BY JOSEPH PANCOAST, M.D., Professor of Anatomy in the Jefferson Medical College, Philadelphia. JOSHUA Shaw, the patient under consideration, æt. 37, is a native of Luzerne County, Pa., and a blacksmith by occupation. He is married, and has two healthy children. Neither of his parents, nor any of his relatives, so far as he knows, have ever been affected with any similar disease. He has always enjoyed good health until about four and a half years ago, when a small tumor made its appearance in the submaxillary region, the con- sequence, he thinks, of an old sore throat. Doubtless, from his description, he suffered from an enlarged lymphatic gland, situated above the submaxillary salivary gland. At first this grew slowly, but later increased rapidly in size, especially dur- ing the last year, assuming the appearance presented in the accompanying photograph. The tumor produced no pain, how- ever, nor any inconvenience, except what might be accounted