hood that could be utilised for closing it. The raw surfaces in the position of what was to be the angle of the mouth were brought together with hare-lip pins, and the rest left to granulate up. In six months time he left the hospital with the wound cheek had come together

completely healed; the tissues of the so as to make a well-defined limit to his mouth; the bone had thrown out granulation tissue, and this had consolidated into a dense and smooth fibrous mass occupying the right half of what would have been his lower lip. There has never been any sign of recurrence since that time; he has been in perfect health, and the deformity in the lip is much diminished by a free growth of hair from the neighbouring skin. Up to quite recently he has had to take fluids through a tube, but now he can drink easily out of a cup.

Remarks. In dealing with epithelioma, when situated in an accessible position, free removal with the knife offers the best chances of success; and perhaps in no situation is it more effectually removed than from the lower lip. But when it has been allowed to progress for a length of time, and there is evident glandular enlargement, the prognosis must be more guarded. It is difficult to be sure that all the diseased tissue has been removed; it is no uncommon thing to find that after a liberal excision of a growth, a local recurrence takes place. In this case there was good reason to believe, from what was seen and felt, that all was removed; possibly had a wider margin been given a recurrence would have been avoided, but certainly nothing in any way suggested the desirability of increasing the extent of an already severe operation. One thing is quite evident, that, had this patient been left much longer with so foul a mass of ulcerating tissue at the entrance to his respiratory system, he would soon have fallen a victim to a septic broncho-pneumonia. Looking at his present condition, and the time that has elapsed since the last operation, we may reasonably hope that there will be no further trouble.

SARCOMA OF THE MALE BREAST.

BY WILLIAM F. HASLAM, F.R.C.S.

G. T., aged 43.-Family History.--Father died aged 61 of "tumour of brain." Mother alive, aged 70. Four sisters alive and healthy; one brother died of "abscess of the finger."

The patient was first seen on January 21st, 1889; he gave the following history. About one week ago he noticed a small lump about the size of a pea in the left breast above and internal to the nipple. This did not give him any pain whatever, but as it rapidly increased in size he applied at the hospital. He was carefully examined as to the accuracy of this statement as to the size of the growth and maintained that it was correct. There was no history of injury. On examination a hard semi-elastic nodulated swelling, about one inch in length and a third of an inch in width, with its long axis directed downwards and outwards was found in the upper and inner quarter of the left breast. The skin was freely movable over it, and the breast was not fixed on the deeper tissues; there was no retraction of the nipple and no enlargement of the axillary glands. It did not give rise to any pain, and could be freely manipulated. To the touch it felt like an indurated nodule of breast tissue.

Jan. 28th. The tumour was rather larger and softer, especially in the centre, so much so that one would have expected to find fluid; pain still absent.

Feb. 4th. Tumour still increasing in size; signs of fluid less; skin movable over it; no deep fixation of growth. Admitted into the hospital.

Feb. 8th. An exploratory incision was made into the growth; this confirmed the diagnosis, and the breast was at once removed. On making a section of the growth after removal it was seen to be solid with the exception of two or three spots where cysts were evidently forming, and it was distinctly limited by a capsule. On examination by Dr. Crooke it was found to be a lymphosarcoma. The patient left the hospital in about three weeks, the incision having nearly healed.

Remarks. So far as I can ascertain sarcomata of the male I therefore make no apology for

breast are extremely rare. briefly recording this case.

There are too some points of interest

about it that are worthy of consideration.

Ist. As to the History.--The patient seems quite certain that when he noticed the growth, a week before we saw him, it was no larger than a pea. We cannot of course say how long it had been there before his attention was directed to it, but its growth was unquestionably rapid from the time it was first observed.

2nd. As to Diagnosis.—When first seen it had all the appearances of a local induration of breast tissue, the lobulation. being very marked. At his next visit there was reason to believe that this patch of induration was softening; the sensation to the fingers being just such as is obtained under these circumstances. But at his third visit there was still an increase in size, and no further sign of softening, indeed it was firmer and more elastic, so that it was then diagnosed as some form of sarcoma and treated accordingly.

