Diseases, like tuberculosis and cancer, that run a long but assuredly fatal course, usually terminate unexpectedly. The tuberculous patient particularly will almost surely be planning for next year the day before he dies. This condition of euphoria, that is, of sense of well being, was recognised as associated with tuberculosis as far back as we have any history of the disease. Hippocrates pointed out as one of the symptoms of consumption the _spes phthisical_ or consumptive hope. If the patient has been very much run down, death may take place from thrombosis of some of the arteries. If the thrombosis takes place in the brain, consciousness will be lost, and the patient will often die without recovering it. Patients often develop tubercles in their brain as the result of a spread of the disease beyond the lungs, and then, as a rule, death will take place in the midst of a paralysis, which may be accompanied by loss of consciousness that lasts for several days or a week or more. Cancer patients also die suddenly, or at least unexpectedly, at the end. Very often in them, as in tuberculosis, {159} thrombosis plays an important rôle in the fatal termination. In cancer of the stomach, peritonitis from perforation of the stomach may close the scene. The fatal termination in cancer of the uterus is often brought about by the development of uraemic symptoms. The new growth in the pelvis involves the ureters, prevents the free egress of urine, and so causes the retention in the system of poisonous substances that should be excreted. Cancer in other parts of the body often causes death by metastatic cancers, that is, offshoots of the original cancer which occur in other organs. Usually these are in the liver, but sometimes they are in the brain, and sometimes in the bones that surround the spinal cord. In the course of their growth they cause pressure symptoms upon the nervous system, and this leads to death. If patients become very much weakened, as is not infrequently the case, thrombosis occurs, and portions of the clots may be shot into the pulmonary veins, and cause death in this way. Two affections which are quite common, one of them usually involving no danger at all, sometimes cause sudden death. They are varicose veins and a discharging ear. Varicose veins are the enlarged veins which occur on the limbs of a great many elderly people. If these people become run down in health and then exhaust themselves by overwork, the circulation through these enlarged veins is sometimes so impeded that clotting--thrombosis, as it is called--occurs. If a portion of the clot becomes detached, and is carried off into the circulation, a so-called embolus, this may cause sudden death, either by its effect upon the heart, or more usually upon the lungs.