A woman, fifty-three years of age, was admitted into hospital under our care for ascites. She stated that about two months previously she had noticed a sensation of weight and fulness in the abdomen, which was somewhat increased after meals, and gave rise to difficulty of breathing. Within the course of a week or two the body began to swell and the dyspnoea became greatly aggravated. She had never suffered from pain or vomiting after food, but had latterly lost a great deal of flesh and had grown very weak. On examination the abdomen was found to be greatly distended, and there was some enlargement of the superficial veins. There was a wellmarked thrill on palpation, but the percussion-note was dull all over and no evidence of floating intestine could be detected. Owing to the urgency of the symptoms, paracentesis was performed, and 246 ounces of clear fluid were withdrawn. Palpation then revealed a hard nodular tumour of obloug shape, which was situated across the epigastrium, about an inch above the navel, and was slightly movable with respiration. There was no enlargement of the liver or other indication of visceral disease. Three days later the fluid had re-accumulated and tapping was again performed, but the patient rapidly sank and died from cardiac failure within a week.
Necropsy. The peritoneum was covered with small circumscribed masses of carcinoma, which varied from the size of a millet-seed to that of a pea. The great omentum was infiltrated, and formed a sausage-shaped roll across the anterior surface of the stomach, to which it was adherent. Situated upon the posterior wall of the stomach, near the cardia, was a large ulcerated growth, which had extended into the substance of the pancreas. The other viscera were healthy.
It will be observed that in the foregoing case the patient complained solely of distension of the abdomen with difficulty of breathing, and had never suffered from any symptom indicative of cancer of the stomach. It may therefore be concluded that the gastric complaint had remained latent until the invasion of the peritoneum had given rise to ascites. In the next case the peritoneal effusion was preceded by sufficient gastric disturbance to permit of an accurate diagnosis being made during life.