about the space of a shilling. There was some induration at the base of the ulcer, but not much. He does not smoke, has not injured the tongue in any way to his knowledge, has never had syphilis, nor are any of his relations cancerous. The general health was not good. He used the borax lotion, and took hydrochloric acid with bark for a month with some benefit. On the 9th of January 1862 I rubbed the ulcer with nitrate of silver, and continued the same treatment. On the 16th the lunar caustic was used again, and once a week until the 13th of February, when the granulations had entirely disappeared, and the tongue was quite well, as is shown in the second drawing of this case. The general health also had greatly improved.

I was unable to assign this case to any class amongst the skin or constitutional affections which obtain a locale in the tongue. Except for the absence of much induration, it at first looked more like cancer than anything else, and would probably have been excised by those whose surgical enthusiasm prevails over their medical instinct. It is a case, I think, which shows that when there is any appearance of deficiency in the powers of life, whatever may be the local lesion, we should attempt to correct that deficiency before attempting any operative proceedings upon the part itself; and in doing so we shall not unfrequently find, as in this case, that the local and the general malady are cured together.

CHAPTER VI.

THE LIPS AND FACE.

THE frequent selection of the lower lip for the localization of a cancerous diathesis in men is doubtless due to the practice of smoking. It has been already observed that tobacco-smoking cannot be accused of producing the disease, because thousands smoke and only the units have cancer. But when we remark how very rare is cancer of the lip in women, and how absolutely without exception, as far as my experience goes, this habit has prevailed with men so afflicted, it is impossible to resist the conclusion, that the determination of the disease to this particular part has been brought about by the local stimulus applied by means of the cigar or the pipe. I am not cognisant of a single case of cancer of the lip in a person who had not at some period of his life smoked. Other causes are referred to, -such as an accidental injury by striking the lip against the teeth; the frequent habit amongst packers and netmakers of holding twine between the teeth, and so making undue pressure on one part of the lip for a long period; the irritation of tartar in that unfortunately large class of persons who neglect the use of the toothbrush; and lastly, the practice of wine-tasting, especially in Spain, where the new wines have a large quantity of

the tartrate of potash held in solution. All these causes, however, must be looked upon as agents only in the determination of the seat of a constitutional defect; and the treatment, to be of any permanent use, must be directed in this instance, no less than in all others, to the whole system as well as to the local mischief. Here, as elsewhere, the diagnosis of the disease is of the utmost practical importance. I have known many persons leading a miserable life, under the impression that they were suffering from cancer of the lip, when in fact the disease was of an entirely different character, and required only a properly-directed treatment to secure its dismissal. The lips are subject, like the tongue, to eczema, psoriasis, and ichthyosis, and the upper lip especially to sycosis and lupus. They are also occasionally the seat of small serous cysts, which only excision will remove. They are frequently ulcerated most severely in syphilitic patients, and I have even seen primary chancre on this part. Although a thick lip is said to indicate a tubercular constitution, I am not sure that I have ever seen disease purely the result of tuberculosis in this situation; but I can imagine it to be quite possible. Lastly, the lips are the seat of cancer, in that form generally known as epithelioma.

I have had under my care for the last two years a man who has had eczema of the lips and palate for fourteen years. He has been submitted to a variety of treatment, and before he came to me nearly all the local applications employed were of a caustic nature. He had never had syphilis, was not a smoker, and had no hercditary taint of any kind that he was aware of. The lips were swollen but not hard; they were extremely red,

and flakes of dried epithelium were constantly peeling off, leaving quite a raw granular surface. This condition extended to the inside of the cheeks and to the palate. He was unable to take solid food owing to the pain produced by mastication, and he was in a weakly state in consequence. Owing to the long continuance of this condition it was suggested to him that it might be cancer, and he accordingly came to the Cancer Hospital. It is not likely that any surgeon of experience would fail to recognise the nature of such a case at once; but it is necessary that the student should have these cases placed in juxtaposition, and I have therefore had a drawing taken of the above case, to show its distinctive features. The patient is not well, but so greatly improved that he is enabled to masticate comfortably, and the general health is now quite restored. The use of caustics doubtless aggravated the disease much. I have found the most useful applications to be phosphoric acid and glycerine, and borax lotion containing glycerine. He has taken arsenic and iron without any favourable result, but latterly chlorate of potash with hydrochloric acid and cod-liver oil have had a most marked beneficial effect, and there seems good reason yet to hope that he may be entirely cured of this troublesome malady. I have given this case insertion here under the impression that an illustration teaches far more than any theoretical description.

Psoriasis labialis is a recognised form of skin-disease mentioned by Willan and Rayer, and attributed by them to the habit of biting the lips. It appears generally as an inflamed crack in the centre of the lower lip, and is often very difficult to cure. Caustics