, the left cheek, the left half of the upper lip and part of the left superior maxilla. The whole frontal bone and the right upper jaw were bare, and both the right eyelids were gone, but the eye itself was not injured. There was no enlargement of any of the glands of the head or neck.

There were depressed cicatrices in the apex of the right lung, small patches of atheroma on the aortic