Case No. 4.-Mr. A., age seventy-seven. More or less epitheliomatous trouble fifteen years. Skin of face, neck and hands shows many scaly points and spots and scars of excisions, etc. When seen a fungating epithelioma left zygo-malar region and growing to bones beneath. Right maxillary another large one. On left lower eyelid, a small hard epithelioma with erosion and crusting. Treatment purely palliative. Case incurable. Cases like the above and the one to follow, the more numerous in records.

Case No. 5.- Dr. ——, age fifty-three. Usual florid type. Following scale-crusted lesion left cheek, a typical cutaneous horn. Beneath—an epithelioma, surrounded by greasy scales. On nose end waxy sebaceous accumulations, with flat epitheliomatous development in a small colorless mole present for years. Caustic potash treat

ment.

Case No. 6-Mr., age sixty-two. Prepuce long; had never been retracted. Fungous epithelioma, cauliflower like, of glans. Urinating through a crevice in side of mass. Inguinal glands small, hard, hyperplastic. Patient refused to permit their removal. Amputation of penis; one inch stump. Well and at work at last report.

Case No. 7—Mrs. W., age forty. Discord epithelioma right side of tongue from tooth erosion constantly kept up. Thoroughly destroyed with paquelin point. Well at last report, three or four years later.

Case No. 8.-Mrs. S., age forty-two. Jolt of car, bit right side of already tender tongue. In three months extensive involvement of side of tongue and glands of neck. Tongue lesion not benefited by X-rays. Neck disease gave way, but patient died after three more months, of exhaustion and a hemorrhage.

Case No. 9-Mr. G., age fifty-two. Several months

before consultation pinched lip with pipe-stem. Pinhead lesion followed; patient often picked it off; each time it returned larger, finally ulcerating. Typical epithelioma right half of lower lip in carmine border. Early involvement of submaxillary glands. Case aggravated by patient's use of some caustic paste. When first seen, over half lower lip down to gum destroyed; involvement of right oral angle, massive metastasis to lymph glands. From the first he refused all operative treatment. He died in about twelve months from beginning of disease.

Case No. 10.—A case of a married woman under forty, three months pregnant. Papillomatous, becoming cancerous, cyst of right breast. Amputation of breast. Re

covery.

Case No. 11.-Old woman seen in consultation. Incurable carcinoma left zygo-malar maxillary region. Developed in sebaceous cyst of many years standing.

Case No. 12.-Mr. C., age sixty-nine. Sarcoma of right shoulder girdle, developed three months before in dark mole over right scapular spine. Rapidly grew in three or four weeks to size of small orange. Doctor excised. Recurrence and gradual involvement of whole shoulder and the axilla. Died within six months.

REFERENCES.

Crocker, 1905, and own case records.

Hyde and Montgomery, 1905.

Fox Brt. Journ. Derm., Mar., 1906.

Johnson Journ. Cut. Dis., Feb., 1905.

DISCUSSION ON DR. HUTCHINS' PAPER.

A Member: I consider this paper of as much importance as any that I have heard at this meeting. I have had a woful experience with cancers, especially cancer of the uterus. I am confident that a large percentage of the

cases of cancer of the uterus are caused by some lesion or tear of the os.

In regard to skin cancer, or epithelioma, I have had good success in treating such cases with butter of antimony. I have the patient apply it in the beginning, or in any form of skin cancer the patient is instructed to take a bottle stopper, apply it to the place affected, not allow it to run all over the sound tissue. He is instructed to apply it every third day, but not to allow any water to go in the spot during the treatment, and I have had good success in getting rid of this kind of cancers.

Dr. Wills: I would ask the essayist if he advises the removal of moles from the skin as a preventive of their development into epitheliomas?

Dr. Hutchins (in closing): Referring to the remarks made by the first gentleman concerning the use of butter of antimony in these cases, I will say that the whole principle of the treatment of epithelioma simply gets down to the matter of destroying the disease; I do not care how you do it. Of course, we will do it painlessly, if possible, which is the best way. Caustic potash, by leaving it open in the bottle until it deliquesces, is the best treatment. It only needs to be left open for five or ten minutes.

REPORT OF FIVE CASES OF FRACTURE OF FEMUR, WITH REMARKS ON TREATMENT AND AN EXHIBITION OF MECHANICAL EXTENSION APPARATUS.

BY J. N. DOWNEY, M.D., GAINESVILLE.

Case 1.-F. H., white, male, age eleven years, caught under a falling tree, received a fracture of the middle third of the femur; the case was treated for eleven days by Buck's extension apparatus by another physician. When I first saw the case the limb was found one and three-fourth inches short, with an inch and a half curve. Patient was anesthetized and limb reset; it was then placed in a double angular plaster of paris splint for five weeks; the result was, symptomatically perfect.

Case 2.-J. J., white, male, age nineteen; struck by a flying timber during the cyclone; received fracture of the right femur two and a half inches below the trochanters; fracture was set and a double angular plaster of paris splint was applied, and was removed on the forty-fifth day; results good, no appreciable deformity; X-rays showed bones slightly out of line.

Case 3.—A. T., white, male, age four years; struck by a piece of timber during cyclone; received a double fracture of the left femur; one two inches below the trochanter, the other at the junction of the middle with the lower third; the limb was placed in position and fracture

set, and a double angular plaster applied; removed on the forty-second day; results anatomically perfect.

Case 4.-N. H., white, female, age forty-five; fell down a flight of stairs and received a fracture of the neck of the right femur; limb was placed in position, and under a slight traction a double angular plaster splint was applied, which was worn for sixty days, when it was removed; measurement and comparison showed both limbs the same length. On examination two months later the limb was found one and a half inches short; the X-ray showed separation of fragments, with supposed ligamentous union; the patient walks fairly well without a crutch.

Case 5.-Mrs. J. W. O., white, female, age seventyfour; caught toe of her shoe under a rug and fell on the floor; received a fracture of the neck of the right femur; Drs. J. B. and H. L. Rudolph and K. A. Smith saw this case with me; the shock was so profound that at first we thought it useless to apply any splint at all for fear of hastening the seeming approaching end, but after some consultation we decided to make the attempt, watching the results; she was placed on a special table devised by myself for fractures of the femur and a double angular plaster splint hastily applied; she was put back in bed and a few hours later showed signs of returning consciousness, and on the fourth day sat up in a chair two hours, and every day thereafter from three to eight hours; plaster was removed on the forty-second day, but patient not allowed to use the limb at all until the sixty-fifth; at this date both limbs were exactly the same, and patient walking with crutches; now, at the eighty-eighth day, there is still no shortening, and patient walking well.

Cases I, 2, 3 and 4 were all allowed to move in any desired position after the plaster was thoroughly