increase; debility and emaciation follow, and these soon lead to extreme prostration, anasarca, delirium and death.

In many cases these symptoms are complicated by ascites, jaundice, perforation of the coats of the stomach, fistula, or phlebitis. In others there arise symptoms showing cancerous deposit in other organs, especially the lungs and liver. The disease usually advances towards its termination with a speed and severity constantly accelerating; and, perhaps, most generally ends in death in about one year from its first invasion. (Brinton. Brit. and For. Med. Chiv. Rev., Oct. 1857.) DIAGNOSIS.-In cancer of the stomach the appetite usually fails entirely. In ulcer of the stomach it becomes capricious; sometimes inordinate; but the patient learns to avoid eating as far as possible, in order to avoid the pain which follows it; though he still has some degree of appetite. Whereas, in cancer the anorexia or absence of appetite seems to be a specific result of the disease. As such it seems to be affected through the same nervous channels which ordinarily transmit the sensations of hunger and satiety. The anorexia, therefore, is seen to commence at a very early stage of the deposits of cancerous matter in the coats of the stomach; and preceding all other local symptoms. It is most clearly marked in the younger subjects, and in the softer varieties of cancerous deposit, and is equally marked in the cases of males or females.

The pain in cancer remits in violence frequently, but scarcely ever intermits. Its site does not indicate the seat of the cancer; though cancer of the lesser curvature seems to be connected with pain in the inter-scapular region, which is often peculiarly severe in some cases; and a marked inflammation of the posterior portion of the stomach seems to cause pain ranging from the middle of the dorsal to the lower part of the lumbar region. The pain in cancer of the stomach is first lancinating; beginning at an early stage and rapidly assuming a marked severity. In the course of a few days it becomes so severe as to leave most other symptoms out of view. The pain of gastric ulcer may intermit, and is increased by food; but that of gastric cancer neither subsides after digestion is accomplished, nor after the stomach is emptied by vomiting. In later stages of the disease the pain sometimes subsides or changes in character. Some patients describe it as a dull, slow, gnawing, or burning, with a sense of weight, oppression, tightness, and distention and soreness on pressure in the epigastrium. The dull burning belongs rather to the stage in which the process of ulceration is going on in the cancer, rather than in the stage of its deposition. It may then be increased by food, is referred to a small spot, and may be partially relieved by vomiting.

The vomiting more frequently attends cancer of the pylorus than that of any other part; it often begins when the cancerous deposit is

very small, and seems to be connected chiefly with local irritation of the nerves distributed to the seat of the disease. At a later stage, when the softening and ulceration of the cancerous deposit has removed the mucous membrane, we have vomiting of a different order. The subjacent tissue being exposed, becomes highly irritable; and vomiting is excited by almost every thing taken into the stomach. It then generally occurs at short intervals throughout the disease, though not in every case. The matter thrown up is large in quantity, has a yeasty appearance, and contains sarcina torula and fragments of destroyed membrane and cancer-cells. There is often at this period of gastric cancer a torpor, or suspension of the peristaltic action of the stomach, either from paralysis of the nerves, destruction of a portion of the muscular fibres by the process of ulceration, or weakening by their undue extension.

The hæmorrhage occurs in, perhaps, half the cases, though some writers have observed it still more frequently. Of those in which it does occur, at least seven-eighths, show the blood so mixed with the gastric juice, food, bile, or softened cancerous substance, as to present the appearance rather of coffee-grounds than of blood. The degree of congestion which causes the hæmorrhage is small in the earlier stage of the cancerous deposit; but it afterwards becomes more considerable; and the flow of blood may then be so great as to cause death. When this occurs, dissection shows: 1. that the blood had proceeded from the sub-mucous plexuses, or from the minute capillaries of the intergastric surface, and not from any large arterial trunks; 2. From vessels destroyed by ulceration; or, 3. From the erosion of large vessels external to the stomach.

