This result of perforation is a comparatively rare cause of death in cancer of the stomach. Brinton noted its occurrence only in seventeen out of 507 cases, or in 3.3 per cent.; Lange in twelve out of 290 cases, or 5.7 per cent.; while in our own series of 265 cases it was observed six times, or in 2.3 per cent. It would thus appear that out of a total of 1,062 cases fatal perforation occurred in thirty-five, or about 3 per cent. The usual site of the lesion is the pyloric end of the organ, near the lesser curvature and on the posterior surface. It is most frequent in medullary carcinoma and in soft growths of the cylinder-celled variety, since both penetrate deeply into the gastric tissues and are prone to undergo rapid ulceration. In scirrhus complete perforation is rarely observed, while in diffuse colloid it is almost unknown (Ellett). The actual perforation is usually inconspicuous, and often resembles a small ragged fissure, but occasionally it appears as an oval or circular hole with gangrenous edges and of considerable size. Ulceration of a large area of the stomach may lead to perforation of its coats at several places. In such cases it is usually found that only one ulcer has communicated directly with the general cavity of the peritoneum; but Zuccarelli has recorded an instance in which several perforations occurred simultaneously.