term it, that the connective tissue cells may be the parents of the cancer cells. But it is not of so much practical importance to determine the origin as the nature of these various forms of growth, and what I wish to impress upon you is that they are, one and all, varieties of cancer. They correspond to that class described by Tiersch in his admirable monograph as flat or superficial cancers, in distinction from the infiltrating (tiefgreifend) form, of which cancer of the lip is the type. The ulcerating form is most frequently seen about the nose or eyelids, but I have lately observed one typical case on the neck below and behind the ear. The patient was a man seventy years of age, and the ulcer, the size of a quarter of a dollar, of two years' standing. There was a great deal of cicatricial tissue at its base which was slightly adhered to the muscle, and the "crow's-feet" folds of skin showed that there had been more loss of substance than was apparent. He had used no caustics. Under the microscope it required a great deal of patient search to find a spot sufficiently typical of cancer to place its true nature beyond a doubt. This is what Billroth would probably call scirrhus cutis. These cancers of the face are chiefly found in old people, although I have seen them in comparatively young individuals. They usually begin between the fiftieth and seventieth year. There are clinical as well as anatomical data which give evidence of the nature of the disease. It is true that we do not find any affection of the adjacent glands, but the disease may spread rapidly, and become very destructive. Under these circumstances we find a corresponding change in its microscopical appearances. The growth is essentially an infiltrating one, destroying rather than pushing aside the healthy tissues. Occasionally it returns after extirpation, but this is usually due to an instinctive unwillingness on the part of the surgeon to destroy a larger surface of the face than is absolutely necessary, and a minute fragment of diseased tissue may thus be left behind. There are, however, instances where a considerable interval of time elapses between the removal of the cancer and its subsequent return. If the growth is excised it should be wiped carefully, and examined with a hand lens, if small, that we may be sure that the knife has not cut through diseased tissue. If you are sure of your bearings, determined carefully beforehand with a lens, it is surprising how close to the disease you can steer with the knife without fear of cutting into it. If the cancer is of the size which usually drives people to seek relief, there is no danger that the wound may cause ectropion if near the lid, provided we bring the edges together so as to form a linear cicatrix on a line radiating from the centre of the pupil. It is very common, after excision, that patients suppose the disease to have returned in the 1 Case of Noli me Tangere, the JOURNAL, vol. xcv., page 508. cicatrix, the nodulated character of which on so sensitive and conspicuous a surface is deceptive. On one occasion I removed such a scar, and found the second cicatrix as suspicious in appearance as the first, a condition which shortly after disappeared. Since then I have been obliged to calm more than one patient's fears, and always with the same result. Those who are afraid to use the knife sometimes scrape out the disease with a sharp spoon. The loss of substance is supposed thus to be reduced to a minimum. The use of caustics is nowhere so popular as on this region of the body, and they are to be advised in the very earliest stages of the disease, provided we can burn it out in a couple of "sittings." Nothing can be worse than frequent applications of nitric acid, on a stick or glass rod, to the surface of the growth. When there appears to be little more than an abrasion of the skin an ointment of chloride of zinc in the strength of two grains to the ounce may prove effectual. The zine may be applied rubbed up with equal parts of fresh plaster of Paris, as recommended by Bryant, as it destroys and dries them. The most efficient substitute for the knife is a pointed stick of nitrate of silver, with which the disease should be thoroughly bored. By pinching up the fold of skin surrounding the mass with one hand, the parts to be burned are made more accessible, and the pain is diminished. Is there such a thing as prophylactic treatment? A great deal can undoubtedly be accomplished by proper attention to the hygiene of the skin. In old people, as we have seen, there is the tendency to derangement of the epithelial structures which exists also in childhood, as may be shown on almost any boy's hands. The formation of crusts or scales should be regarded with suspicion, and any tendency to a disturbance of function of the sebaceous glands should be corrected. Crusts may be removed, according to Bush,1 by the application of soda on cloths (from one to two and five tenths per cent.), and subsequently washings with a weaker solution. It would seem almost needless to say that a judicious use of soap should be a daily habit. The "pores" should be kept well "open." Esmarch recommends the use of Fowler's solution, one drop three times a day, gradually increasing, till intolerance of the remedy follows, to prevent a return. I have never tried it. You will observe that in the description of these affections I have not used the term epithelioma. This name was first given to cancers of the face, when the epithelial character of cancer in general was not recognized. They were then thought to be quite a different disease, the epithelial structure being a striking feature. The term should now be discarded altogether, or substituted for that of cancer, in whatever part of the body it may occur. 1 Recent Progress in Dermatology, Dr. J. C. White, the JOURNAL, vol. xcix.,) ,page 767. TREATMENT OF INGROWN TOE NAIL. BY GEORGE W. GAY, M. D., Surgeon to the Boston City Hospital. In a late number of the Philadelphia Medical Times may be found an elaborate paper on the above subject, in which the writer, Dr. Hunter, gives a careful description of what he considers the best method of treating ingrown toe nail. It is a modification of Gosselin's operation, and consists in scraping a longitudinal groove in the nail, brushing the granulations with collodion, introducing small pledgets of cotton under the edge of the nail with a probe made for the purpose, and wrapping the toe in adhesive plaster in such a manner as to draw the diseased tissues away from the nail. Bad cases require four or six weeks' treatment, and even then the disease is likely to return unless the cause has been removed. Neither in that paper, nor in the discussion by prominent surgeons which followed its reading before the Philadelphia County Medical Society, was any allusion made to an operation for the radical