Cases of this description are much rarer than those of the preceding group. The onset of the complaint is insidious, and characterised by progressive pallor of the skin and mucous membranes, which subsequently changes to the lemon tint so often observed in idiopathic anaemia. At the same time the patient suffers from loss of appetite and thirst, and becomes markedly emaciated and feeble. Gastric symptoms are almost always present, but vary from occasional attacks of discomfort and flatulence to severe pain and vomiting after each meal. The bowels are usually confined, but at a late stage of the disease diarrhoea is apt to alternate with constipation. In most cases the temperature is elevated at first, but subsequently remains subnormal. Thrombosis is apt to occur in the veins of the lower extremities, and pneumonia is often the immediate cause of death. Examination of the stomach seldom affords any distinctive evidence of disease, since the growth usually occupies the central region of the organ. At a late stage, however, gastric dilatation may be observed, or a tumour may develop. In every instance the gastric contents are devoid of free hydrochloric acid, but the presence of lactic acid and of the Oppler-Boas bacillus is variable. The blood is very pale and exhibits a great diminution of red corpuscles, with poikilocytosis, and sometimes nucleated red cells and megaloblasts. Occasionally retinal haemorrhages develop, or bleeding takes place from various mucous membranes or into one of the serous cavities (Bouveret). Death usually occurs within nine months.