men, and possibly further interrupted in its function by the early congestion of a catarrhal bronchitis, the heart seems to have failed beyond the power of stimulants to recover it. The slight epileptiform fit which occurred in the last illness had nothing fatal in it, being much slighter than had occurred in him before, whilst it was also such as might arise from, but not produce, the exhaustion of his last hours. The disturbance of the digestive system, which initiated the fatal symptoms, appears to have commenced with the last alteration of his diet, and to indicate the extreme care which is necessary in the selection of articles of food for a person deprived, as he was, of the proper organs of mastication.

CASE III.-Extensive Rodent Cancer of the Face.
Operation. Recovery.

was narrow,

GEORGE W., 59, was sent to me from Congleton, by Dr. Beales, August 31, 1865. In the middle of the face was a vast ulcer, laying into one cavity the nostrils, right orbit, and mouth. Its highest part and reached a little above the level of the eyebrows its lowest part was formed by a deficiency of all but the outer half-inch of the upper lip on each side. In the interval it extended from within a quarter of an inch of the left tendo oculi, across to the middle of the right lower lid. The entire nasal part of the face was gone, with the inner part of the right orbit; and the globe of the right

eye, covered only by some thin cellular tissue and conjunctiva, was exposed. It was, however, movable and healthy. See Figure 6.

The character of the disease was that of a solid deposit in the natural tissues, advancing in one direction, viz. towards the healthy structures, and followed so closely by ulceration, or degeneration of the mixed deposit and tissue (if, indeed, any tissue remained), that the edge nowhere reached the thickness of a quarter of an inch. The cutaneous margin was thus thick, and the anterior edges of the bones in the nasal cavity. The tissues exposed in the orbit were thinly covered with the morbid growth, and not contracted. Their surface secreted and discharged pus in small quantity, which being in the current of the breath, formed scabs. Both parts of the divided upper lip ended in a contracted scar, but they were thick and firm, seeming to be filled out by some of the morbid deposit. The teeth were nearly all gone from the upper jaw, though only the front of the alveolus was destroyed by the disease.

The man looked robust. He was short and thickset, and what remained of his face was well-nourished and ruddy. Nevertheless he said he had much difficulty in accommodating his stomach, and could not digest any but light food. Whenever he had gone into a hospital, he was soon made ill by the air and confinement, and was speedily obliged to leave it.

He had had the disease twenty-six years. It had begun on the right side of the nose, as a small red

pimple, in a pit left after an attack of small pox, which occurred in his infancy. It spread in all directions, and it had never entirely healed, although he had undergone treatment when it was smaller, and had had it nearly well for more than a year afterwards. Three years ago, during the Exhibition in 1862, the ulceration was not larger than a half-crown piece, but it had lately extended with comparative rapidity, and about Christmas 1864, had split open the lip. His exercise, general health, and work were not interfered with, and he had supported himself, was married, and had a large family of children since the disease had begun.

The most comfortable application to the ulcer proved to be a mixture of glycerine and starch.

September 4.-I removed all the solid deposit by galvanic cautery. The trench sunk by the hot platinum was even, dry, and black. I could not remove the diseased parts of the nostril with it, or those near the globe of the eye. These I partly cut away with scissors, and then over the whole surface applied chloride of zinc paste. He was not under the influence of chloroform during the latter part of the operation.

The operation was followed by pain, and by much swelling of the adjoining parts of the face and forehead. He took little support, and had a good deal of pain and little sleep; and on the 7th, for some short time he seemed to be somewhat uncontrolled in mind, wishing to go home instantly to Cheshire, by train, without having his wound dressed, and refusing all

interference. I felt it necessary to prevent his doing this, and ordered a male nurse to watch him. He slept that night, and awoke rational and refreshed, and took food. The sloughs then began to separate, and he rose and went about the garden. On the 11th some large pieces of slough were detached, and healthy granulations appeared underneath them; and on the 14th he was allowed to return to Cheshire, being quite well again in himself, and able to attend to the dressing of the large wound. The only part in which it appeared doubtful if the whole disease had been removed, was at the inner and back part of the right orbit near the globe of the eye.

November 23, 1865.—By the direction of Dr. Beales of Congleton, W. showed himself at the Hospital to-day. He said that his journey down had tried his strength, and that for about a month afterwards he had kept his bed. He did not yet feel mentally recovered, and was sometimes giddy if he exerted himself. He had, however, no headache, or other head symptom, and he struck his head forcibly with his hand to demonstrate his sense of its soundness. He had latterly resumed light work, and was capable of doing it, but greater efforts, and the journey of yesterday (160 miles), were too much for him. He felt more than usually tired, and he was troubled with cold caught yesterday, in the exposed right eye. Nevertheless he was stout and well nourished, and he looked healthy.

The aperture in the face had remarkably contracted,

and there being very little scar the cheek was drawn forward to the edge of the bones. The same process had, however, a little widened the gap between the parts of the upper lip which, in adhering to the bones, had retracted. The alveolar part of the upper jaw was thus exposed widely, and covered with red cicatrix. At the left side the canine tooth hurt his lower lip. Cicatrisation was complete in all but the former site of the nasal spine of the frontal, and about the front of the right maxilla, where some dead bone still adhered. Even the parts behind the right eye seemed sound; but the eye itself had a scab adhering to the inner and lower part of the cornea, and surrounding grey opacity. Above this the cornea was clear, the pupil was distinct and contracted, and the anterior chamber contained natural fluid. The upper lid, which was nearly entire, was firmly fixed to the inner part of the superciliary ridge, near to the right edge of the ulcer, but without thickening by disease. The outer remnant of the lower lid was turned downward, and involved in the margin of the scar below. Between it and the globe there was a great livid soft chemosis; the conjunctiva being inflamed with yesterday's catarrh, and much swollen. I pulled off the scab from the cornea, but that membrane, though ulcerated, was not yet perforated. The sight of the eye was much impaired, and as it could not get better, I proposed to him that he should have it removed. He assented, but wished it done without chloroform. Before operating I sent him to Mr.