or tooth extractions, were followed with an unusual loss of blood. There was one feature in this case which limited experimentation with drugs- namely, the patient had a very irritable stomach. Ergot, iron, mineral acids and all vegetable astringents brought on nausea or vomiting. The remedies which seemed to control the hemorrhage to some extent were internally, two-grain doses of pyrogallic acid, given four to six times a day, and hot water (115° F.) vaginal douches, twice or three times daily. For the anemia in the intermenstrual periods, she took large doses of Fowler's solution of arsenic and a highly nutritious diet. At twenty-eight years of age she married a man a great deal older than herself. She has had no children, but her catamenia has been normal ever since.

CASE II. Mrs. McD., aged about 50 years. I was called to this patient in a hurry and found her lying in bed in a large pool of blood; the matting by the bedside was also covered with blood and clots. She said that she had been losing a little blood at intervals of about two weeks for at least a year, but thought it was only "change of life." She had had two husbands and twelve children and thought "she could stand. a little bleeding without complaining or calling in a doctor."

The patient was very pale and weak from the hemorrhage, so I gave a strong stimulant and then a copious vaginal douche of hot water. When the flow was arrested I made a vaginal examination and found extreme hardness of the cervix; the uterus was fixed and immovable; around the os was a mass of ulceration, the discharge from which had a sickening, fetid odor. I had no hesitation in pronouncing it a far advanced case of cancer. She was only a visitor in our village, so she wanted to return to the city in a few days. I gave her tincture of cannabis indica, fifteen drops every third hour. She had no more bleeding during the few days she remained in the country and the medicine seemed to keep her free from pain. Later she fell into the hands of Dr. B. B. Browne, who said "it was too late to

operate, in his opinion, and only palliative measures could be used." More hemorrhages followed and she died within two months.

CASE III. Mrs. S., aged about 46. Twice married, but no children. This patient had been a sufferer for years with three fibroid tumors of the uterus. She complained of excessive pain and flooding monthly. She had been curetted several times by the late Dr. Christopher Johnston and Dr. W. T. Howard. On the last occasion she was told that the walls of the womb had been scraped so thin that they would not dare to repeat the operation. The following summer I was called to see this patient with an unusually large hemorrhage. Just previous to this time I had read an article by Dr. Thomas Oliver, in the Lancet, in which he speaks of hydrastis canadensis and its wonderful control over uterine hemorrhage. So I thought I would try it in this case. this case. Accordingly I ordered fluid extract of hydrastis m. xv, with m. x of fluid extract of ergot every third hour, also copious hot water douches, adding to the last pint of each injection thirty drops of hydrastis and the same amount of witch hazel. This treatment was only to be carried on while the hemorrhage lasted. During the interval the hydrastis alone was to be taken internally.

Under this treatment the patient improved wonderfully. In the fall of that year, she went to Europe. I recommended her to consult Apostoli in Paris, thinking that his electrical applications might remove the fibroids. However, she took a good supply of her medicines with her and did not consult Apostoli. Next year she went down to Louisiana, and telegraphed to me for the renewal of her prescriptions. Since then, she has made a complete recovery and now is a picture of robust health and good spirits.

Recently Gottschalk records the results of the use of stypticin in fortyseven cases of bleeding from the uterus. Stypticin is the hydrochloride of cotarnin, one of the oxidation products of the opium alkaloid, narcotin. In chemical

structure it is closely allied to hydrastinin. It can be given subcutaneously, or more conveniently in powder. Dose, one grain, four to six times a day. Its advantage over hydrastis is its sedative action. It is useful in those cases where the patient objects to curetting. I have

not touched on the subject of uterine hemorrhage during pregnancy, fearing to make my paper too long, and I have only thrown out these few cases as a "skirmishing line" before this Association. Now let us hear from the artillery!

IN looking over the history of carcinoma, it is surprising to note the large number of deaths from this almost fatal disease. The different salves, the internal medications, and even the knife, judiciously used by expert surgeons, have incidentally failed to cure numerous of the so-called cancer patients. Of late, this grave disease has drawn quite a marked attention. How many cases each year do we hear of and read of as past a cure, the remainder of life to be lived in dread; and to feel that you are a victim of a disease which is now slowly eating and gnawing toward your vital organs?

