valves, and a large smooth liver, though soft and decidedly granular, on section. No Cancer could be found in any part of the body, and the thickened margin of the ulcer contained no Cancer cells. CASE XII.-Tumour of the Tongue; query Rodent? MR. FRANCIS W. DAVIS reported a case to the Pathological Society in December 1859, in which a hard ulcerated tumour, of sixteen years' standing, involved the tip and right half of the tongue to the extent of about two inches. The rest of the tongue was small and atrophied, and the pharynx and œsophagus were also small. The patient was a man aged 79. He had suffered shortly before death from constant gnawing pain in the tongue and the right side of his face. The Repórters on the specimen, Dr. Bristowe and Mr. Jonathan Hutchinson, observing the margins of the ulcer indurated, but of no great thickness, and finding the elements displayed under the microscope to be almost exclusively those common in chronic inflammation of the part, and only indistinctly composed of nested cells, were of opinion that the disease was allied rather to that known as 'Rodent Ulcer' than to the more decidedly malignant class. CASE XIII.-Syphilitic Ulcer of Scalp. Added for contrast with foregoing cases. May 29, 1862.-I admitted into the Middlesex Hospital a short, stout, full-faced, bloated-looking, feeble man of 45. His head was bald, and at the back of the crown in the mesial line was a nearly circular ulcer, with deep precipitous edges, a scabbed base nearly on the bone, and as large as a five-shilling piece. The skin around was slightly red and tumid, but the whole looked inactive, and except in form and depth characteristic of nothing. There were a few scars on his body and legs, but no very definite syphilitic marks, and none on the penis. He had long had a pimple on his bald head, and often scratched it. The sore, which might have been primary, had come in six weeks to its present state. I ordered him iodide of potassium and bark. May 31.-Last night he seemed to the nurse teazed with his throat. Early this morning he had a fit. I saw him in the fourth and fifth fits in the afternoon. With just a respiratory catch in his breathing, hardly enough to call a scream, he became unconscious, stretched and involuntarily twitched his limbs, compressed his chest, and became red in the face. In a few seconds he strained with efforts to vomit; the muscles relaxed, and he was at once conscious again, and spoke quietly. During the fit his eyelids were open, his eyes fixed, and pupils dilated, but there was no grinding of teeth, foaming, or further distortion of face than that of the fixed unearthly stare. The whole was over in thirty or forty seconds. Pulse 140, scarcely perceptible. The fits continued through the afternoon, and he died at seven quietly and suddenly, having been the moment before quite conscious. On examination, the scalp was found thick and closely adherent. The cranium was moderately thick, rather dense, having little diploe, and slightly bossy externally. Internally the greater part of the vault was marked by many thin deposits of new bone, on which distinct grooves were filled with vessels full of blood. Parts of the substance of the base of the skull were deeply congested, an abrupt line separating the vascular from other pale parts. In the right frontal sinus there was free pus, and the lining membrane was vascular. Neither appearance was found in the left cell. The dead piece beneath the wound reached one third through the skull; the inner layer was living, dense, bossy, and lined by a small patch of very vascular soft membrane, which came off with the calvaria. It was not so large as a threepenny piece, and it corresponded with one only of two dead portions which could be distinguished on the outer table. The dura mater was everywhere thick: in some places it was covered externally with old leathery sheets of yellow lymph. Many vessels were seen in the membrane, much larger and more numerous than natural, but having the aspect of old, almost varicose, dilatations of the vessels rather than of recent inflammation. Immediately beneath the base of the ulcer, the dura mater was thick, yellow, and vascular. It was adherent to the bone, and had no trace of suppuration about it. The longitudinal sinus and the arachnoidal surface beneath the thickened dura mater were quite healthy. At the front of the parietal region were some ossified Pacchionian bodies, small, rather sharp, and presenting near the longitudinal sinus toward the brain. The cerebrum was vascular on the surface, not varicose, and opposite the ulcer was quite healthy. Gray substance somewhat pale, decidedly thin. White rather congested in large holes, but not tinged with blood. Perfectly clear serum in the ventricles. There were many dotted small glandular elevations over the oesophagus. The mucous membrane inside the higher process of the thyroid cartilage was raised on one side in low, flat, slightly pale elevations. The microscope showed that these were natural, not condylomatous. Intense deep venous congestion of trachea and bronchi: moderate of lungs. Liver large, firm, deeply congested, shrunken in parts between the lobules, so as to seem there rather hobnailed. An obsolete cyst, nearly as large as a pea, containing cheesy stuff. Kidneys large, scarred in pits, capsule adherent in parts. Heart fairly firm, pale, not distinctly fatty. There had long been disease of this skull and dura mater, which is partly intelligible from the later details of the post mortem examination; but the little patch of vascularity beneath the ulcer, and necrosis, seemed to indicate acute inflammation just begun. CASE XIV. Construction of a new Nose by transplantation in four portions. Necrosis of the Frontal bone. Death from Cerebral Abscess. Added for contrast with foregoing cases. JOHN J., aged 37, a married courier, lost by syphilis the entire cartilage and septum of his nose, and the extremities of his nasal bones. The skin and mucous membrane at the sides having joined in a linear cicatrix, there remained a somewhat triangular opening, bounded by the scar, and having for its only raised part the remaining projection of the nasal bones. The lower transverse base of the triangle rather receded, and the scar descended over the upper lip. This portion had not even a remnant of the nasal spine which might have formed some support for a new nose, and with the entire absence of the septum there seemed no hope of maintaining any prominence of a flap of skin taken from the forehead. I accordingly declined to operate. The man returned after some weeks and urgently desired that, though only a flat web of skin were laid across the opening, even that improvement should be made in his visage; as his appearance, notwithstanding his artificial nose, prevented his gaining a live |