Although the disease cannot be said to be of frequent occurrence, yet its duration leads to its being long under observation, and the Cancer department of the Middlesex Hospital, in which hopeless cases are retained until their death, is rarely without one or more examples of the disease. Usually at the very admission of the patients the erosion of the face has been so far advanced that all treatment has been deemed hopeless, except such as might alleviate the mode of dying. Either the destruction of the face has been too extensive to justify, perhaps even to suggest, any attempt to extirpate the morbid parts -the Surgeon having a natural repugnance to any treatment which must augment the already dreadful deformity or the invasion of some important organ, as the cranium or its membranes, or even the brain, has seemed peremptorily to forbid any interference. Surgical art supplied no remedy which could be regarded otherwise than as an unwarrantable intrusion.

Whilst yet of moderate extent, it has long been deemed proper to operate upon these Rodent diseases, and permanent cures have been obtained. But when such treatment has not been adopted at an early period, or has been inefficiently performed, the continuous ravages of the disease have carried it apparently beyond control. It is a part of my object in this essay to show that even these cases are not hopeless, but are capable of being relieved at the hand of

the Surgeon. Originally undertaken with no prospect beyond that of alleviating one of the worst examples of the disease, by postponing the loss of an eye, one of these great operations proved to be remarkably well borne, and the extirpation of the disease was complete and the comfort permanent. The operation, in similar and even in worse cases, has consequently been deliberately repeated. It is found to be applicable to very advanced and formidable instances of the disease, without even the precaution, which I took in my most extensive case, of lessening the shock by dividing it between two distinct operations. For the constitutional disturbance is very slight; and it is equally a matter of surprise, that the system should tolerate an operation on so wide a superficial area, and that a ready and complete removal can be ensured by so shallow a destruction of the morbid substance.

Under various titles the disease has been referred to or described in some of our surgical works. Its most common names are Rodent ulcer, Cancroid, Lupus exedens, Noli me tangere, Ulcère chancreux. And these appellations have been given it with the object of asserting an essential distinction between it and Cancer. Dr. Jacob described it as 'An ulcer of a peculiar character, which attacks the eyelids, and other parts of the face.' Mr. Cæsar Hawkins, however, includes it among cancerous

diseases. Had the title Cancer originated with scientific men, and been first employed with a precise signification, there would be no difficulty in testing the fitness of it as a name for Rodent disease. But the word has always been indefinite in proportion to the ignorance of the times, and it has even yet not settled to a precise use. The characters of the recognised Cancers are partly shared by other tumours, and the propriety of ranking any particular tumour with them must be determined by the preponderance of their resemblances over the differences which distinguish them. My own opportunities of observation have been sufficiently numerous and prolonged to show me a more real identity of the Rodent disease with Cancer, than is assigned to it in published accounts. It is accordingly a second and principal object with me to furnish proofs of this character of the disease, and to justify denominating it Rodent Cancer.

It is rare to see the actual commencement of the disease. The patients usually describe it as attracting their attention by some trifling change in a small spot of skin which previously had not been quite natural. Some mole, or wart, or minute thickening of the skin, which they had always known to exist, or some pimple which had grown up unnoticed, began to itch or to be tender when touched; and a slight scab, which showed already

a breach of the surface, was found to have formed upon the spot. One patient had a mole from infancy, in which the disease began at sixty-five years of age. In another a pimple first formed at fifty, and then ulcerated. The disease sprang up in a third on the scar of a pustule, which remained from an attack of small-pox thirty years before. The first sign of ailment in another case was the escape any of blood from a small crack on the edge of the eyelid. In most cases, however, a single solid growth was observed to have formed, or was known to have existed for some time before scabbing and ulceration.

It is not conceivable that Cancer should have existed in a mole for sixty-five years, or that anything cancerous should have been imported into the healing of one small-pox pustule. The origin of this disease, like its continuous progress, is that of a local textural ailment; and it appears to resemble many cases of Cancer in starting forth at the meeting-place of dissimilar structures. Thus, at the edge of the lip, which is a tissue intermediate between mucous membrane and skin; at the orifice of a duct, which texturally is in transition from one kind of mucous membrane to another; at the top of the cheek, where the skin somewhat abruptly changes from thick to thin, and still more markedly in the cases before us, where natural integument abuts upon that which is

morbid, as in a mole, or upon a rigid scar; in such places it is that tumours form; and they possess at first, and appear to maintain, different characters, which correspond not to any peculiarities of constitution, but with the particular textural defect out of which they sprang.

The disease once established, it continues to increase, extending in all directions into a wider area. It spreads by the growth of the original solid ‘pimple,' advancing upon, and involving with itself, the adjoining healthy structures. The central crack, or excoriation, too large to be longer concealed by a scab, becomes a distinct ulcer. Thus the aspect of the disease changes, though not its nature. At first a cutaneous nodule, with a superficial and central ulceration, the solidity claimed most attention, and it was named a pimple; but as the growth spreads deeply and abroad, its thickness not increasing with its area, while the scabbed excoriation widens into a cavity, the loss of substance attracts most notice, and the disease is miscalled an ulcer. Did the disease only spread in the skin by growth, it would form a broad tough plate, resembling keloid; but it is as keloid with all the central part of the flat plate ulcerated out. If it spread without a preceding solid growth it would be rightly called an ulcer. The hard substantive margin and base are indeed sometimes not observed at all, and the disease is for this