CHAP. II.] CANCER OF THE STOMACH. 177 



food, we have the symptoms of flatulent dyspepsia. " According to 

 Riegel, in cases of round ulcer ^ of the stomach, the acid constituents 

 of the gastric juice are greatly in excess, and the fact has been further 

 established by the observations of Korczynski, Jaworski and many 

 others 1 ." The vomiting of blood is the most prominent symptom ; 

 the blood vomited is either red, fluid, unaltered (erosion of a large 

 blood-vessel) .or coagulated and dark, fluid and acid (change brought 

 about by contact with the gastric juice). 



Cancer of The changes in gastric digestion will vary here also, 



the stomach, according to the symptoms, and any of the changes 

 described under the different forms of dyspepsia may be observed. 

 The vomited blood appears here, from its prolonged contact with the 

 gastric juice and from the fact that the haemorrhage is rarely profuse, 

 in the form of the coffee-ground vomiting. 



Von den Velden 2 found in 8 cases of cancer of pylorus (in 5 of 

 which the diagnosis was verified post mortem) that the gastric juice 

 obtained by means of the stomach-pump, contained no trace of hydro- 

 chloric acid ; in all of these there was considerable dilatation of 

 stomach, but no pyrexia, and he believes the absence of the HC1 

 to be an important point in the differential diagnosis between cancer 

 and other affections of the stomach. In all these cases he examined 

 the gastric juice repeatedly, but always with the same result. 

 Rosenstein 3 could not verify these observations. In one case at the 

 Manchester Infirmary where the symptoms during life were those of 

 pyloric cancer and where the HC1 was always found absent in re- 

 peated examinations, the post mortem examination shewed the 

 presence of a sarcomatous tumor at the upper end of jejunum, while 

 e stomach was free from disease. 



In general the experience of physicians appears to be that in 



cer of the stomach the colour reactions due to hydrochloric acid 

 either feeble or absent, and the non-discovery of hydrochloric 

 id is one point to be taken into consideration in establishing a 

 diagnosis. In advanced cases of cancer of the stomach, the quantity 

 of pepsin formed appears to be exceedingly scanty, and the rennet- 

 ferment, which is a constant ingredient of normal gastric juice, is 

 often entirely wanting. 



degeneration Edinger and Riegel (loc. cit) found in 2 cases total 

 of stomach, absence of hydrochloric acid. 



It was stated by Fen wick that in this affection pep- 

 sin is absent or present only in very small quantities, 



atrophy of , , , . r f 4 i J c. \\. 



stomach. an d the observations of W. Jaworski confirm the asser- 

 tion 4 . 



1 v. Jacksch, Medical Diagnosis, p. 96. 



2 Deutsch. Archivf. klinische Medicin, Vol. xxm. p. 369. 



3 See Article 'Dyspepsia' in Eulenburg's Cyclopaedia. 



4 W. Jaworski, ' Zur Diagnose des atrophischen Magencatarrhs,' Wiener meil. 

 Presse, 1888, Nos. 48 and 49. 



G. 12 



