indolent, insensible, and of a slow growth. The sizes which they individually attained were various, from that of a marrowfat pea to that of a pigeon's egg; some exceeding the latter size, and a few, in their progress, assumed the ovoid, or, rather, the teat-like form, and rose from half an inch, to an inch and a half above the adjacent surface. These globular and ovoid tubercles, when first developed, felt consistent and solid; afterwards this character was changed for that of fluidity.* These tubercles softened at all sizes. While on the increase they retained their primary hardness, but, as soon as they softened, they ceased to grow. As the teat-like tubercles, and the globular ones that were fairly developed above the surface of the skin, softened, they lost their smooth shining appearance, and shrivelled. This change took place from their contents being partially absorbed, or exuded, imperceptibly. I think the fluid was exuded, as scales were constantly peeling off their surfaces, but none peeled off the tubercles that retained their hardness; though the subcutaneous globular tubercles softened, yet no diminution took place in their bulk, which would have been the case, had their contents been absorbed. On puncturing the softened tubercles, black-coloured matter escaped.

Both the flattish and globular tubercles kept increasing in number throughout the disease, and at last they had made their appearance on every part of the surface of the body, except the penis, scrotum,

* This circumstance favours the opinion entertained by M. Laennec and Mr. Fawdington, namely, that Melanosis has two stages, the first a stage of crudity, the second of ramollissement.

and the ears. The scalp was thickly studded with tubercles; they were exclusively those of the flattish form, as were those on the roof of the mouth and face, save one or two small globular ones on the latter. These tubercles neither checked the growth, nor changed the character of the hair and beard. The trunk, and the inferior and superior extremities, were occupied by both the flattish and globular tubercles.

In examining the colour of the tubercles, along with my friend, Dr. Traill, (who took much interest, and repeatedly visited the case,) we found, according to Mr. Patrick Symes's Nomenclature, that the tint of the tubercles, generally, was a mixture of the blackish purple, No. 44, with the bluish black, No. 18; and that the lighter discolouration, as seen in the portrait, on the chest, was the bluish grey, No. 14. The tumour which caused the latter discolouration, was a subcutaneous one, and was originally deposited a little above the scapulary extremity of the right clavicle. When its transposition commenced, it was no larger than a common-sized hazelnut, but while on its progress to its ultimate site on the chest, it increased to the size of a walnut, and afterwards it kept increasing until it equalled the size of a hen's egg.

As the disease advanced, the skin in the interstices, between the tubercles, became gradually darker and darker: and, a fortnight before his death, his visage darkened very rapidly; the forehead was darker than the face, the latter than the chest, and this was somewhat darker than the rest of

the body. This change in the natural colour of the skin, may, in my opinion, be considered as an example of a generally diffused form of cuticular melanosis; for, just before his death, the skin had all the appearance of being infiltrated with the mela

nose matter.

It may be asked with respect to the tubercles we have described, why those that seemed to be deposited on the rete mucosum, or between it and the cutis, should invariably assume a flattish form; and those that seemed to have their origin in the substance of the cutis, or the cellular texture attached to its under surface, should assume a globular form. Was this difference of form, consequent upon the structure of the tissue, which served as a nidus to the melanose deposit? Or, in other words, does the melanose matter, when deposed in a cellular texture, always develop itself in a globular form? And, again, when deposed on a membrane, or a structure of greater continuity than cellular texture, such as that of the rete mucosum and cutis, does it always develop itself in spots? The generally received opinion that melanosis is a morbid secretion, accidentally deposed, and moulded to the form of the nidus it is lodged in, and the description of our own case, favour, in my opinion, the affirmation of this query. However, further elucidation is required upon this point, for M. Breschet states that he found small globular melanose tumours, resembling cassia buds, arise from the tissue of Malpighi.

* The change which ultimately took place in the colour of the skin,.cannot be judged of from the portrait, for that was taken on the 24th of September, seven weeks before the death of the man.

The cicatrix on the back remained free of any morbid growth until the beginning of August, then a blackish tumour sprung up from its centre, as did another from the surface of a flattish tubercle, situated a little below the cicatrization. These tumours were indolent, and, as they grew, assumed something of the mushroom form. Towards the latter end of October, they spontaneously began to discharge from their surfaces a thin sanguineous fluid.* This discharge continued to ooze unceasingly to the last; it neither was offensive to the smell, nor was it acrid in its effect upon the surrounding integuments. The surfaces from which the discharge oozed, had a peculiar raw-like appearance.

With regard to the effects of the melanose disease on his general health, I may state that, shortly after his recovery from the slight pleuritic attack, which he laboured under when I first saw him, he presented a fine muscular frame, and, according to his own statement, he then weighed within five pounds of the weight he had averaged the preceding five or six years. Notwithstanding this, however, he was not able to do a day's work, for he had attempted twice or thrice during the preceding days, and each day, after a few hours' labour, he found himself unable to continue it, on account, as he described it, of his strength failing him; and yet, he said, he felt nothing the matter with him, the rheumatic pains which had troubled him after leaving the Manchester Infirmary, had left him. I examined him by percussion and

* Professor Lobstein, of Strasburgh, describes a melanose tumour, having something of the character and origin of these tumours.-See Edin. Med. and Surg. Journal, vol. xxxiii. p. 213.

auscultation, as I did frequently afterwards, but never found any thing amiss either with the lungs or heart. The excretions, to all appearances, were natural; pulse 70. After this he never again attempted to work; yet, until August, he would, occasionally, walk ten and twelve miles a day. Early in June he began to complain of head-ache, which ever afterwards troubled him; slightly, only, at first, but, for the last two months of his existence, so severely, as to produce stupor, and even to affect his intellect. His rheumatic pains affected him again, and continued, every now and then, to recur; but they were always much relieved by a few doses of Dover's powders. From the beginning of August, his constitution gave way rapidly; he lost flesh; the tongue furred; he became thirsty, and the pulse quickened. His urine was now high-coloured, somewhat scanty, and without the usual urinous smell. It neither reddened litmus paper, nor was it coagulable by heat. After standing a few hours, it precipitated a sediment of the colour of coffee grounds; this became more copious as the disease drew towards its termination. The alvine excretions were natural, and continued so to the last. The perspiration had a peculiarly rank smell, and, towards the latter end of his life, was colliquative. About the latter end of August, a tumour, that in time discharged a brownish-coloured fluid, developed itself in the left antrum maxillare. Towards the middle of October, a tumour was developed in the epigastric region. This extended itself rapidly to both the hypochondriac regions, and caused much uneasiness and pain, to relieve which he was bled. Dr. Traill and myself