A labourer, aged fifty-two, was admitted into the London Temperance Hospital for severe pain in the epigastrium of six weeks' duration. He stated that one afternoon, while lifting a heavy weight, he had been seized with violent pain in the belly, which caused him to feel faint and to vomit. The pain continued intense for three days, after which it subsided somewhat, but was always increased by the ingestion of food. Since the commencement of the iUness he had lost more than a stone in weight and had become very weak. On examination the patient was observed to be much emaciated. The lower border of the stomach extended to the umbilicus, and immediately above and to the right of that spot an indistinct and tender tumour could be felt. The gastric contents were devoid of free hydrochloric acid but rich in lactic acid. The general condition rapidly deteriorated, and even milk soon gave rise to pain. At the end of a month a secondary nodule was detected in the right lobe of the liver, and death ensued from exhaustion about fourteen weeks after the onset of the pain. The autopsy revealed a malignant ulcer of the spheroidal-cell type, situated on the lesser curvature, close to the pylorus, with secondary growths in the liver and cceliac glands.
(c) Profuse hcematemesis as an initial symptom is practically confined to ulcerating growths of the pylorus or cardia. Both in its quantity and general appearance the haemorrhage closely resembles that of simple ulcer, and the case is usually regarded as an example of that disease until the continuous loss of flesh, anorexia, and increasing discomfort after food, lead to the suspicion of a malignant affection.