Latent cancer of the stomach with a secondary growth in the brain. A man, fifty-seven years of age, was admitted into hospital for paralysis of the right arm. It appeared from his history that three months before he had fallen down in a fit, after which the arm had become weak and had sometimes been attacked with trembling. He had also suffered from persistent headache, giddiness, and occasionally from nausea, but there had been no vomiting. Examination allowed much weakness of the right hand and forearm, with slight wasting of the muscles. There was also well-marked double optic neuritis. Death occurred suddenly about a fortnight later. At the necropsy the pylorus was found to be adherent to the under surface of the liver, and presented on its inner surface a large ragged cancerous growth, which had given rise to a few secondary deposits in the liver. There was a secondary nodule in the posterior part of the corpus callosum on the left side, with recent haemorrhage into its substance.
In this variety an abundant exudation of fluid takes place into the peritoneal cavity, which masks the signs and symptoms of the primary lesion and gives rise to considerable difficulty of diagnosis. In the great majority of cases the effusion is due to secondary carcinosis of the peritoneum, but occasionally it may arise from the pressure exerted by a nodule of growth or an enlarged gland upon the portal vein. The following examples serve to illustrate the symptoms presented by cases of this description.