This variety would seem to be even less, frequent in cancer than in ulcer of the stomach, since out of the twenty-eight cases of gastro-cutaneous fistula collected by Murchison, twelve were due to the simple and only six to malignant disease. Moreover, the records of 1,142 necropsies upon cancer of the stomach contain only three instances of external fistula (0.26 per cent.), while a careful search through the literature reveals only nineteen examples of this affection. In those cases where the fistula was established spontaneously it was usually situated at the umbilicus, but when it resulted from surgical interference it was sometimes located in the epigastrium or in the left hypochondrium. In the majority only one sinus existed, but in the case reported by Murchison there were two, while in another there were several (Coote). The external orifice varied considerably in size, in two cases being only large enough to admit a fine probe, while in the rest a cannula or even the forefinger could be inserted into it. In one instance only it possessed the diameter of a shilling (Cameron). In every case the external fistula communicated with the stomach through the medium of an abscess which was bounded behind by the stomach, the left lobe of the liver, and the colon, in front by the abdominal wall, and at the sides by adhesions between the aforementioned viscera and the parietes. In fifteen out of seventeen cases the primary disease was situated at the pylorus, which was usually adherent to the anterior wall of the abdomen, while in the other two the growth affected one or other curvature. An obvious perforation of the stomach existed in twelve cases, and was invariably situated upon the anterior wall. It varied in size from a small chink to an aperture several inches square. The malignant disease was always of the spheroidal-celled type, and in two instances presented colloid changes.