Eroding ulcers attack the cheeks and eyelids and nose, but they are generally of a lupoid character, and it is beyond the scope of my present intentions to enter into that very important subject. True cancer, however, occasionally is seen on the cheek, and of that I have to offer an illustration or two.

John C. of Fulham, aged 56; tolerably healthy; cut off a mole in shaving in 1859, after which an elevated ulcer appeared on the cheek over the malar bone. This was removed by ligature by Mr. W. Rae of Fulham, and it reappeared in three months. He was admitted an out-patient at the Cancer Hospital, January 9, 1862, when the appearance presented was an elevated vascular growth, the size of a crownpiece, but twice as thick, having an indurated base. I gave him bark and hydrochloric acid, and applied the manganese caustic. May 30: tumour gone, surface healed. October 2: slight return of tumour, size and shape of a percussion cap. The same treatment was employed which kept the disease in subjection, but when last seen, February 26, 1863, he had a severe attack of bronchitis, and did not again present himself at the Hospital.

James W., aged 45, admitted March 23, 1852, is a shoe-clicker, of pallid aspect and leucophlegmatic temperament. Has for two or three years felt pain in the left side of face, which he attributed to cold. About four years since two very small pieces of thin transparent bone came into the mouth from the nose, together with much purulent matter. The discharge soon ceased, and he had no further trouble until about nine months since, when the cheek over the zygomatic

N

arch began to swell, and then he applied to a surgeon. Six months since an exploratory incision was made in the expectation of finding caries of the superior maxilla. About this time a large abscess formed, which was opened, and much thick pus discharged. Poultices were used for a long time after this. Many surgical examinations took place. A fortnight ago he went into one of the Metropolitan Hospitals and had the advantage of the combined opinion of several eminent surgeons, amongst whom there was some difference as to the propriety of attempting the removal of the supposed seat of disease, namely, the superior maxilla; but it was ultimately decided that no operative procedure was justifiable. These several examinations somewhat inflamed the diseased mass, and produced much pain, to which he was not as a rule much subject; indeed, there was generally an extraordinary and happy absence of suffering. The tumour now occupies the whole of the left side of the face from the orbit which it encroaches upon to the inferior maxilla, and from the side of the nose to the ear. There are two open wounds with ragged edges made by the lancet for evacuating matter some time ago; one under the eye, the other at angle of jaw. The neighbouring glands are not enlarged. Bowels confined. Appetite not goodsleeps tolerably well. Pulse 126, very feeble; has been taking six glasses of wine daily. Mist. cinchona cum opio; castor oil (occasionally); carrot poultices.

March 27 some diminution of tumour, everted edges of tumour more clean and red, granulations not particularly superabundant. Lotio zinci.

April 7: a large abscess has formed at angle of jaw.

He is very much reduced. Opened abscess, from which two ounces of laudable pus was discharged. Continue

the tonic and zinc lotion.

April 10: abscess at angle of jaw discharges still; there is fluid above the integument covering the hard palate of the left side; upon probing the two openings in the cheek blood flows freely, and the probe does not reach any bone, but breaks through soft tissue; debility increasing. Ordered quinine and iron, and

acid.

May 24 has been oscillating, now better and again worse. The enlargement of the face has gone on slowly with occasional bleedings. The palate is more bulged and the eye more encroached upon; not much semi-purulent discharge from the openings in the cheek. Is much emaciated and unable to leave his bed; sleepless, but not from pain; appetite bad; is now taking a soap and opium pill each night with large doses of quinine and ether.

June 16 continues to get gradually weaker; occasional hæmorrhages; the whole of the side of the face is implicated in the enlargement extending from the temple to the lower jaw, encroaching upon the neck, and making the mouth wry, as well as pushing the nasal cartilages to the opposite side. Takes but slight nourishment, is much emaciated, and keeps his bed entirely.

July 4: died on this day, having for a day or two previous suffered from sickness and suffocative obstruction owing to the discharge of blood down the throat from the back of the tumour. Except during and after the various examinations and probings by

surgeons under whose care he placed himself, the remarkable immunity from pain continued until his death. Autopsy twenty-four hours after death. Body much emaciated, tumour apparently decreased (owing to the blood having receded from it). It extended from the top of the temporal fossa to beneath the lower jaw, and from the ear to the nose, pushing it and the mouth to the opposite side. An incision being made from the superior to the inferior portion of it, a brain-like mass was exposed nodulated on its surface, and having in its centre cavities containing dark, dirty, puriform semi-fluid matter; one of these opened into the pharynx. The whole of the superior maxillary bone as well as the malar were utterly annihilated, save a minute portion of the frontal process of the malar, which was, however, nearly detached from the os frontis. The lower portion of the orbit was entirely gone, and the edges of the orbital process of the os frontis had become ragged from the absorption. The palate bone was also gone, and most probably the basilar process of the occipital bone, inasmuch as a scalpel could be easily passed into the brain. The anterior edge of the ramus of the inferior maxilla of that side was roughened by absorption; no other part of that bone being affected. The opposite superior maxilla was intact, the zygomatic process of the temporal bone was unaffected by the disease. The vomer was also healthy, neither vessels nor nerves could be traced in the encephaloid mass into which these several bones and the surrounding tissues had been converted. Owing to ill health and the great heat of the weather, I did not pursue the examination into the internal organs.

These two cases illustrate well the relative amount of malignancy shown by epithelial and medullary cancers. The first is very amenable to surgical treatment, whilst the second pursues its course unchecked by any interference of art. Some terrible cases of melanosis of the scalp are portrayed in the drawings at the Cancer Hospital, which have been taken from patients in that institution. There is one especially, of a peculiarly shocking character, which seemed to take its origin from the dura mater, pass through the parietal bone of the right side, and extend itself in huge black masses over the os frontis, falling down ultimately over the eyes. As these cases are entirely beyond the reach of art, I do not propose to distress my readers by any further description of them.