sicians and Surgeons. The condition at that time is shown in Fig. 12. There was an ulcer involving the tip of the nose the size of a five-cent piece. Sections taken from the borders of the ulcer confirm the diagnosis of epithelioma, Fig. 13. It was an epithelioma beginning deep in the subcutaneous tissue, showing many pearls and of rapid growth.

He was put under X-ray treatment on the 23d of May, and was given exposures more or less regularly for two and a half months. There was a healthy scar by the 15th of September. His condition since that time is shown in the accompanying photograph (Fig. 14).

CASE VIII. Healthy man, age 73, referred to me November 5th, 1901, from the Illinois Eye and Ear Infirmary, for treatment of the ulcer shown in Fig. 15. This was a sharply punched out ulcer in the right nasal furrow the size cf a little finger nail, with raised waxy borders, profuse blood supply, and painful. The disease began about two years ago in a warty rowth, which bled easily. In July, of this year, it ulcerated and assumed

its present condition. I got no section of it, but it was in appearance a typical epithelioma, and I believe there is no doubt of the diagnosis. The result is shown in the second photograph (Fig. 16). There is a smooth, soft, white, healthy looking scar, without induration.

CASE IX. Man, age 75 years, referred to me by Dr. Norval H. Pierce, surgeon to Illinios Eye and Ear Infirmary, on November 5th, 1901. About eleven years ago a small growth developed on the inner surface of the auricle, near the meatus. This gradually became larger and during the past two years has been the source of considerable pain. He made no effort at treatment until the summer of 1900, when he went to the Illinois

Eye and Ear Infirmary. The ulcer was there recognized as an epithelioma, and during the summers of 1900 and 1901 he was treated at the Infirmary, whence he was referred to me by Dr. Pierce. The sections taken at the Infirmary were examined by Dr. E. V. Brown, Assistant Pathologist, who made the diagnosis of epithelioma.

When the patient came for X-ray exposure there was an epithelioma which involved the circumference of the auditory canal for its external onethird inch and the entire inner surface of the concha, and had spread for half an inch upon the cheek in front of the ear, the tragus having been entirely destroyed. In the last few months it had gotten worse rapidly. He was put under X-ray exposures November 5th and given them daily to December 5th, 1901, when some erythema developed and the ulcer began

to heal. The sittings were nevertheless continued to January 25th, 1902, when there developed marked congestion of the exposed area. This has gradually subsided, and with its subsidence the ulcer healed.

Until a few

days ago there remained an ulcer about half the size of a little finger nail, which rapidly diminished in size. This has healed and the entire site of the epithelioma is now covered with healthy skin. Were the tragus not missing, it would be hard to discover that an ulcer had existed. The side of the head has been entirely free from sensitiveness or pain since about two weeks after beginning treatment.

CASE X. Mrs. W., age 61, was referred to me by Dr. M. F. Engman, of St. Louis. About twelve years ago a lesion developed on her forehead above the right eye which was recognized as an epithelioma. Two years ago it had developed into an ulcer the size of a half dollar, and in November, 1899, she went to Dr. William T. Bull, of New York City. Dr. Bull has kindly given me his memoranda of the case, as follows: "Circular ulcer of forehead in center and reaching to eyebrows as large as a fifty cent piece. Edges slightly elevated and hardly movable. This appeared first ten years ago as an indurated nodule and was destroyed by

caustics. It reappeared and was cut out three times the last time four years ago. At operation (Dr. Bull's) the ulcer, with a wide margin of skin, was removed and the raw surface covered with four skin grafts. Healing was complete in three weeks. Dr. Dunton, 33 East 33d St., examined the tissue removed and pronounced the growth an epithelioma. After Dr. Bull's operation the scar remained healthy until September, 1901, when two small ulcers developed in the border of the scar.

The condition when she came under my care, November 14th, 1901, is shown in the accompanying photograph (Fig. 17). On the forehead,

Fig. 24. Case XII.-Photomicrograph from a section of tumor in stage of subsidence, showing disappearance of carcinoma tissue and the existence of a degeneration product in place of the previous masses of epithelium.

above the left eye-brow, there is a white, healthy looking scar, 2x2 inches, which is not movable. On the external border of the scar there were two small ulcers, one at the upper outer angle the size of a little finger nail, the other at the lower outer angle somewhat smaller. Both had raised, hard, pearly borders, had numerous dilated capillaries around them, and presented the picture of typical small epitheliomas. The upper half of the inner border of the scar was occupied by a red indurated scaly patch an inch long by half an inch broad, around which were numerous dilated capillaries. This presented the picture of an inflamed patch of senile keratosis undergoing degeneration into epithelioma.

She was given exposures daily over the patch and over the ulcers until the lesions became somewhat inflamed, and afterwards the dermatitis was kept at this stage. By December 8th, 1901-approximately a month-the ulcers were healed, and by January 8th, two months the induration had entirely disappeared. The skin was smooth, but quite red from the X-ray effects. The condition since that date is shown in Fig. 18. The skin at the site of the ulcers is smooth, perfectly soft and free from induration. The site of the patch of verruca senilis on the inner border of the scar is still slightly red as a result of the exposures, but it is smooth and soft and the induration has entirely disappeared.

Fig. 25. Case XIII. Recurrent carcinoma of the breast, July 18, 1901.

CASE XI. Lady, age 50 years, the wife of a physician, who referred her to me. Five years ago the disease began as an indurated tubercle near the inner canthus of the left eye.

Its condition, when she began treatment, is shown in the accompanying photograph (Fig 19). The disease involved an area on the side of the nose and around the inner canthus as large as a fifty cent piece. There are two ulcers in the area, one the size of a finger nail on the side of the nose, the other half that size at the inner canthus. The ulcers were sharply excavated, with elevated, rolled, nodular borders, and around them the tissue was indurated and waxy looking. It was a typical small rodent ulcer, such as is often seen in this location, but no tissue was gotten for examination. The result after two months of treatment is