An excess of fluid (hydrothorax) in one or other pleural cavity was noted in 3 per cent, and a bilateral effusion in 6 per cent, of our cases. Acute pleurisy existed in 14 per cent., and was usually accompanied by a moderate amount of sero-fibrinous exudation, which in one seventh of the cases was distinctly blood-stained. This latter appearance was always associated either with metastatic deposits in the pleura or with a similar effusion in the abdomen. Suppurative pleurisy was never encountered, except when the oesophagus was invaded by the cancerous disease. Adhesions between the base of the lung and the diaphragm existed in 16 per cent., and were almost twice as frequent on the right as on the left side. Secondary growths of the pleura occurred in about 4.5 per cent, of all cases; but this estimate does not include those in which the lymphatics were visibly distended with cancer juice (Hillairet). Obsolete tubercle was found in 16 per cent, of the cases, usually near the apex of the lung; but a recent extension of the disease was never observed. Emphysema was present in 28 per cent. The frequency of this condition has often been the subject of comment, and it is usually attributed to antecedent bronchitis. Careful inquiries, however, have convinced us that the subjects of gastric cancer rarely suffer from cough or shortness of breath prior to the onset of the gastric complaint. Moreover, it is significant that this variety of emphysema is always associated with atrophy of the heart, whereas in ordinary cases the right ventricle is invariably found to be enlarged. It is also noteworthy that the degree of emphysema is generally proportionate to the wasting of the soft tissues, and is most marked when the pyloric orifice of the stomach is stenosed. It is probable, therefore, that this form of emphysema is due to atrophy of the tissue of the walls of the lung, which deprives the alveoli of their natural elasticity and causes them to become dilated under the pressure of their contained air.
Acute pneumonia was noted in 6 per cent., and was usually lobular in its distribution and affected both lungs ; but occasionally it occurred in the form of a grey hepatisation of one of the lower lobes. Signs of bronchitis and of oedema existed in every case where death was preceded by coma, while secondary growths were present in 7.6 per cent, of our cases.