3rd. As to Prognosis.-The clinical history of the case suggests that a recurrence may very fairly be expected; the rapidity of the growth being unfavourable. The structure of the growth being that of a lympho-sarcoma, and the sarcomatous element consisting almost entirely of small round cells, it seems possible that a deposit may take place in the neighbouring glands.

PERISCOPE.

THERAPEUTICS.

BY ROBERT SAUNDBY, M.D. EDIN., F.R.C.P. LOND.

On the Phenacetins.-By Dr. Dujardin-Beaumetz (British Medical Journal, 1889, Vol. 1., p. 521.)

Phenacetin CH,

LOC,H,

NHC,H,O

occurs under three forms

-meta-acet-phenetidin, para-acet-phenetidin, and ortho-acetphenetidin. The first possesses no therapeutic properties, the second and third are alike in their antithermic and analgesic properties, but the latter is far the weaker. The dose of paraacet-phenetidin is from 20 to 30 grains daily. These substances are not poisonous, they are insoluble or very slightly soluble in water. Phenacetin is sold in tabloids, and may replace antipyrin as it is cheaper and effective in a smaller dose. It may be used for the relief of every form of pain, neuralgia, migraine, rheumatic pains, muscular rheumatism, acute articular rheumatism, lightning pains of tabes, etc.

Actæa Racemosa in Diseases of Nervous Origin, by J. Craig Balfour, L.R.C. P. & S. Ed. (The Lancet, 1889, Vol. I, p. 476). -The writer recommends actæa racemosa, or tincture of cimicifuga as it is called in the new pharmacopoeia, in acute dysmenorrhoea, in acute spasmodic gastrodynia, in hysterical neuralgia, and other nerve pains; the dose he employed in the cases related was only ten minims.

6

12

Contribution to the Study of Paraldehyde, by John Gordon, M.D. (The British Medical Journal, 1889, Vol. I, p. 515).Paraldehyde (C,H,,O,) is a polymeric form of aldehyde (C,H ̧O); it was introduced by Cervello of Palermo in 1883 as a hypnotic; it is stated that its use is followed by no headache, disordered digestion or depression, that the pulse is slowed

but the heart's action strengthened, that it does not diminish the blood pressure but slows the respiration. Dr. Gordon, from numerous careful experiments, comes to the following conclusions:

(1) Paraldehyde caused an increase in the excretion of urea. (2) It did not in any marked way affect the quantities of chlorides excreted. (3) It did not invariably increase the excretion of the fluid constituents of urine, but in the majority of cases which I have recorded it diminished them. (4) The odour of paraldehyde, when given in large doses, was found in the urine, shewing that some of it probably passed unchanged through the system. (5) After the full dose of the drug the respirations were slowed, and rendered tranquil and steady. (6) It had no appreciable effect on temperature. (7) In cases of average health without sleeplessness it did not have any hypnotic influence except in large doses. (8) It caused no loss of appetite. (9) There was sometimes a tendency to perspiration under its influence, which atropine controlled. (10) The blood-pressure was only slightly reduced by the smaller doses, the large dose reducing it more, but only after distinct slowing of the respiration. (11) The pulse was slowed. reflex excitability of the spinal cord. influence in controlling sensation. and in large doses destroyed, the (15) Equal doses diminished the excitability of motor nerves sooner than that of muscle. (16) Small doses first slightly excited and then diminished the excitability of muscle substance. (17) Large doses speedily destroyed (temporarily) the irritability of muscle substance. (18) There was a tendency to complete recovery in the muscle after a small dose, but seldom complete recovery after a large dose. (19) Curarised muscle shewed increased excitability over non-curarised muscle when treated with an equal dose of paraldehyde and equally stimulated.

(12) It diminished the

(13) It had a peripheral (14) It speedily diminished, irritability of motor nerves.

Cocoanut as a Vermifuge.-Professor Paresi, of Athens, when he was in Abyssinia, happened to discover that ordinary cocoa

T