ish substance protruded from the meatus externus, resembling in colour the surface of the ulcerated part.

The child appeared lively, and none of his senses were affected; he had a cough, which the mother supposed to be the hooping-cough; his appetite was bad; but in other respects his general health was good.

About nine weeks previous to this period, without any apparent cause, the child began to complain of a severe pain in the right ear, from the external meatus of which a thin fetid fluid was discharged, at times slightly tinged with blood. About a fortnight afterwards he met with a fall, which was supposed by the parents to be the cause of a polypous tumor, which was perceived filling up the meatus externus. About a fortnight after the appearance of this growth, a general swelling was observed around the ear; no change of colour was remarked, except in a small spot about the size of a shilling behind the ear, which was of a pale livid colour.

About this time, i. e. a month from his first being observed to complain, a small hard lump was felt over the zygoma, but it did not seem to be attended with any pain. The swelling now increased rapidly in size, and extended chiefly backwards, and downwards along the side of the neck. The posterior part was moveable, but at the edge of the condyloid process of the lower jaw, it seemed very firmly attached to the subjacent parts. The ear continued to be pushed outwards, and formed the apex of the tumor. Three weeks after its appearance the livid spot ulcerated, and a fungus grew from it, which frequently sloughed off, but was quickly regenerated, and discharged a large quantity of fetid bloody matter, and frequently hemorrhage to the extent of an ounce or two occurred.

As the patient lived at Leith, I was prevented from seeing him regularly, and he soon grew so weak as to be unable to be brought to the Dispensary; but by Dr Kellie's assistance I was enabled to collect the following particulars. The ulceration and size of the fungus kept pace with the increase of the size of the tumor. About three weeks before the child's death, he was attacked by diarrhoea, and during that time the tumor increased very rapidly, and its substance became much softer. The ulcerated fungus discharged large sloughs, attended with more alarming hemorrhage; a larger fungus protruded from the external meatus of the ear.

About a month before death, the lower jaw was observed to have the appearance of being dislocated, though the mother said she had remarked it three months before; but till this time he VOL. VII. No. 25.

D

could always chew his food very well. Four days before death, he complained of a severe pain in the tumor and in the right eye, and he could not shut the right eyelid. He was able to sit upon his mother's knee the day before his death, which happened on the 22d September, exactly fifteen weeks and four days after the first appearance of the disease.

Dissection.

The tumor was examined after death, in presence of Dr Kellie of Leith and of Dr Gordon of Edinburgh. Our attention was first attracted by the enormous size of the tumor, which was fully as large as the child's head. A drawing of it was not taken, as it very much resembled the engraving of Mr Astley Cooper's case, inserted by Mr James Wardrop in his excellent work on Fungus Hæmatodes. The only difference was, that in this case the upper part of the tumor was attached higher up on the cranium, and the external ear was carried outwards, and formed the apex of the tumor. The ulceration behind the ear was more than four inches in diameter; the fungous mass was soft and friable, and had a most offensive smell. The tumor was removed by a circular incision: it weighed forty ounces.

On examining the cranium after the separation of the morbid mass, an aperture was observed in the squamous portion of the temporal bone. After sawing off the upper part of the cranium, we found that a small part of the tumor had passed inwards through the aperture in the temporal bone, and formed a depression on the middle lobe of the brain, about half an inch in depth. This portion of the tumor was as large as a small egg, of a round shape, connected to the large external tumor by a narrow neck, but did not adhere to the brain; the dura mater was destroyed at the part where the depression was formed. The brain was in other respects sound.

On comparing a slice of the brain with a slice of the tumor, the appearance was so similar, that it was almost impossible to distinguish them from each other. The only difference that could be perceived was, that the texture of the tumor was firmer than that of the brain. On dividing the small internal tumor, it was found to be formed of the same medullary-looking substance. On dividing the tentorium cerebelli, a white spot about the size of a sixpence was observed on the surface of the cerebellum. This appearance was caused by another small irregular shaped tumor, protruding from the internal meatus auditorius; the whole of the pars petrosa of the temporal bone was awanting. On continuing the examination of the external tumor, it was

found to extend inwards and backwards under the lower jaw, towards the posterior part of the cavity of the mouth. The condyloid process of the lower jaw was destroyed. The zygo ma was also gone, and the articulating cavity under it filled up by the tumor.

This case affords another example of the very rapid progress, and almost universally fatal termination of this disease. The quick increase of size indeed was very remarkable, only six weeks having elapsed from the appearance of the child at the Dispensary, when the tumor was as large as the fist, to the termination of the case, when the tumor was as big as the child's head. No attempt was made to remove the tumor, as it had ulcerated, and seemed so firmly attached behind the angle of the jaw; for it has been remarked, that any operation in cases of this disease, except when it is situated on the extremities, invariably accelerates the fatal termination, and the dissection afterwards completely showed the impracticability of such an attempt in the present case. The very slight derangement of the patient's health was also very striking. During the whole progress of the disease, till within a few days of his death, he slept well; had no thirst; heard distinctly; and the mother even expressed some doubt, whether the hearing on the affected side was impaired or not; his vision was also unaffected till the four last days of his life, when it was supposed that he did not see so well with the right eye. He was never observed to be drowsy or comatose; and he could move both the upper and lower extremities freely: the latter were slightly edematous.

With regard to the structure of the morbid mass, a better opportunity has seldom occurred of comparing it with the substance to which it bears so striking a resemblance, viz. brain, and no case more fully illustrates the correctness of the appellation of medullary sarcoma, given to this morbid structure by Mr Abernethy. I am very much puzzled to assign a conjecture, with regard to the origin or cause of the disease. Had there been no internal tumor, we might have supposed that the external mass had been formed by an enlargement of some lymphatic gland surrounding the parotid; but how are we to account for the destruction of the temporal bone, and for the small internal tumor? Are we to suppose, that when the tumor had acquired a certain size, instead of increasing outwardly, it caused an absorption of the bone, and proceeded inwards; or are we to suppose, that the origin of the internal tumor was simultaneous with the external, and that their united pressure destroyed the intervening bone? -But we have no mark in the history of the case, to enable us to decide at what period this happened.