“Analgesic”

diet. A large haematemesis of 2 pints (1.1 litre) occurred 7 days later. A blood transfusion was given on usual indications and improvement followed only to be punctuated by another haematemesis. Investigations included test meal, which indicated high total acid. Radiography demonstrated an ulcer on lesser curve and a duodenal ulcer. Progress uneventful. (2) A housewife aged 58 admitted on history of 7 days' weakness melaena, and recent haematemesis. Past history pointed to symptoms of gastric ulcer dating from 1933. She had small repeated haematemeses, and response to transfusion was good. Radiography revealed two gastric ulcers. She was discharged in due course. (3) A woman aged 70 was admitted as an "acute abdomen." Past history yielded vague dyspeptic symptoms culminating in an attack of upper abdominal pain associated with vomiting of two days' duration. Abdominal section showed blood-stained fluid and early peritonitis. On inspection of stomach a large prepyloric perforation below lesser curve was noted. Induration was a feature. On opening lesser sac a gastric mass posteriorly was attached to pancreas without obvious signs of malignancy. On separation, a larger ulcer presented. Ulcers were closed. Histological examination demonstrated chronic ulceration and ruled out neoplastic change. Condition on discharge was satisfactory. (4) A middie-aged Chinese man was admitted with a diagnosis of pulmonary tuberculosis and died from this malady. At necropsy two chronic ulcers were found on lesser curve about 1 in. (2.5 cm.) apart. (5) A man aged 69 was admitted with vague abdominal pain occurring mainly after meals, of several years' duration. Radiography one year previously had yielded negative results. Three days later he vomited three-quarters of a pint (430 ml.) of " coffee grounds " fluid. In spite of blood transfusion and other supporting measures he deteriorated rapidly and died. Necropsy findings(a) Oesophagus: dilatation of lower end, with ulcer 3 cm. by 2 cm. immediately above ridge separating oesophagus from stomach. Base indurated and adherent to left lung. Floor of ulcer presented several small oozing points. (b) Stomach: ulcer 2.5 cm. by 2 cm. immediately distal to gastro-oesophageal ridge. Floor smooth and fibrotic.