This is by far the most common variety, and is often associated with a localised malignant ulcer of the posterior surface of the stomach. After a comparatively short period of ill-health the patient loses colour in the face and lips and complains of shortness of breath, thirst, and great debility. Not infrequently these symptoms develop suddenly after a sharp attack of abdominal pain or diarrhoea, which is attributed to indulgence in fruit or some indigestible article of diet. Contrary, however, to expectation, the symptoms increase rather than diminish, the anaemia gradually becomes more pronounced, and there is faintness, giddiness, or palpitation upon the least exertion. The appetite is greatly diminished, there is a steady loss of flesh, and in the majority of cases discomfort and flatulence are experienced after every meal. The subsequent progress of the disease is variable. In some instances the anaemia steadily increases and is attended by the usual symptoms of cardiac failure ; or sudden exacerbations of weakness and debility occur at irregular intervals, and are accompanied by excessive pallor. In other cases severe pain after food is experienced, and is followed by vomiting, anorexia, and eventually by haematemesis. During the first few months physical examination throws little light upon the nature of the complaint. With the exception of a somewhat feeble impulse, and perhaps of a murmur over the pulmonary area, the heart appears to be healthy, and the lungs are quite normal. The pulse is small and of low tension, the temperature is slightly elevated at night, and there may be oedema of the ankles. No enlargement or tumour of the stomach can be detected, and the urine is quite healthy. After a time, however, increasing pain is experienced in the epigastrium or right hypochondrium, the temperature remains permanently subnormal, emaciation proceeds rapidly, the liver becomes enlarged, and ascites or jaundice develops. In other instances the pain after food and vomiting become excessive, the stomach undergoes dilatation, and a growing and painful tumour is detected in connection with the viscus. An early diagnosis can be made only by examination of the contents of the stomach. For this purpose a soft tube is passed into the organ during the period of digestion, when the evacuated material is found to contain altered blood, sometimes in considerable quantity. Free hydrochloric acid is invariably absent, but lactic acid may not exist until a late stage of the disease. Examination of the blood shows a great reduction in the number of red corpuscles and of haemoglobin, but an absence of poikilocytosis. The average duration of life is about eight months.