Numerous publications on lethal midline granuloma have recently appeared. We have one purpose in further encumbering the literature: to reinforce the plea for early institution of large-field, small-dose irradiation. Such treatment is aimed at modifying the localized “hyperimmunity” which in some still obscure way may be responsible for this relentless destructive process. That irradiation can suppress the immune response has been well demonstrated in other quite unrelated instances, e.g., in heterologous bone-marrow infusions, in organ transplantation, and in modification of the Sanarelli-Shwartzman phenomenon. Irradiation of lethal midline granuloma is not new. Its possible value was first suggested by M'Arthur and Dew in 1925 (18), was later brought up again by Ellis (6, 7) and by Glass (9), and more recently by Walton (27), Merrill (16), Wildermuth (29), and Dickson (5), among others. In addition, data gathered in a comprehensive review of the literature by Blatt et al. (1) reveal that 5 of the 6 “survivals” listed out of a total of 124 cases had received some form of irradiation. (Unfortunately, the authors do not dwell on this method of treatment but go on to a discussion of cortisone therapy instead.) Our experience with 4 irradiated cases tends to support the impressions of Ellis, Glass, Dickson, and the others. The relatively low incidence of midline granuloma, however, precludes the establishment of a statistically significant series in any one institution. We feel, therefore, that wider use of early irradiation will be necessary to establish its place in the management of this disease. Nature of the Disease Since lethal midline granuloma was first mentioned by McBride (19) in 1897 and thoroughly described by Stewart (24) in 1933, numerous reviews and discussions of the disease have appeared in the literature, including those of Hoover (12), Hargrove et at. (11), Williams and Hochfilzer (30), Friedmann (8), Blatt et al., De Oreo (4), Dickson, and Wildermuth. Wegener (28) in 1936 described a systemic, ulceronecrotic, granulomatous condition involving the vascular system, lung, spleen, and kidney, as well as the laryngotracheobronchial tree and the facial structures. This strange disease of unknown etiology is an inflammatory, granulomatous process which progresses to ulcerative and gangrenous necrosis of soft and osseous tissue. When it affects the mid-facial structures, it is known most commonly as lethal midline granuloma, though it has several other names. The upper respiratory tract may be involved, either alone or in combination with the lower respiratory tract, and there may be associated systemic involvement, i.e., Wegener's disease.