the same change; this goes on until finally we have a mass of cells bearing the most striking resemblance to epithelium; in fact the resemblance is in every respect so marked that, on isolating them— as seen in Fig. 16-it certainly is impossible to distinguish them from epithelium taken from any part.

As the drawing presented in Fig. 14 is not a schematical representation, nor a sketch drawn from memory aided and amended by fancy, but an actual accurate portrait of what the microscope revealed, carefully prepared and perfectly objective in every respect; it is obvious that the tumor is exceedingly interesting in a pathogenetic point of view, as showing what Virchow was the first to observe and prove, that sometimes, though it is not, I think, the general rule, epithelium is developed from progressive metamorphosis of

connective tissue.

Its starting point being in the connective tissue, the tumor unquestionably has a right to the title connective-tissual tumor, or "fibroma," but every pathologist examining its superficial portions only would as unquestionably call it a true and typical "epithelioma ;" and as to seriousness of prognosis it approximates the latter, or at all events a "sarcoma."

CASE II.-E. F., æt. 31, had been hoarse for a long time, perhaps two or three years, when one night, after returning home from a fire, he being a fireman at the time, he found he could not make himself heard at three feet distance; and his voice has never returned, in spite of the most assiduous "doctoring" for the last five years. Otherwise his health is very good, although his whole life almost has been, he says, "a succession of colds." Has never had syphilitic disease. His breathing is slightly audible, and his voice a low rough whisper. The whole pharyngeal and laryngeal mucous membrane was found in a state of chronic catarrhal inflammation, and an irregular leaf-shaped soft polypus was found sprouting from the right half of the posterior wall of the larynx and covering nearly half of the vocal cord on that side. Fig. 17 shows how hist larynx looked after two or three weeks of preparatory treatment. The polypus was entirely destroyed by alternating cauterizations with chromic acid and nitrate of silver; the chronic catarrh yielded only partially. His voice kept a hoarse harsh sound, but became sufficiently loud. The radical treatment, i. e., the destruction of the tumor, lasted from April 19, 1862, to nearly the end of December VOL. XVI.-46

of the same year. From a letter recently received from him, I fear the return of a morbid growth.

CASE III.-One of the most satisfactory cases possible was the following. The subject is a boy who came to me on one of the coldest mornings last winter, very early in the morning immediately after having had a horrible suffocative paroxysm. The examination, which he bore perfectly, revealed the picture presented to the reader in Fig. 18, careful inspection of which makes all description unnecessary. The bluish tint, especially of the lower polypus, and the bilobate form of the upper, are very faithfully rendered. The patient's age was fourteen years; for over eighteen months he had been subject to the most terrible "choking spells," coming on sometimes at night (on turning or lying on his right side doubtless); and sometimes in the daytime during the most perfect enjoyment of health, suddenly on turning, or stooping down, or the like, he would "get a fit." His suffocative paroxysms were somewhat like epileptic seizures, it seemed, at least so all his friends, and even his doctor, had called them. When he first spoke of his spells, I did not know to what he referred, as he said he had the fits. He suffered also from vary. ing hoarseness, dysphonia, and aphonia. Everybody that knew him thought his case a very strange and extraordinary one; one moment's look at the condition of his vocal organs explained everything.

After I had examined him, I told him to come back in two hours. In the mean time I procured an artist who took the portrait Fig. 18, while immediately after-the patient having inhaled a very little chloroform-I succeeded by good luck in throwing the 'loop of the ecraseur around both polypi at the same time, and both were drawn out with the loop. There was not a drop of blood lost that I could see; the boy's voice was immediately entirely restored, and he has never had a return of the paroxysms since.

Examined under the microscope, the growths showed epithelial cells and fibres of connective tissue. The two had two separate extremely slender stalks, and I wondered greatly that these thin threads could so long support the polypi with all their mobility.

CASE IV. Mrs. S., a widow lady, still rather young and very talkative, was sent to me for examination on account of a very anomalous cough that had resisted all medication. Besides various drugs, probanging had been in vain resorted to for several months. She