_Case IV._—Mrs. D. S., aged 53, first seen July 6, 1916, is a rather recent case of recurrent cancer of the left breast, in private practise, but it is instructive. Over five years ago a small pimple, as she called it, appeared on the left side, which was left alone for five years. Then on January 21, 1914, the left breast was removed by a surgeon of prominence, and all seemed well for six months, when there was some return and a second operation was performed in January, 1915; there was again a third removal in April, and a fourth in August, 1915, all by the same excellent surgeon, and the wound has never healed since. There had never been any attempt at dietary or medical treatment or any effort to check the causes producing the malignant growth. Since January, 1916, there have been many cutaneous nodules developing around the open sore, which when first seen presented a characteristic ulceration eight inches long, by two or three inches irregularly wide. The axillary glands were enlarged and the left arm, which had been greatly swollen since the first operation, was hard, tense, and painful, and, of course, helpless. The forearm measured 13 inches and the upper arm 14 inches, the right arm being 8½ and 9½ inches, respectively. Her weight, which had been 168 three years ago, was reduced to 133; she was always very constipated and her urine deficient and irritating, calling her also at night; she had long suffered from rheumatism, and also severe headaches up to the menopause, seven years ago. Under a rigid “green card diet” and the mixture already referred to, with a larger amount of cascara, she began to improve at once in her feelings, the arm became softer, and somewhat flabby, and the nodules, which had been painted with 50 per cent ichthyol, were less prominent. Later thyroid extract being added after meals, brought her weight down a little, but during the last months it had been maintained steadily at about 120 pounds. The urine which at the first was sometimes only 26 ounces in the 24 hours, with great deficiency in solids, has been brought up some days to 45 ounces, with the proportion of solids to the body weight about right. The saliva, which was very acid, is much less so, though still acid and scanty, and the mouth dry. Not to dwell too long on the case I may say that I find a recent note to the effect that she said that she feels very well and friends think that “there cannot be much the matter with me.” But she still has a considerable ulcerating surface, though with islands of healing; she still has many metastatic nodules in the skin in various places, and the arm, which is still swollen, though no longer tense, is smaller, and, really, the flesh shakes when the arm is quickly moved.