patch of considerable size on the surface of the right ventricle. The endocardium of the left ventricle covering the septum was opaque and thick, and from this slender, white, fibrous bands passed into the substance of the septum nearly through its whole thickness. They resembled cicatricial tissue, but the muscular substance between them and in the rest of the heart was firm, and natural on microscopic examination. There were patches of atheroma on the mitral valves, and both atheromatous and calcareous plates along the whole aorta.

The intestines were matted together by old fibrous adhesions, and were also adherent to the abdominal wall. They were otherwise healthy. The liver was small, and firm in texture: its hepatic venous system was somewhat congested. The gall bladder held a small quantity of viscid colourless mucus, its duct being obstructed by a small biliary calculus. The common duct was dilated, the hepatic normal. The spleen was small and healthy. The stomach was nearly empty; the mucous membrane near its pyloric end injected. In the sigmoid flexure of the colon a soft polypus, half as thick, and nearly as long as the little finger, hung from the mucous membrane. Except near its root, it was nearly black: its surface was mucous, and its free extremity was its largest part.

The kidneys were small; their cortical substance was rather wasted: the capsules were slightly adherent, and their surfaces somewhat granular.

If this case stood alone, it would be admissible to

refer the whole of the fits which occurred in the last few years of life to the renal disease, except perhaps the first of all, which was apoplectic. But when the cases which follow are also taken into consideration, it can hardly be doubted that the fits observed after the operation were consequences of the application of the chloride of zinc to the skull, and its penetration to the dura mater. Neither those which preceded her admission into the Hospital, nor any which occurred after the healing of the wound, and the complete restoration of the patient to health, can be attributed to that cause.

I may further briefly remark, that this severe operation was well endured, notwithstanding the possible existence of renal disease at the time when it was performed, and suggest the enquiry whether the chloride of zinc prevented the pyæmia, which might otherwise have been expected, by coating the surface with a dry inodorous slough. Certainly the caustic alone proved the means of relieving her of her extensive disease, though the incisions made way for the effective application of it, and the patient lived her natural term unshortened by the cancerous disease. Considering the separate nodule of the disease in the eyelid, and that afterwards supposed to exist in the skull, the title of Cancer may perhaps be allowed, notwithstanding the obscure indications of syphilis which undoubtedly existed in the cicatrices in the heart, the tibial node, and the atheromatous arteries.

CASE II.-Very deep and extensive Rodent Cancer of the Face, removed by two operations. Recovery. Subsequent death from Bilious Cholera.

On my showing the case of Mrs. H. to my friend, Mr. James, of Uxbridge, he expressed a wish to send to my care a man who was suffering from the same disease of the face, and was living as an incurable patient in the Infirmary of the Uxbridge Union. The disease in him being of 13 years' duration, was much further advanced than it had been in the woman, but as it might not be quite hopeless of treatment, I agreed at least to see the patient, and he was accordingly sent to the Middlesex Hospital, May 30, 1864.

He had been a country postman. At the time of his admission, he was 54 years of age, and he appeared to have sound general health. His parents also had been healthy, and both of them had lived beyond 70 years of age. He was, however, thin, cheerless, and enfeebled, partly by the long continuance of the disease, and partly by being insufficiently nourished.

Some notion of the formidable character of the disease may be obtained from an inspection of the photographic drawings, Nos. 2 and 3; but these representations fall short of the reality, as they exhibit only the rugged orifice in the face, the vast cavern amongst the bones behind it not being lighted up and visible. It extended from the brow to the lower

lip, and was formed by the destruction of the greater part of the cheek, eyelids, nose, and upper lip on the right side, and of much of the osseous framework of the face. The entire front of the right superior maxillary bone, and the alveolar ridge of the left one as far back as the second molar tooth, were gone. Nearly all the hard palate was wanting, and only its hinder edge remained, forming a narrow but sufficient support for the velum. The front of the nasal septum was deficient, and what remained of the cartilaginous extremity of the nose had fallen in. The left turbinated bones were partly destroyed, the right ones entirely so; and the loss of the floor and inner wall of the right orbit, with the right half of the ethmoid bone, exposed the soft tissues of the orbit behind the eyeball. The extent of the disease in the direction of the cribriform plate was uncertain. The right eye was uncovered by the lids and the cornea of it was opaque, and the sight dim.

The character of the disease was precisely that of the previous case. Its edge was sinuous and raised, and was formed by a firm and solid deposit in the structures next to the ulcer. A similar deposit thickened the ulcerated septa of the air-cells and thin bones of the nares at their exposed anterior edges. The ulcerated surface was of a pale pink colour, uneven, and firm, like the cutaneous margin, and it bled readily when the dressings were removed from it. In no part did the solid deposit reach a depth of a quarter of an inch; little of it exceeded

an eighth of an inch; for, as it grew on into new and healthy textures, it was followed at nearly an equal rate by an advance of the ulceration. With the extension of the ulcer healthy and morbid structures alike disappeared, but their substance was not represented in its scanty and often scabbed discharge. The bones were not bare and exposed in the ulcer, and did not crumble away in visible fragments; they appeared to be converted and removed, like the soft parts, as the morbid deposit advanced upon them. The thin bones of the nostrils and orbit were more extensively destroyed than the nasal and malar bones; for the disease spreading easily along the mucous membrane invaded them from both sides at once. Mere thickness of bone did not appear to delay its destruction, for a very large part of the alveolar ridge was completely gone. But thickness combined with compactness of osseous structure evidently retarded the disease, as the nasal and the malar bones remained prominent and entire long after the loss of the skin which had covered them, and when the cutaneous edge of the ulcer, in which the activity of the disease appeared greatest, had already advanced an inch or more beyond them. Nevertheless, these bones also were enveloped in the morbid growth, and were gradually, though more slowly, undergoing absorption.

Though resembling Epithelial Cancer with the most exact precision in all the particulars which have been referred to, there were yet characters in which this disease differed from the usual progress of