A man, aged fifty-five, was admitted into the London Temperance Hospital with the diagnosis of chronic gastric ulcer. It appeared from his history that he had been perfectly well until four months previously, when after supper one evening he suddenly turned faint and vomited a chamberful of bright blood. After remaining in bed for several weeks he tried to resume his former mode of life, but found that he had lost a great deal of flesh and was unable to take any solid food without experiencing pain in the epigastrium. Vomiting occurred occasionally at night, and the emaciation made rapid progress. On admission the stomach was found to reach two inches below the level of the umbilicus, and the peristaltic movements of the viscus were clearly visible through the attenuated parietes. No tumour could be detected, but as a result of a test meal the gastric contents were shown to be devoid of free hydrochloric acid. Despite lavage and careful dieting he grew steadily worse, and died five weeks after admission. The necropsy revealed scirrhous carcinoma of the pylorus with extensive ulceration.

In all cases where the disease appears to begin in an acute manner, it will be observed that the physical signs show that the growth has already made considerable progress, while the total period covered by the subjective symptoms seldom exceeds more than a few months.