vitality of any morbid fragments which may remain in them, and thus to diminish the probability of a return of the disease.

It may be possible to employ caustics in a diluted state, and gradually, and with less pain, to effect the destruction of the disease. For this purpose the carbolic acid appears suitable, in the mode of application suggested by Dr. John Barclay, of Banff. He advised the following formula in the British Medical Journal,' for April 21, 1866.

3jss.-zij

3j.

ij.

It soaks into the morbid structure, and, without causing a slough, occasions a more than naturally rapid ulceration. I cannot say however, that in the instance of Rodent Cancer this increase of ulceration is exempt from pain. In the single case in which I tried it, a man who had an extensive and very painful uleer of the temple, considerable suffering ensued, and the ulceration did not at once cease upon the withdrawal of the acid. Neither did the parts subsequently heal. The diluted chloride of zinc may be used with the same object.

The failure of ordinary mild superficial applications has been abundantly proved in the treatment of these cases. I have tried many of them, but have found no reason to attribute to them the slightest curative

effect. Mr. Middlemore obtained some advantage, though not a cure, from the employment of the black and yellow washes: my observation of the effects of the black wash corresponds with this. I have been lately informed by Mr. Luke that he had succeeded in curing some cases of Rodent disease of the face by means of the mercurial ointment, and I have consequently employed it in two patients. The effect under my observation was not curative. Only a more than usually rapid and painful ulceration was produced, and eventually the disease proceeded unchecked by this local treatment.

The treatment by caustics is readily applicable to cases in which the disease is of moderate extent, but not after its increase beyond the area of a half-crown or crown piece. At the latter dimensions it has been thought better to excise the growth, and since the introduction of anesthetics into practice it has been not very unusual to adopt that plan of extirpating it. Mr. Hutchinson, in his very complete Clinical Report on the Rodent Ulcer' in the 'Medical Times,' has recounted twelve cases in which excision was practised. The treatment proved successful in nine of these, so far as the time following the operations allowed the result to be stated. Two of the nine remained well a couple of years after the operation, and two others three years after.

In a few instances the excision of the disease may

be supplemented by a plastic operation, for the purpose of filling the gap in the features. There can be no doubt of the propriety of this method in suitable cases, and there is no reason to think the transplanted healthy flap likely to hasten, but rather to retard, a return of the disease. Mr. Hutchinson lately showed me a man aged 37, in whom he had made a perfect transplantation of a flap of skin to fill a space in the forehead, from which he had excised a large Rodent Cancer. The surface of the flap was even, and the line of union remarkably narrow and indistinct. In this case there was disease of the lymphatic gland in the parotid region. The only instance of a plastic operation among the cases in Mr. Hutchinson's report proved eventually unsuccessful. The disease was very extensive, and the patient died, after its recurrence and a later operation, in the Middlesex Hospital.

The employment of ether spray in the manner made available by Dr. Richardson, appears well adapted for the removal of Rodent Cancers of moderate size by the knife or by the potassa fusa. In either case, the operation is a superficial one, and within the limits of the chilling action of the local anæsthetic. If the disease be extensive, it is more convenient to narcotise the patient with one of the general anesthetics, in order to follow out with precision every ramification of the morbid deposit.

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Moreover, when it is designed to proceed, after excision, to a plastic operation, it does not appear advisable to apply cold, as the subsequent union of the transplanted flap mainly depends upon the preservation of the parts, as much as possible, in their natural condition.

The foregoing methods of treatment are applicable to cases of moderate extent; but there are others in which, by strange indifference on the part of the patients, or through the inadequacy of early measures, the disease has reached an apparently hopeless state. Can anything be done for these cases, which Surgeons have hitherto abandoned?

On reviewing the cases in which attempts to extirpate this disease have been made, it is to be remarked that they present differences from the ordinary cases of Cancer, both in the frequency of operations which they allow, and also in the proportion of cures which result. Many times a caustic application may be repeated, and excision may be practised over and over again. Yet the disease recurs in the same place, and advances with but little increase of its rapidity. For a Cancer, it is eminently a local disease; it is also eminently a curable disease; and yet it very often recurs after removal. Incisions, or the action of caustics, are carried into apparently healthy parts, into parts so nearly healthy that granulation and cicatrisation follow, and the wound

remains well for a year or more; but in or near the scar the old disease breaks out again, and pursues its former course. Like Cancer, in fact, the Rodent disease is less concentrated than it seems to be. Portions of it exist in the structures outside its perceptible limits, and the extirpation is not completed by the removal of the solid marginal disease.

The success attending the treatment of the recent cases is intelligible, because, in its early stages, the morbid growth is confined to the skin and to the subjacent loose tissue, and because caustics, which are then commonly selected, completely penetrate the shallow disease. But as deeper textures are involved, the morbid parts are less easily reached by any method of treatment. This is particularly the case with the bones, which are easily perforated by the deepening growth, and which also protect from the knife the soft fragments of it lying in their recesses and canals. It is not enough to cut or scrape from the surface of a facial bone the pale thin granulations which cover it; the bone itself must be taken away to a depth exceeding that which has yielded to the disease. Recurrence is otherwise inevitable.

In these advanced cases it has been usual to forbear from operating altogether, and to abandon the patients to the progress of their disease; for neither did it seem possible to remove the whole of it with the knife, nor right to attempt to overtake it by