scopic examination; the surgeon removed the indurated area, but lost the specimen. The induration returned and I made some more applications of the ray. In March, 1904, I insisted that the induration be removed, and also some glands which had become involved. This was done and the pathologist reported that the glands were very malignant. More raying was then given; in a few weeks it was evident that new glands were indurated. These were rayed for about two months, when I asked to have them removed and examined. Dr. Wilder reported that while these glands also contained many epithelial cells, they were nearly all degenerated and would hardly take the stain. A number of prophylactic treatments were then given. Up to the time of writing this paper, over fifteen months since the last operation, there has been no sign of a return of the disease.

Case No. 2. Referred by Dr. E. J. A. Rogers. Miss N. J., aged thirty-five. This was a case, not of epithelioma of the lip, but of Paget's disease of the nipple with carcinoma; I report this case here because there was an indurated gland between the axilla and the pectoralis major muscle. This gland entirely disappeared during the successful treatment of the disease.

Case No. 179. Referred by Dr. Leonard Freeman, H. I., male, aged about forty-seven. This patient, with epithelioma of the cheek, had some Roentgen therapy, but as he lived out of the city, decided to be operated upon to save time. Shortly after the operation several glands showed involvement, and they were thoroughly rayed for a time. One induration entirely disappeared and two others became smaller, but as some more were discovered down in the neck where the ray had not been applied, it was decided to operate again. I consented to this so as to get a microscopic examination of the glands on which I had been working. The epithelial cells in these glands were but few and were markedly degenerated. One gland had almost no epithelial cells in it and its structure had been almost replaced by fibrous tissue.

Case No. 56. Referred by Dr. P. V. Carlin. P. A. P., male, aged eighty-one years. Family history, negative. In 1889 face was burned by the fall of a lamp. Some time after this.suffered a severe frostbite. In 1891 an epithelioma began to develop. In June, 1903, the diseased area was three-fourths

inch long, as wide as the thickness of the lip, and a typical induration. There was no involvement of glands. Twentynine exposures were given, resulting in recovery. At this time, after over two years, the lip is absolutely normal, with

out even a scar.

Case No. 63. Referred by Dr. C. B. Van Zant. W. F. McC., male, aged sixty-four. Fourteen months previous to consulting me a triangle had been removed from his lower lip on account of epithelioma. In twelve months a recurrence appeared, and when I saw him the diseased area was threefourths inch long, about one-fourth inch wide with induration. No glandular affection manifest. Eighteen exposures were made and treatment discontinued, as the patient had to leave on business, which was permitted, as he was nearly well. this time, two years after, there is no sign of further trouble, and the lip is of normal appearance.

Case No. 46. C. P. R., male, aged sixty-two. Family history, negative. Lip has been sore for several years; three months ago the present sore appeared. Induration and some ulceration; occasional stinging pain. Thirty-eight Roentgen exposures were given, and up to this time, two and one-half years after, there has been no recurrence.

Case No. 150. Dr. M., aged about fifty. Small epithelioma with some induration, but without glandular involvement. Only eight exposures were made, and the doctor stopped coming because improvement was so great. At this time, over a year and a half after, there is no sign of there having been any trouble in the lip. Case No. 29. Referred by Dr. P. V. Carlin. P. S., male, aged forty-one. Sore covered by a crust, indurated, and about one-half inch in diameter, without involvement of glands. Occasional stinging pain. Eighteen exposures were given, resulting in apparent recovery. I learn while writing this paper that there has been no return of the trouble, after two and one-half years.

Case No. 87. W. H. E., aged fifty-seven years. Family history, negative. Pipe smoker for many years, always carrying pipe on left side. In 1891 noticed scaling of left side of lower lip, and later a warty growth appeared. Caustic was applied several times; a gland under the chin became involved; the growth took in nearly the whole width of the lower lip and ex

tended down the cutaneous surface toward the chin. The lip was indurated and there were five large warty-looking lumps

on the ulcerating surface of the growth; there was a discharge with the characteristic odor. As the patient would not listen

to talk of surgery I consented to treat him for a month; during that time some of the lumps on the surface came off and

the swollen gland under the chin seemed to become smaller; during the next month the induration in the lip became less and the discharge and odor disappeared; during the third month, my notes state that an operation ought to be done, but patient refuses and insists on continuing the ray treatment. During the fourth month, December, 1903, I obtained some radium and used it. but without favorable effect. From this time on my notes show that I frequently urged operation, but

it was always declined, until April, 1904, when I declined positively to do any more, as he was getting worse. He was then operated on by Dr. W. W. Grant. It was certainly as unfavorable looking and difficult a case as ever presented itself to a surgeon. You may judge of this and of the result obtained, from the photographs which I offer for inspection. After the operation a number of exposures were made as a prophylactic measure; no recurrence took place in the lip, but a gland on the left side of the neck became involved.

Case 42. Mrs. A., Italian woman aged about forty-five years. She had been given Roentgen treatment by another party, and was said to have been nearly well; she was sent for

by this party and when she came to his office he made an incision into the lip, for what reason I know not, and made another series of exposures, but she became rapidly worse; when she came to me there was a large mass involving the whole lower lip; after eleven exposures the daughter who came with her to my office took sick, and as the woman could not find her way about alone, she got no treatment for three months; when

she did return her condition was pitiable; the mass had grown to a length of about four inches and was over an inch in diameter, with a horrible odor; at their earnest request I gave a few treatments and then declined to continue.

Case No. 143. Referred by Dr. ———. H. T., aged fortyfive years. Family history, negative. Cigarette smoker for twenty-nine years, always holding cigarette in right side of mouth. Whiskey drinker and politician. A year before he came to me there appeared a sore on the lower lip near the right corner of the mouth. When I saw him it was half an inch long, as wide as the thickness of the lip; it frequently crusted over and was accompanied by induration. He had been applying caustic to it for some time. I could feel no glands. After several months' treatment the sore seemed to