lihood. I accordingly devised a plan for making a septum out of an inverted bit of the upper lip, stripping the cicatrised margins of the aperture down, and attaching their extremities to the septum in a curve, so as to form nasal apertures, and then bringing down a flap of skin from the forehead, and attaching it to the margins of the aperture laterally, and to the newly made alæ below. In doing this operation, I raised the whole thickness of the scalp, after the manner of Langenbeck, with the view of obtaining from the transplanted periosteum the support of a layer of new bone in the nose. The exposed frontal bone was washed with a solution of chloride of zinc, 20 grains to the ounce of water. The four transplanted portions united together throughout, and the result of the operation was a nose of very satisfactory shape and prominence, with a wellformed nasal orifice on either side of the septum.

On the sixth day the patient was reported to have erysipelas of the right side of his face, but this was doubtful, and he soon recovered from it.

After three weeks of health and comfort, he had headache about the exposed bone, which was necrosed. The pain extended to the vertex. His tongue was

dry and brown, and he lost sleep.

On the twenty-sixth day he spoke of slight shivering. His headache was less, his tongue less furred, his bowels open, his pulse 80.

Between the twenty-seventh and twenty-ninth days he had four epileptic fits. They were slight,

and quickly over. He then recovered his natural and comfortable feeling, and for more than a fortnight he had neither headache nor fit. The convulsive symptoms appeared to indicate nothing further than is usual in the separation of a layer of bone to which chloride of zinc has been applied, namely a superficial and transient local irritation.

On the forty-fifth day after the operation, headache recurred, with excessive soreness of the granulations overlapping the circumference of the dead bone, and of one or two which protruded through it. These symptoms alternately moderated and returned. After a more than commonly restless night he was found, on the morning of the fifty-first day, to be unconscious without any fit, and in the course of a few hours he died.

At the post-mortem examination, besides syphilitic deposits in the liver, a large fibro-calcareous concretion on the aortic valves, and a granular state of the kidneys, it was found that an abscess existed in the substance of the right hemisphere of the cerebrum beneath the exposed frontal bone; that there was much cerebral meningitis, and some pus in both lateral ventricles. The dura mater was not perforated, but the inner table of the frontal bone beneath the exterior layer of necrosis was cribrous. In the lungs were a few abscesses of small size and pyæmic appearance; but there were besides a few deposits of miliary tubercle.

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FIG. 1. The aperture remaining in the face and nostrils after the healing of the wound made in removing a large Rodent Cancer. CASE I. Photograph by C. Heisch. FIGS. 2 and 3. Photographs of a large Rodent Cancer of the Face before operation.

FIGS. 4 and 5. Photographs by C. Heisch, showing the same face after operation and death from bilious cholera, and the contraction of the aperture resulting from the process of healing.

(Figs. 2, 3, 4, and 5 belong to CASE II.)

WOODCUTS

BY CALEDONI STECHER.

FIG. 6. Copy of a Photograph showing the contracted aperture in the face after the removal of a very large Rodent Cancer of the Face of 26 years' duration. CASE III.

FIG. 7. The appearance of the same patient when wearing a mask in Vulcanite made by Mr. Turner. From a Photograph.

FIG. 8. Side view of a section of the forehead and front of the brain, showing the superficial extent of a Rodent Cancer on the head and nose, and the depth to which, after perforating the frontal bone, it had encroached upon the anterior lobe of the cerebrum. CASE V.

FIG. 9. Extensive Rodent Cancer of the temple and adjoining parts, of nearly 14 years' duration. Drawn on wood shortly before the death of the patient by hæmorrhage in the neck and mouth. CASE VI.