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projected an irregularly globular mass of scirrhous cancer, seven inches in diameter at its base, and excavated to the extent of four inches in breadth, into a foul ragged ulcer, with profuse fœtid discharge. In the greater part of its circumference the margins of the cavity consisted of round bosses of a purple colour; the depth of the ulcer was an inch and a half, but, owing to the elevation of the whole mass above the level of the chest, the base did not adhere to the ribs, but only to the pectoral muscle, and the tumour was partially moveable; the skin covering the outer borders of the cavity was thin and violet-coloured, and for some distance around the base it was red and oedematous. There was no disease in the axilla or chest. For the first fortnight the treatment consisted in applying palliative remedies to the ulcer, and giving diffusible stimulants and carminatives, with nourishing diet. Although Burnett's solution was employed plentifully about the bed and outside the dressings, the bad smell from the breast was but imperfectly corrected. On the 16th, lint moistened with Burnett's solution of the strength of one part to seven of water was inserted into the cavity of the ulcer, and frequently changed; but as it caused much pain, it was desisted from in three days, and a lotion with chlorate of potash substituted.

On the 22nd of January Dr. Fell commenced his treatment. For the first three days he employed his remedy diluted with stramonium ointment; afterwards he applied it undiluted, previously scoring the dead surface slightly at each successive dressing, or first scraping away portions of the friable eschar, and then incising the surface before

putting in his remedy. At the end of a week the whole morbid mass had perceptibly shrunk, without occasioning particular pain, or more than slight irritation in the adjacent parts. The surface of the ulcer consisted of a dry, ashcoloured slough, the incisions in the firmer parts of which extended to the depth of half an inch; at the bottom of the ulcer there was collected each day a few drachms of thickish fluid, which came apparently from an abscess opening from beneath the adjoining red skin. The effect of the application was to destroy at once the offensive smell which formerly extended beyond the bed.

February 19th.-The shape of the diseased mass, as well as its size, is much altered. The large bosses constituting the margins of the ulcer have shrunk, and the uneven excavations forming its bottom have united into one funnel-shaped cavity, which has been considerably reduced below its original dimensions by the general contraction of all the diseased part. About this period the measurement of the mass had diminished to 3 inches transversely, by 2 inches vertically.

February 21st.-A line of demarcation has been gradually forming around the eschar, and it is now in some parts of considerable depth. Portions of the more projecting parts of the slough, with the view of diminishing its weight, were cut away; the remainder was incised, and dressed as before.

March 18th. For a few days poultices have been applied. The eschar having become loose, was easily removed with the forceps and scissors.

March 20th. The base of the cavity, which is much

diminished in depth, and scarcely exceeds two inches in breadth, is a healthy granulating sore. Except a small portion of the upper and inner part, the margins are sound; but the edge is hard, and the ulceration presents the characteristic appearances of cancer. A small quantity of the undiluted paste was applied to the unsound portion of the edge, the cavity being filled with cotton wool spread with stramonium ointment.

March 31st. The paste has been daily applied to the part of the edge where the disease remained, and the eschar has almost separated. Cicatrization has proceeded rapidly in the remainder of the sore.

April 19th. The whole cavity has healed, except a part about the size of a thumb nail, where the granulations are healthy. The surrounding parts, embracing a portion of the mamma, are soft and natural.

For completing this report it remains to speak of the pain, and of the effects on the constitution produced by the treatment. As to the first, it is to be admitted that the patient frequently expressed herself strongly as suffering pain; she sometimes also said that the pain continued even when she was asleep; but at no time did she manifest any unwillingness to have the applications renewed. She declined opiates when proposed, and, according to the nurse's reports, she seldom passed a night without long and sound sleep. From the day she was put under Dr. Fell's treatment her general health greatly and strikingly improved; her appetite was keen, her digestive functions were regularly performed without the assistance of medicine, and she soon gained

perceptibly in flesh and healthy appearance. With few exceptions, she was out of bed early for several hours together; latterly, as an apology for not being dressed at our visits, she informed us that she was unprovided with her proper clothes; that when she first entered the hospital, neither she nor her friends expected she would survive a fortnight, and that they had therefore disposed of her day clothes. Soon afterwards a new dress was procured, and she was then seen, strong and hale for her age, walking actively about the ward; she also attended divine service in the chapel, and took exercise in the garden. She invariably expressed herself in terms of warmest gratitude for the benefits she had experienced.

EXTIRPATION OF A CANCEROUS TUMOUR WHICH GREW FROM

THE SITE OF THE LACHRYMAL SAC, AND OBSCURED THE

EYE-BALL.

Jane K, aged forty-nine years, a charwoman, was admitted into the Middlesex Hospital, under the care of Mr. Shaw, 20th of February, 1857, for a scirrhous tumour, which occupied the hollow below the left eye-brow, and by the side of the nose, and concealed the eye-ball. The tumour was oval. In a vertical direction, it extended from below the upper and inner angle of the orbit, on a level with the uppermost part of the eye-ball, along the side of the nose, to the ala nasi, measuring two inches in that direction; transversely, it reached from the side of the root of the nose,

with which it was in contact, across the front of the eye, to the malar bone, measuring an inch and a half. The only part of the eye-lids visible was the external commissure; by depressing the tumour and elevating the upper lid, the eye could be partly seen, moveable, and in its proper position, and, except for some increased vascularity of the coniunctiva, in a sound condition. The base of the tumour was broad, the mobility was slight; the part which was principally fixed being at the site of the lachrymal sac. The skin was of a livid purple hue; at the uppermost part the tumour was truncated by an ulcer of the size of a shilling, in the centre of which was a deep depression of the breadth of a quarter of an inch.

The patient had been subject for eight months to a weeping of the left eye, and occasional slight attacks of inflammation. Five months ago, she observed below the inner canthus a lump like a pea; that increased in three weeks to the size of a hazel nut, but it continued moveable, and the skin preserved its natural colour. A surgeon appears at that time to have taken the humour for a fistula lacrhymalis, and to have attempted twice to introduce a style into the nasal duct. But the tumour continued to enlarge, and owing to the style being constantly pushed out as the tumour grew, it could not be retained. Ulceration then spread from the part where the style had been introduced, causing the ulcer seen at the apex of the tumour to be formed. The patient subsequently came under the charge of Mr. Wharton Jones, who, after consultation with Mr. Shaw, requested Dr. Fell to undertake the treatment of the tumour.

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