CANCER OF THE STOMACH. 375 



The stomach itself, which was large and very heavy, was adherent 

 to the diaphragm over an area of g inches by 7 inches. The adhesions 

 were particularly marked near the small curvature, towards the 

 termination of the oesophagus, where the serous coverings of the 

 stomach and diaphragm become continuous. These adhesions were 

 supplemented by an enormous number of short, fibrous bands, some 

 old, others of recent formation. While the posterior portions of the 

 wall of the stomach were normal, or nearly so, the anterior were 

 thickened, hard, and bosselated around the adherent area. On being 

 removed and incised along its greater curvature, the stomach showed 

 an enormous ulcerated swelling developed on the anterior wall of the 

 left cid-dc-sac. 



This new growth was of irregular, triangular shape, the base being 

 upwards ; it measured loi inches in length by gi inches in width. 

 Limited above by a horizontal line which followed the small curvature, 

 and of which the cardia occupied the central part, it extended along 

 the mucous membrane of the oesophagus, forming a small reddish patch, 

 clearly visible against the whitish ground of the adjacent normal 

 mucous membrane. This patch was but slightly elevated above the 

 surrounding parts, and did not sensibly diminish the lumen of the canal. 



The lesion stopped exactly at the line of separation between the 

 cuticular and villous portions of the gastric mucous membrane, leaving 

 the latter intact. On the left side the principal ulcer was very 

 irregular in shape ; its margins were indurated and excavated ; at points 

 the mucous membrane was thickened, loosened, scalloped, or exhibited 

 apertures due to circular losses of substance — some of which were 

 as large as a sixpence ; all produced by extension of the process under the 

 mucous membrane, and by ulceration of the latter. 



Around the margins of the injury the walls of the stomach were 

 everywhere thickened and indurated for a width of 2A inches to 4 

 inches. At several points the submucous connective tissue was also 

 oedematous. 



The tumour was not of the same appearance and character through- 

 out. A portion of the upper part — about six by four inches immediately 

 below the cardia — was very prominent, soft in consistence, and reddish 

 or violet in colour, according to the point examined. This first part 

 was limited below by a deep semicircular groove. Over the rest of its 

 surface the ulcer was covered with reddish, rounded, irregular vegeta- 

 tions, varying in size between a pea and a hazel nut, separated by 

 sinuous depressions filled with an ichorous stinking material. 



On cutting through the walls of the stomach from the cardia to the 

 lower portion of the ulcer, i. e. through the entire thickness of the 

 tumour, the serous and muscular layers were seen to be greatly thick- 

 ened and indurated by infiltration with the new growth ; the muscular 

 tissue, however, was only ulcerated opposite a few of the above-men- 

 tioned grooves. The projecting mass formed by the upper part of the 

 tumour contained irregular communicating spaces with friable walls — 

 spaces filled with sloughing debris and ichorous liquid. 



This tumour had certainly existed for several months, but its 

 insidious development (it had produced no apparent disturbance until 



