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ment was present. The new growth was found to be located in the submucous layers, and in most cases the mucous membrane over the nodules was normal, though in certain areas infiltration had oc- curred upward between the gastric tubules (see Fig. 2). Small fibrils of connective tissue were found passing between the discount cymbalta 60 mg cells in every direction. (See Fig. 3.) The submucous lymph-nodes appeared, for the greater part, free, but in places they were surrounded by areas of small round-cell infiltration, apparently inflammatory, and not neoplastic. In all the sections taken from various portions of the anterior and su- perior surfaces of the stomach the submucous layer of connective tissue was found generic cymbalta from canada to contain masses of greater or less size, and presenting the same char- acteristic picture in each case. One small nodule taken from near the esophageal opening (£, Fig. 1) presented the usual submucous masses, but cymbalta online pharmacy in this section generic cymbalta available us the glands of the mucous fold were found to be dilated, and, in places, of an almost adenomatous character. The submucous vessels were very large, and filled with cymbalta discount program blood- cells. Sim- ilar appearances were not found in any of the sections taken from other portions of the stomach. The growth appeared to be a typical round-cell sarcoma. Its point of origin, no doubt, was in the submucous connective-tissue layers of the stomach. Notwithstanding the great similarity of the growth in its structure to lymphosarcoma, it seems probable that if this were the case more involvement of F10. 2. {A) Tumor growths. (B) Uninvolved mucous membrane. (C) Lymph-nodule. the lymph-nodes would have been present, and also that the growth would not have been so strictly lo- calized as it was found to be. From the location of the external scar made by the entrance cymbalta discount card of the bullet, the position of the scar on the surface of the liver and the area of old ulcera- tion in the wall generic cymbalta from india of the stomach, it seems probable that the bullet, after piercing the discount generic cymbalta parieties, perfor- ated the left lobe of the liver and passed buy online cymbalta on into the stomach. Unfortunately, the generic cymbalta 2013 symptoms immedi- ately following the infliction of the wound were not minutely inquired into, but from the anatomic find- ings we were forced to conclude that such was the Digitized by Google 620 SANITATION AT -CAMP TAMPA HEIGHTS." [Medical Nkws course of the generic cymbalta bullet. That the new growth was primarily induced online cymbalta petition by discount cymbalta the wound is negatived by the time elapsing between the infliction of the wound and the cymbalta discount prices onset of symptoms indicative of gastric neoplasm. Yet it is probable that the irritation re- sulting from the old ulceration finally favored the for- mation of the growth, which evidently first developed near the seat of the old process. Cases of sarcoma originating in such seats of irri- tation are commonly reported. From the character of the growth and from the clinical history it is evi- dent that it developed quite rapidly. Primary sarcoma of the stomach is an exceedingly rare disease. No, doubt, however, discount prescription card cymbalta it is more fre- generic cymbalta online quent than the number of cases reported would seem to indicate, since microscopic examinations are not universally made in cases of gastric tumor, for the tendency is to rely upon gross appearances, which are extremely unreliable in differentiating between ordinary carcinoma and some of the varieties of sar- coma and endothelioma. In most of the reported cases the growth has been located at the lesser curvature of the stomach, or its Fig. 3. W Growth sketched under one-twelfth oil immersion (Zeiss). maximum growth has been in this region. It is somewhat unusual to find sarcoma originating after adult life, and the advanced age at which the growth developed, not only in this case, but also in several of the cases recorded in literature, is quite striking. Of the 15 cases of primary, gastric sarcoma which the author has found reported, 6 have been round- cell sarcomas, 4 of the spindle-cell variety, 2 myo- sarcoma, and 2 of uncertain type. The case re- ported by Hadden as lymphosarcoma is beyond doubt one of perithelioma, as the author very per- fectly cymbalta 60 mg discount card describes the structure of this, at that time, unrecognized growth. In none of these generic cymbalta 60 mg cases did ulcer or traumatism of the discount cymbalta coupons stomach-wall precede the development of the growth, and in this respect the author believes the present case to be unique.

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