Turner, that he might consider if any further preparation were necessary to fit the face for a mask.

24. He took chloroform, and I excised his right globe. I also removed the lower lid and its mucous membrane, and attached the upper lid to the adjoining part of the cheek. This lessened the deformity. He did well, and left the Hospital five days after the operation. Before he returned to Cheshire, Mr. Turner made him an admirable mask. See Figure 7, and the contrast in the same man's appearance as shown in Figure 6.

July 7, 1866.-He has a small concave ulcer at the inner corner of his remaining (left) eye. It is pale, and without granulations, and its hard margin involves the inner extremity of each lid. The front of the inferior turbinated bone is covered with scab, and appears likely to be ulcerated. The front of the right superior maxillary bone, where exposed, is pale, and covered with slightly elevated separate granulations, which bleed when roughly touched.

All these I removed, either by caustic, or by knife and chloride of zinc combined.

I saw him at the Chester Meeting of the British Medical Association, August 1866, with the parts nearly healed. His health and vigour were good; but in May 1867, I was informed by Mr. Solly that W. had died in the previous month. The report was that some vessel on the brain was affected, and gave way.'

6

H

CASE IV. Rodent Cancer of the Forehead, perforating the Cranium.

AN emaciated cheerful woman, of 73, sent me by Mr. Henry Lee, was admitted into one of the Cancer wards early in 1864. She had one ulcer covering the whole forehead, nose, parts of the eyelids, with the conjunctivæ near the inner canthi, and the cheeks. All these parts retained their form, and looked as if they had been flayed; for the ulcer was very shallow and had but a thin edge, and the nose and lids did not fall in. One eye, however, which was involved in the disease, was shrunken and sightless. She sank, after a few days of exhaustion, early in April.

At the P.M. examination the frontal bone was found perforated and necrosed; white solid substance was lodged in parts of it, and the dura mater and bone near the crista galli were separated by a mass as large as the surface of a florin, and nearly one quarter of an inch in thickness. The aspect of this morbid mass was distinctly cancerous; it was soft, juicy, and white, and under the microscope it showed numerous nests of large nucleated cells, resembling pavement epithelium; many of them forming large mother cells, with others in their interior, and looking like the section of an onion; many fragments of cells and nuclei; very distinct round dark granular cells, and oil.

The appearance after death, when the superficial granulations were dried, was that of what is commonly called a Rodent ulcer, without solid deposit ; but the deeper part showed it to have been epithelial.

There was not a trace of disease in any gland. Those on the masseters were not in the least enlarged, and those in the neck were also perfectly healthy. Nor was Cancer found in any internal organ. There was an adherent clot-cyst with puce-coloured and puriform contents in the right external iliac vein, and oedema of the right leg and foot. The thyroid gland contained spherical tumours, resembling the rest of the gland substance. One of them was encircled by so distinct a yellow wall that, on section, the tumour looked like an ovarian Graafian spot after escape of the cell.

CASE V. Rodent Cancer, perforating the Cranium, and deeply excavating the Brain.

A WOMAN, advanced in years, died in the Middlesex Hospital with a vast cancerous ulcer of the forehead, left temple, and adjoining parts of the upper eyelid and nose. Its cutaneous edge was everywhere thick and abruptly raised: its surface was formed of uneven masses of solid morbid deposit, here and there covered with plates of dead bone, and nowhere with healthy granulations. The scalp having been destroyed, the morbid substance lay close upon the frontal and nasal bones, except in the left of the forehead. At that part the bone was gone, and an aperture existed, measuring two inches vertically by 13ths horizontally. Within this aperture, and thus inside the level of the frontal bone, a cavity of the size of half a hen's egg lay exposed. The walls

of this cavity were pretty regularly concave, and they appeared to be formed of brain substance, infiltrated with the same solid material as elsewhere composed the base and margins of the ulcer, the actual surface of the cavity being similarly soft and uneven. There remained no trace of the frontal sinuses, which were filled with the morbid deposit.

On making a vertical section through the cavity and the adjoining parts of the skull and brain, it was found that the anterior lobe of the brain was destroyed nearly to the front of the ventricle. The base of the cavity was formed of firm material, from one to four lines thick, to the posterior part of which the brain substance, partly granular and partly in long stretched fibres, adhered. The morbid substance did not appear to be widely infiltrated through either the brain or the bone, but it reached between them along the dura mater to the extent of a quarter of an inch. There was no disease or even adhesion of the coats of the brain, except in the immediate neighbourhood of the base of the ulcer.

This case was reported by Mr. Shaw to the Pathological Society in 1849, under the title of a 'Cancerous Ulceration of the Integuments of the Forehead,' and from his account it appears that the patient had been long subject to epileptic fits, and at one time had been affected with insanity. When she was admitted, the ulceration had reached the bone, and by degrees a circular portion larger than a crown piece was eaten away. Under the ob

servation of the attendants, the process of destruction went gradually deeper, until it reached an inch into the substance of the brain on the left of the falx cerebri. She lived for two months after the disease commenced in the brain, and she died from gangrene of the right lung. It is remarkable that till the day before her death, except one or two epileptic attacks, similar to those which had previously occurred, she had no symptoms of cerebral affection. Her mental faculties remained unclouded and apparently unimpaired until the time of her actually dying.

Dissection showed the brain to be sound, except in the neighbourhood of the cavity. Figure 8 represents a section of the excavated cerebral lobe. Under atmospheric pressure, too great for the brain of an aged person to resist, the solid growth has assumed a concave form.

CASE VI. Rodent Cancer, exceeding thirteen years in duration, and extending over the right side of the Head and parts of the Face and Neck. Permanent destruction of parts of the disease by cautery. Improvement by general treatment.

M. W., A BRICKLAYER, was in the Hospital under my care in 1862, having a shallow ulcer on the right temple, spreading in all directions; its edge was solid and raised. It was treated with the chloride of zinc used as a caustic; and on the separation of the slough it was cicatrising, and seemed likely to