A middle-aged man was admitted into hospital under our care on account of debility and loss of flesh. The first symptoms of ill-health had consisted of breathlessness, weakness of the legs, and flatulence after food, with great distaste for meat. The bowels were confined, and nausea with occasional vomiting had been experienced in the early morning. Examination showed the patient to be profoundly anaemic and emaciated. The lower border of the stomach reached to the level of the umbilicus, and pressure over the centre of the epigastrium gave rise to pain. There was no tumour, and the other viscera of the body were healthy. The corpuscular richness of the blood was 54 per cent, of the normal and that of the haemoglobin 48 per cent. There was also a slight excess of leucocytes. After a test meal the contents of the stomach were found to be devoid of free hydrochloric acid, but to contain an excess of lactic acid.
For nearly a fortnight the patient showed signs of improvement and gained half a pound in weight, but at the end of that time he grew suddenly worse and the anaemia became much more pronounced. Exploration of the stomach after the midday meal led to the evacuation of a large quantity of altered blood. From this haemorrhage he gradually rallied, but began to complain of pain after food, which grew more severe and was also troublesome at night. The liver became enlarged, and a hard tender tumour developed under the right costal margin. Six weeks later the liver extended nearly to the umbilicus, and presented several discrete tumours in the substance of the right lobe. Ascites occurred and was followed by jaundice, and the patient fell into a comatose state, which terminated fatally in three days.
Necropsy. The liver was extensively infiltrated with soft carcinoma, and several nodules presented recent haemorrhages. Near the lesser curvature of the stomach, in the posterior wall, there was an ulcerated growth of cylinder-celled carcinoma about the size of a two-shilling piece.