There are different kinds of cancer. The hard or scirrhous, and the soft or medullary, often called brain cancer, are the important diseases. Frequently they are still farther separated into skin cancer, stone cancer, bone cancer, etc. The cases to which I ask your attention are of the skin, mammary and internal variety.

CASE I.-H., aged 65. He was from Salisbury, Md., a strong, healthy, white man, married and had no history of hereditary cancer. Shoemaking was his occupation. For three years he had noticed a tiny red, glossy pimple on his lower right eyelid near the inner canthus. When he called at my office in May, 1893, a slight elevation of the skin, with red, angry-looking blood vessels extending out in different directions from it, intense itching and pain, presented a typical picture of skin cancer of the epitheliomatous variety. The pain in the area was sharp and shoot

ing in character. From irritating with his finger nails, the inner part of the glossy pimple was slightly ulcerated and was discharging a yellow, aqueous fluid. No lymphatic glands seemed to be involved. Discomfort was evident from the man's expression of anxiety and fear. I insisted upon his having it cut out at once, but to no avail. He would agree to nothing but, as he termed it, internal treatment; and cutting or burning was torture, as he expressed it. The result was, he returned to his home. In six months, I learned (from his son who brought the case to me) that some doctor in the country had burned the rapidly growing cancer with bad results.

Shortly afterward, the patient was brought to me again, with a most horrible ulcerating cancer, which had eaten his lower lid almost completely away and likewise his upper lid, the eyeball was encroached upon and the sclerotic coat eaten through, with the skin and tissues of the upper part of the nose all destroyed. The bones of the orbit and of the nose in the immediate vicinity were burrowed through like a honeycomb. Worse still, on close inspection with a magnifying glass I could plainly see the cavity was alive with numerous tiny maggots, which resembled corn meal spread over the surface. At this stage of the disease, I refused to operate. A letter from his son five weeks later informed me of his terrible death. This no doubt was a rodent epitheliomatous cancer from its scaly, glossy, infiltrating and ulcerating character of its prog

ress. The cells, however, were not found to be smaller than ordinarily found in any epithelioma. This man could have been saved if an operation had been allowed at his first visit.

CASE II.- A man, aged 52, married, an active merchant and a very hearty eater; and had never been sick since childhood. June 10, 1895, he came to my office and complained of headache and a very heavy feeling about his stomach. While talking he belched, and a number of pieces of meat and tomato came up into his hand. I then washed his stomach out and corn, lobster salad and numerous vegetables eaten the previous day were washed out. He suffered little pain, but belched up large pieces of meat, etc., regularly as clockwork about one hour to three after each meal. A marked jaundiced appearance was noticable, especially about the face and eyes.

His business was continued daily, although he felt hungry and weak every day, and, as he expressed it, a grinding or twisting sensation was felt. in the pit of his stomach after each meal. His spine at times gave him great annoyance and pain. Twice during the three months that I attended him, he vomited frothy and black material like coffee grounds. The loss of flesh was very evident, as well as the increased jaundice. I could discover no hardness over the gastric region.

The case continuing to grow worse, I diagnosed it carcinoma of the stomach and referred him to Drs. I. E. Atkinson and Wm. Osler of this city. They both confirmed the diagnosis of carcinoma of the stomach, as his son related, and had him under treatment for some time. The patient got violently angry when I told him of the gravity of his case and would not moderate his mode of eating, contending that it was his liver which troubled him and not his stomach. He gradually grew worse, and while in Boston, having gone there by sea for his health, died suddenly after eating a heavy meal. His son had an autopsy performed in that city and the pathologist found an enormous perforating cancer on the posterior wall of the stomach reaching to the pylorus. He had re

duced in weight from 170 pounds to 85 pounds during the fourteen months he was sick. An intesto-gastrostomy was not entertained at all by the family or by himself.

CASE III. A woman, aged 44, during the month of March, 1891, applied to me, through Dr. Fawcett, for an examination of a lump recently discovered as painful, on her right mammary gland. She was white, seemingly healthy, and had had successfully four healthy children without any breast complications whatever. Her complaint was of a nervous character, as she almost always felt faint and nervous whenever any pressure was made upon her breast by a corset or by a child's weight. This she kept secretly from her husband for one year before disclosing to him the state of affairs. While sweeping her room one morning she accidentally struck the part with the broomstick and pain never ceased from that moment till the tumor was removed, which was only three days after I had been called to see the case by Dr. F. C. Fawcett. The tumor was not adherent to the ribs, nor was there any family history of interest. The axillary glands were slightly enlarged and therefore were removed. Her arm and hand remained stiff, shiny and painful for eight months after the operation and it was fourteen months before she could use her hand freely enough to dress her hair completely. Result, recovery.

