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.

February 23rd.-A thin layer of the undiluted paste was applied on cotton to the surface of the ulcer.

24th. The ulcer is covered with a black, almost horny scale. This was scored to-day. The whole mass seems broader, and is redder below.

25th.-Redness less; the pains which she experienced before the treatment began have not increased, but after each dressing she has decided "darting" pain, which continues into the night.

The

26th. The mass has diminished in depth, whilst there has been no alteration in the lower part of the tumour. shrinking must, therefore, arise from the action of the remedy on the upper part of the tumour. The pain from the application is less; that which she experienced before the treatment began is unaltered.

March 2nd. The change is most remarkable. The upper part of the tumour is much sunken, and more of the upper lid appeared. The skin covering the front of the tumour has been gradually destroyed, and the ulcer, which at first was horizontal, is now nearly vertical. The depth of the incisions is not more than half an inch, but that measurement does not nearly represent the depth to which the tumour has been destroyed. The undestroyed skin over the tumour is assuming a very healthy appearance, and is becoming freed from its connection with the diseased growth.

7th.-Half an inch more skin has sloughed as the tumour beneath it yielded to the action of the remedy. She feels during the dressing as if something were being put into her eye. The conjunctiva is inflamed. A nitrate of silver lotion was ordered.

11th. The dressings were discontinued. The stramonium ointment was applied over and around the eschar.

14th. Some redness has come on upon the nose, and extended to the inner canthus of the right eye, which is oedematous. A gland over the left masseter became enlarged and tender, and she complained of great pain, as it were in the malar bone. The redness continued several days, without spreading as erysipelas does, and was gone after a brisk purging, by the 25th.

27th. The eschar loosened itself all round, rose above the surrounding surface, and fell out this day. A healthy granulating surface was exposed, reaching to the lachrymal bone; but so remarkable had been the contraction of the healthy parts before the fall of the tumour, that the area of the healing sore was not equal to more than half that of the tumour. The inner half of the lower lid and the palpebral conjunctiva belonging to it were removed in the tumour.

April 19th.-Except a part at the inner canthus not more than half an inch square, where the granulations are healthy and on a level with the adjacent skin, the whole surface has cicatrized. When made to close her nostrils and blow her nose, no air has been observed at any time to escape through the nasal duct, at the wound. In the process of healing, owing to the contraction of the newly formed skin on the side of the nose, the left ala nasi has been slightly drawn upwards. May 1st.-Patient discharged well.

THE END.

LONDON:

SAVILL AND EDWARDS, PRINTERS,

CHANDOS STREET.

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