The coffee-grounds appearance may be observed in cases of ulcer of the stomach, though there is generally less of it than in cancer. The characteristic cancer-cell growth can be detected in the matters expelled from the stomach, when the disease has reached the stage in which these cells are thrown off by exfoliation or sloughing. The microscopical examination can be made by diluting the fresh liquids expelled by vomiting, and placing a portion under the field of a microscope of sufficient power.

The diagnosis may be further assisted by manual examination of the external surface of the abdomen. The tumor may at least be detected, though its nature must be made out by comparison of the various concurring symptoms.

The color of the skin in gastric cancer is "a muddy greenish pallor." The original or pathognomic cachexia is "regarded as the result of the humeral disease which precedes, and brings about the cancerous deposit." (Brinton.)

The cachectic aspect of gastric cancer often imitates that of ulcer

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of the stomach, and the resemblance is sometimes so close as to defy distinction; both diseases involve a similar general condition, the joint product of ulceration, hæmorrhage, vomiting, pain, starvation. Wherever cachexia precedes these circumstances, or is present in a degree utterly disproportionate to what their aggregate influence might lead us to expect, it becomes a leading, almost pathognomonic symptom.

A case was published by Dr. Porter, of New-London, Conn., of a man aged sixty-six, who had good health up to two months before his death, though he had some regurgitation of food and slight fullness after eating, but no pain. The coffee-grounds vomiting commenced Dec. 19, 1847; but he continued to attend to business till January 3, nineteen days before his death. Jan. 14, he threw off a large quantity of uncoagulated blood mixed with coffee-grounds, and this was often repeated afterwards. He had, however, scarcely any pain. Near the close of life there was an indefinable distress, a sense of sinking and emptiness, like faintness from want of food. Still there was none of the lancinating pain common in cancer, only some enlargement like a small tumor near the pylorus or duodenum. There was none of the "dingy, sallow, exsanguinous, yet opaque appearance so common in cancerous diseases." On dissection a scirrhous tumor, the size of half a small orange, occupied the pylorus and adjoining portions of the stomach, somewhat hypertrophied, mainly hard, but some ulceration had commenced. (Amer. Jour. April, 1848, p. 378.)

PROGNOSIS.-Cancer of the stomach may be regarded as one of the most hopeless forms of this most terrible of human diseases. It is dreaded, not so much because of its being almost uniformly fatal, but for the insufferable pain which attends on it throughout so much of its course. The duration, says Dr. Brinton, of cancer "may be estimated at about thirty-six months from the first appearance of the symptoms; but few cases survive the twenty-fourth, and some have sunk under extreme suffering at the end of a single month.

TREATMENT. This can only be palliative. The mildest measures can alone be used without injury, though Arsenicum may be tried in homœopathic doses far enough to test its powers, which are sometimes surprisingly great.

Lime-water may often be employed in quieting the stomach; but its remedial powers seem confined to the stage of ulceration from chronic gastritis.

Although in fully developed cancer of the stomach, no just hopes can be entertained of effecting a cure, we may do much to palliate suf fering, and even to prolong life, with judiciously-selected homoeopathic medicines. Among these may be cited, Arsenicum, Cicuta, Conium,

Veratrum-alb., Veratrum-viride, Kreosote, Mercurius-corr., Thuja, Carbo-animalis, Ipecac., Tabac., Cannabis-ind.

Clematis.-Induration of the lymphatic glands of the breast, when painful to the touch; appearance of cancerous degeneration; ulceration with pulsating, burning and lancinating pains along the borders of the ulcer, particularly upon being handled.

CANCER OF THE UTERUS.

SYMPTOMS.-Incipient Stage.-Sharp and lancinating fugitive pains in the back and loins, across the supra-pubic region, or shooting along the front of the thigh, or along the course of the sciatic nerve, inducing numbness or debility of the whole limb. A tumor or decided fullness in one or the other iliac fossæ, fixed pain or tenderness appearing to issue out of the abdominal ring, irritation of the bladder with dysuria; sensation at the termination of the rectum like that of hæmorrhoids. Menstruation may be regular, but there are often bursts of hæmorrhage at the period or in the interval. After the disease has continued long the appetite is impaired, sleep disturbed, the flesh wastes and becomes softer, countenance pale and expressive of distress.