CASE IV.-June 20, 1896, a white man, single, thin and pale, aged 50, called to ask me about a "stye" which had been on his left lower eyelid for some months. He had been born with a slightly red spot on the lid in the same location. A few months previously this spot began to scale, swell and pain. Itching, too, accompanied these symptoms. It now having become hard, shiny and nodulated, his mother mistook it for an ordinary stye and pulled three or four eyelashes out and later she picked it with a small needle. Still it slowly enlarged; and finally it began to pain considerably. When he applied to me the vessels were angry-looking, tortuous and the lump had changed to a

discharging ulcer which was rapidly infiltrating and eating the edge of the lid slowly away. Every appearance was typically epitheliomatous in character. An operation was advised at once, to which he consented. The usual Vshaped piece of the lid was removed and the cut edges were gently brought in apposition and carefully sewed in that position with eight split threads of silk. Bandaging was kept up for ten days; at the end of which time the stitches were removed. The tension was quite five weeks before accommodation of the lid ensued. About six weeks ago he was in my office and had had not the slightest recurrence of the trouble. His grandfather died of cancer of the tongue two years before. Examination of the growth proved it to be epitheliomatous in character.

CASE V.-A woman, aged 42, with the same disease of one of her eyelids, the following week was treated likewise and with similar results.

The pathological symptoms of cancer vary so in different cases that we look specially at present for our diagnosis to the microscope and to the old clinical history of infiltration, nodulation, pain, loss of function, with or without ulceration. It occurs in late life most frequently and usually takes its origin from some seat of friction, irritation, or from a scar or bruise. Generally speaking, the young, under 35 years, have the soft or medullary variety, while the old, or those over 40 years, have the hard or scirrhous variety. It is, say most surgeons, an extremely difficult task to tell accurately the different types of cancer. The cells and nuclei in this class of tumor resemble more closely the epithelial cells. A glandular and lymphatic enlargement is secondarily characteristic of carcinoma, other symptoms being present. Cancer moves by metastasis, travels through the lymph channels, hence the enlargement of the lymph glands nearest to the seat of the disease. Then, too, cancer so often recurs.

The etiology is most obscure. Persistent local irritation is doubtless the most constant cause. Local injury and degenerating organs, such as the uterus,

mamma, stomach and tongue, are the points of special attack. We invariably link cancers with adults only, but children, and some authorities say even the child in utero, may be the center of attack. Hereditary influences occur to mar our prognosis about once in every five cases. If cancer attack an organ in full vigor of its functional activity, it equally becomes active and runs its course with marvellous rapidity, soon causing death. Cancer grows like a parasite, at the expense of the tissue into which it lies, be it bone, muscle or what-not. Alcoholic stimulants used in excess may thus indirectly by weakening some organ cause a cancerous growth. The cancer germ, which can be preserved indefinitely, is extremely prolific and virulent, and is one of the most sure causes of death which enters the human system. We are supposed to take them into the body by breathing, by certain food and drink, by contact with some other cancerous part, by kissing and inoculation of the germs into a comparatively healthy and healing wound. The weak part of the body suffers first from these germs. Tobacco smoking, which results in friction of the lips or tongue by the pipe stem, will cause cancer in some instances. Bruises, irritation of any kind, such as the suspender chafing our shoulder, etc., and it has been claimed that narcotics, pork and tomatoes (one of our best blood purifiers) cause cancer. The Jews are frequently sufferers of cancer, yet they supposedly do not eat pork. Anything, it seems, which has a tendency to weaken our vitality may predispose to the development of the cancer germ in our system.

Treatment.-General and local are the two divisions. General treatment consists in giving fresh air, moderate exercise, the best of nutritious food and tonics, such as iron, arsenic, strychnia or quinia in small doses. Looking after the skin, kidneys and digestive apparatus to see that they are functioning properly and having the diseased part protected with cotton wool are important factors in the general treatment.

Local treatment means in good sur