should certainly be avoided, as tending to irritate and aggravate the malady. It may be known from cancer by the absence of any great amount of induration. Ichthyosis of the lip has escaped the observation of dermatologists, but it nevertheless exists, and is, of all the non-malignant forms of disease affecting this part, the one which most frequently gives rise to question as to its cancerous or non-cancerous nature. A hard brawny scale, frequently circular but of varying shape, appears on the lower lip. It yields to no treatment, and frequently reappears after extirpation. It is quite uninfluenced by any constitutional remedies, and may continue for many years without really interfering with the health or the usual habits of life in any way. It is distinguished from cancer by its uniform brawny appearance, in contradistinction to the more warty aspect of epithelioma; and it, above all, has not that indurated base, which is a necessary and unvarying concomitant of the malignant growth. Ichthyosis of the lip is purely a local disease, and may be cured by excision. It returns again and again, but by slicing off the horny growth, either by means of a sharp scalpel or scissors, as often as it reappears, taking away at the same time a free quantity of the subjacent tissue, it will be found that after the second or third operation there will be no return of the disease. I have had many cases of this kind under my care, and such is the result of my experience: any attempt at cure by any other means is waste of time.

That frightful disease sycosis of the upper lip is too characteristic to be mistaken for cancer; but lupus exedens is, I expect, more frequently denominated cancer,

in this position, than is generally imagined. Perhaps it is not of much moment to distinguish carefully these diseases, inasmuch as the treatment would be the same for both. But the prognosis would be different. Lupus is a progressive eroding ulcer, even more destructive in its progress than cancer; but it is of slower growth, and does not ever give signs of secondary deposits, which may by affecting more vital organs rapidly destroy life. I have twice excised indurated ulcers of the upper lip, and have found the usual epithelial irregularities under the microscope; but the disease has returned in the cicatrix, and quickly put on the aspect it bore previous to excision. The common result of excision of an epithelial cancer of the lower lip is, either that the disease is abated for a lengthened period, or that the neighbouring glands are secondarily affected. It is most unusual to get a return of the disease in the cicatrix itself: it would seem, therefore, that the rare instances of an indurated ulcer on the upper lip are more nearly allied to lupus than to cancer. I have never seen the induration in these ulcers of the upper lip approach in severity that of the ulcers of the lower lip.

Cancer of the lip commences as a small hard nodule at the junction of the mucous membrane and the skin, most probably in one of the labial glands. It increases gradually and, unless excised, sends down a line of indurated tissue towards the junction of the lip with the jaw. It sometimes spreads along the margin of the lip, involving a large portion of it, and occasionally even (but that is generally as a secondary result following operation) the induration extends to the angle of the mouth, and passes upwards to the upper lip. In ex