We pass on another few years, and our friend reappears. This time his sore has a more permanent appearance about it. It is hard, and somehow looks as if it goes deep, and has a tendency to bleed. We look at it and tell him that he ought to let us cut out that small sore, but as a rule he won’t allow this procedure; he wants medicine to take for it, an ointment to put on it. If we were again to have a microscopical section at our disposal we should see a very different state of things. Those epithelial cells which before were just thickened, and a little angry looking, have at last wakened up and begun to grow. They have branched out and grown deeper into the lip; there is nothing to check them since they have thrown aside all the restraints imposed by the necessity of keeping to their original form, and have, so to speak, got out of the control of the usual mechanisms which the body possesses for keeping cells in their proper place. The only thing we can do for the patient is either to find some means to kill them――an end which has not yet been achieved, as what will kill them will also kill the patient――or to cut away the tissue in which they have grown, leaving a wide margin around the farthest palpable edge of the ulcer. If this is done, the patient can be assured of a permanent cure. But if he will not believe you, as he often will not, possibly because you are not willing to stake your reputation on the ulcer being malignant, or the _certainty_ of its cure by surgery, he will go away for another year or so. One day he appears again because his ulcer has been showing a tendency to bleed and has got a bit bigger lately; also he has noticed, while shaving, a small hard lump in his neck which he feels as the razor goes over it. He still has no pain and no discomfort whatever. We look at this and tell him that he has to undergo an operation, both on his lip and on his neck, and that he has got cancer. We remove the ulcer and every gland that we can find in a large area around, but we can only assure him that he has a one in five or three chance of a permanent cure whereas, if he had taken our previous advice, we could have promised him a permanent cure in between ninety and one hundred per cent. of chances, according to the age of the disease.