The os uteri is hard at the margin, or fissured, projecting more than natural, and irregular in form. In the situation of the muciperous glands, several hard well defined projections like grains of shot under the mucous membrane; pressure on them gives pain or makes sickness at the stomach. The cervix is slightly enlarged and tender; circumference of the os uteri, especially between the projecting glandulæ, feels turgid and presents a deep crimson color. No thickening or other alteration of the parts adjoining. At the connection with the cervix the movement is free; no consolidation of the uterus with the neighboring contents of the pelvis. The morbid change seems entirely confined to the os uteri, with an anomalous tingling in front and inside of the thighs. These last for a few hours, or a day or two and then disappear, perhaps for weeks, but again and again return in the same situation, for a long time not increasing in severity. Internally the feeling of tenderness increases. There is now slight irritability of the bladder; but appetite, digestion and sleep may continue good; the pulse not changed, as in many other uterine affections of serious character. The patient does not yet anticipate danger.

When the disease assumes a more dangerous form the first change takes place in and around the muciperous glandules which exist in such numbers in the cervix and margin of the os uteri. They become indurated by the deposition of scirrhous matter around them, and by thickening of their coats, in consequence of which they feel at first almost like grains of shot or gravel under the mucous membrane.

The further symptoms correspond more nearly with those of cancer in other organs. See p. 282. Remedies, p. 285 to 297.

FUNGUS HEMATODES.

Case of Field-marshal Count Radetzky.-In July and Augus 1839, this distinguished Austrian general was attacked with congestion of the head and vertigo; and soon after it passed off there commenced a pressure in the right eye, inflammation of the eyelids, lachrymation, occasional protrusion of the eye, and pressure in the forehead. He was relieved by remedies, but the under eyelid remained inflamed. In May, 1840, there was another attack of vertigo; after it he was well except one eye. October 9th. The Marshal, on the occasion of a great review was exposed during five hours to extremes of temperature and fatigue. Towards evening his face became red, he had fever with great pain in the right side of the head; the right eye was inflamed and protruding from the orbit; pulse full and hard. He was relieved by homoeopathic remedies; but lachrymation of the right eye continued and there was a small swelling in the external angle. About the end of October further exposures were followed by the appearance of a small tumor commencing at the inner angle of the eye near the lower lid; the external tumor enlarged; the eye protruded, and there was pain in the head. Dr. Hartung, medical counsellor to his Excellency, prescribed the ordinary homoeopathic remedies, beginning with Aconite and all the symptoms of immediate urgency were, for the time, removed. But the growth of the fungous tumors could not be stayed. That above the external angle assumed a purple color, that between the eye-ball and the lower lid became fungus-like, elastic, granulous, purple, and painless. The eye became protruded and turned from its normal axis of vision, so that the pupil stood looking outwards and upwards, the ball restricted in its motions, but the power of vision uninjured.

At the beginning of the next year, the case beginning to be regarded as incurable, Dr. Hartung made an official report to Vienna, and further medical counsel was ordered by the Emperor. The tumors had increased to one-third of an inch each in diameter, and the fungous growth was evident around the whole circumference of the eye-ball, which began to protrude more sensibly. Vision began to suffer; towards the external angle objects were only partially visible; the conjunctiva was softened, and dark-red, approaching to blue; lids glued together in the morning; sensibility to light increasing in the day-time; lachrymation, heat, dryness and pain at night becoming worse. A consultation was held on the 26th of January, at which the consulting allopathic physicians, Drs. Jager and Flurer, declared the case as hopeless, "after forty years of experience." Dr. Hartung despondingly resumed