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times copiously on the side of the head. There were no fits of any kind in that case, but a feebleness of mind, a little slowness in collecting his thoughts to answer questions, and some hesitancy in utterance. There was, moreover, some muscular weakness during the more rapid progress and copious secretion of the great ulcer, symptoms which all lessened when the activity of the disease was subdued, and which were perhaps not more than the general exhaustion accounted for. There was, at the same time, no paralysis, excepting from the destruction of the portio dura in the ulcer. Death, in most of the cases, is the issue of increasing and protracted exhaustion, but it is sometimes brought on suddenly by hæmorrhage.

In most cases the disease commences during the decline of life. It rarely arises before fifty years of age, though in one instance which came under my care, the growth first appeared as early as at thirtythree years of age. Mr. Hutchinson also observed a case in which the patient, when first attacked, was only a year or two older than that age.

General healthiness, as a rule, has been the prevailing condition of the persons in whom this disease comes on. One man expressed this by saying to me, 'I never had fingerache nor toothache for forty years.' Syphilis had left its mark on the persons of some of the patients who were under my observation, either

in a slight thickening of the shin of the leg or in a scar on the penis, but Syphilis was not an universal precursor of the Rodent disease. Neither did it appear that unusual exposure of the face to rough weather had preceded the disease, for, although it presents itself only on skin not covered by dress, none of my patients had been sailors, and nearly half of them were women.

THE STATE OF THE ABSORBENTS IN RODENT

CANCER.

It is not usual to find any disease of the subordinate glands in connection with Rodent Cancer. Not only are they commonly without enlargement during life, but after the disease has endured for years, and has reached a fatal termination, they may prove, on examination, to be free from any morbid deposit. That which exists at the borders of the ulcer is not usually transferred to the glands. Indeed, it is not by any means infrequent to find the lymphatic glands of even less than their natural size. They appear to be in a state of emaciation rather than of increase, and are difficult to discover in their natural situations. But they are not always in that condition. They occasionally enlarge, not with the soft, tender, and oedematous swelling of glands that are inflamed,

but with hardness as great and as abrupt as that of the marginal substance of the disease itself. Occasionally they very slowly subside again, but sometimes not until they have first softened and evacuated their contents by a kind of suppuration. In two cases of Rodent Cancer I have had the opportunity of watching an absorbent gland, which in the course of months attained to three or four times its natural size, and assumed a hardness which would have been held to be unquestionably characteristic of Cancer if found associated with a Cancer of the breast. The hardness and enlargement in one case slowly disappeared after the removal of the adjoining primary disease, and they did not recur. In the other case,

the gland, which was over the splenius muscle, shrank as the disease slowly encroached on the nape of the neck. Mr. Bowman has informed me that he also has met with an instance of glandular disease below the jaw in connection with a Rodent Cancer of the forehead, and that, after enlarging considerably and then softening, the gland discharged its contents and subsided. Some years afterwards, when the primary disease reappeared, and the patient was committed by Mr. Bowman to the care of Mr. De Morgan, I had the opportunity of ascertaining that there remained no disease whatever in the submaxillary region. Mr. Hutchinson showed me a man under forty years of age, from whom he had removed a Ro

dent Cancer of the forehead, and he also had found disease arise in a gland in the corresponding parotid region. In my own cases the disease of the glands did not present the character of ordinary inflammatory engorgement or proceed to suppuration; and the account given me by Mr. Hutchinson and Mr. Bowman of the morbid process in the glands of their patients was rather that of a slow, dense thickening and gradual softening than of inflammatory suppuration. Hence these exceptional instances, though possibly peculiar glandular abscesses, appear to supply just that rare proof of the cancerous nature of Rodent disease which is consistent with its slight malignancy, and is therefore ordinarily wanting.

THE DIAGNOSIS OF RODENT CANCER.

In making distinctions between diseases which have some important features in common, it is necessary to regard those characters only which manifest their essential differences. For it would be possible to discriminate so minutely as to separate from one another diseases identical in their nature. Now the Rodent Cancer has this in common with Lupus, Syphilis, and Epithelial Cancer, that it progressively invades the structures of the face, and destroys, without repairing them. Yet they are

all distinguishable, in certain broad and practical particulars.

The distinction of Rodent Cancer and lupus is shown both in the persons whom they attack, and in the characters of the local ailment. Lupus occurs in the young adult, Rodent Cancer in the decline of life. Lupus is exclusively a strumous disease, Rodent Cancer originates in persons previously healthy. Whilst both diseases arise in the skin, lupus is peculiar to thin and fair integument, Rodent Cancer to skin of ordinary firmness and colour. The aspect of the two diseases is different at their commencement in the skin, and not less so in their later progress. Lupus begins as a pink, low, tuberculous elevation of the skin, Rodent Cancer as a firm, uncoloured nodule in it. In lupus there may be more than one tubercle, and the intervening skin may be healthy, or pink, or scaly, or oedematous : the pimple of Rodent Cancer is solitary. The surface of lupus first scales or peels before it breaks; the Rodent Cancer excoriates, and then scales or bleeds. Both ulcerate; the lupus at one or at several of its tubercles, the Rodent Cancer by the mere deepening of its central scabbed excoriation. Lupus may cicatrise and cease at any time; Rodent Cancer proceeds with at most but a temporary and partial healing near its edge. When both are far advanced, the lupus has a superficial ap

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