Difficulty of swallowing is by no means infrequent during the later stages of the disease. In many cases where the anorexia is extreme the patient ascribes his dislike to food to an inability to swallow, and complains either that a special effort of deglutition is required to dispose of each mouthful, or that the ingesta become arrested in the oesophagus. The former condition is purely subjective in character, and is usually associated with some disturbance of taste or an alteration in the salivary secretion, while the latter frequently arises from flatulence, and is relieved by the eructation of gas. True dysphagia accompanies most malignant growths which involve the cardiac orifice or which extend into the oesophagus, and in such cases it constitutes the principal symptom. Occasionally, however, it arises from reflex spasm of the pharynx or oesophagus. Thus Ebstein and Eichhorst have recorded cases in which tetany of the constrictor muscles of the pharynx was associated with carcinoma of the pylorus, and Poncet, Ewald, and Osgood have related others where the spasm affected the lower segment of the oesophagus. Two cases of this description have come under our own notice. In the first the difficulty of swallowing was so great that the patient had to restrict himself to liquids, and even these often provoked choking and regurgitation. After death the pyloric third of the stomach was found to be infiltrated with spheroidal-celled carcinoma, but no organic obstruction existed to the passage of food into the viscus. The other case was remarkable from the fact that no stricture, either functional or organic, could be detected during life, so that the dysphagia was probably clue to paresis rather than to spasm of the lower end of the oesophagus.