cure of this affection, which in this city and vicinity has in a great measure supplanted all others during the past half a dozen years. We refer to Dr. Cotting's operation, which may be performed as follows: The patient having been etherized, all the overlying tissues, with a portion of the side of the diseased toe, are sliced off freely (Figure 1, a c), leaving the edge of the nail clearly exposed and uncovered. The incision should commence well back, as is shown at d e, Figure 2, and should expose all of the border of the nail as far as the matrix. There is more danger of cutting off too little than too much. The nail itself need not be interfered with, as nothing will be gained by scraping or removing any portion of it. b FIG. 1. The comparative size and depth of the portion removed, with its outlines, are indicated in Figure 1, a c, and in Figure 2, d e f. The wound may be treated with simple dressings, and in the majority of FIG. 2. cases is well in two or three weeks. Occasionally, the patient is not laid up more than a day or two after the operation, but continues his occupation during the whole period of convalescence. The same kind of a boot may be worn after recovery as when the affection began, without fear of a return of the disease. "Thus," to use Dr. Cotting's words, "as may be seen, the operation. is a very simple one; but it differs from all others hitherto described in itself, and in the principle on which it is founded, that of cicatricial contraction." 2 1 Vide JOURNAL, January 2, 1873. As a fair illustration of the good results of the operation we give the following case, in the words of the patient, premising, however, that at the time of the operation he was completely disabled, laid up at home, and unable to walk on account of the excessive tenderness of the parts. The toes were very much enlarged and club-shaped. The disease completely covered the edges of the nails at their sides and ends, from under which pus was constantly oozing. As in all bad cases, it was simply impossible to pass lint or even a probe under any part of either of the nails. Both sides of the great toes were thus affected, and both were operated on at the same time. The portions removed were quite an inch in length, three quarters in width, and half an inch in thickThe tendency to bleed from the cut surfaces was considerable, owing to the inflamed state of the parts, but this was readily controlled by a compress of lint and a narrow roller bandage, the whole being covered with oiled silk. ness. The patient in a recent letter writes as follows: "I was troubled with ingrowing toe nails three years previous to the operation, and had tried all kinds of methods of cure, but without success. At first lint under the nails, then caustic; after that all kinds of salve were tried. These failing, large pieces of the nails were removed repeatedly, with the after-application, at times, of something to burn the diseased flesh. This last would temporarily ease me; but as soon as the nails commenced to grow again they would become more painful than before. Dr. Cotting's operation was performed in March, 1873, and since that time I have felt no return of my old trouble. My toes healed in about" three weeks, and are now perfectly natural in appearance.' The distinguishing feature of this operation is that as the wound heals the cicatrix contracts and draws the tissues away from the nail, leaving its edge free (as at b, Figure 1), so that it is hardly possible for it to become infleshed, or buried in the soft parts, in the future. This operation has been performed many times at the Boston City Hospital; in fact, it is about the only one for this affection that has been done there for several years, and so far we have never seen a failure, nor a case in which the cure was not complete, permanent, and satisfactory. THE USE OF THE FREEZING MICROTOME. BY MORRIS LONGSTRETH, M. D., Pathologist to the Jefferson Medical College Hospital and the Pennsylvania Hospital, Phiiadelphia. THE subject of freezing microtomes is not a new one, but the instrument or apparatus which I am now using presents some advantages which I have found lacking in the previous inventions, so that a descrip tion of it may prove interesting. Nothing needs to be said of the great utility in this method of preparing sections of tissues for microscopical examination since the appearance of the numerous journal articles on the subject by Rutherford, Bevan Lewis, Hughes, and others during the last few years. I am, however, making a further use of it in cutting sections of already hardened tissues, merely freezing them fast to the plate of the instrument, thus saving the labor of embedding them in paraffine or wax, and the manipulation necessary to freeing the sections from the embedding material before mounting them. The instrument has four essential parts: first, an ordinary microtome, such as can be firmly fastened to a table; second, a chamber into which the spray is injected and condensed, and on the upper surface of which the tissue is placed to be frozen; third, a section-plate, arranged above the condensing chamber; and, fourth, a handball atomizer with metal tubes (Codman and Shurtleff's). The wood-cut shows the ordinary microtome with screw clamp for fastening it to a table; above it is the sectionplate resting on three legs and fastened firmly to the microtome by a binding screw. The top of the section-plate is pro- A. The section-plate of the microtome. B. vided with a glass plate having The clamp for fastening the instrument to a table. a round hole, through which densing chamber, screwed fast to the plug in the C. Embedding chamber. D. Freezing and conthe tube of the condensing embedding chamber E. The top of the tube or chamber passes when advanced cylinder of the condensing chamber on which the tissue is placed to be frozen. The condensing by the micrometer screw. The chamber is raised and lowered by the micrometer tube of the condensing cham- screw, F. G. The section-plate for the freezing ber is provided with a small microtome, resting on three legs, and fastened aperture made in the side of firmly to the microtome by the binding screw, H. This section-plate has a circular opening, through it (not shown in the wood-cut), which the tube of the freezing chamber moves. and just below the surface of T. Escape tube to draw off the condensed rhigolene or ether. The opening in the tube or cylinder the brass cap which closes the of the condensing chamber into which the nozzle upper end of the tube. The of the atomizer is introduced is not shown in the nozzle of the atomizer is in- figure, being concealed by the section-plate, G. troduced into the aperture of the tube, and the spray produced by using the hand-ball. Ether may be used, but I have confined myself to rhigolene entirely, the applicability of which to freezing by |