METABOLISM IN THE STOMACH AND INTESTINES 619 



ciency already described. This picture, however, is in no way specific 

 of ulcer, it simply represents a starvation phenomenon, whatever be the 

 cause of the obstruction and the motor insufficiency; a gumma or an 

 extragastric lesion producing the same degree of stenosis will bring about 

 practically the same train of symptoms. 



Carcinoma and Other Neoplasms of the Stomach 



No other gastric disease has such an influence upon metabolism as car- 

 cinoma the usual malignant neoplasm of this viscus or sarcoma, which 

 is extremely rare. Many factors play a part in this the type of growth 

 to a certain extent as the more cellular medullary and colloid forms are 

 more likely to grow more rapidly and to ulcerate than the scirrhus form ; 

 the location of the growth, those at the cardia or pylorus due to their me- 

 chanical effects, leading to more rapid loss of weight and strength, and 

 death from starvation unless surgical means are employed; the effect of 

 the growth upon the appetite, this varying very markedly and often quite 

 inexplicably, even when no obstructive phenomena are present, although 

 as a rule loss of appetite, especially for meat, is a comparatively early 

 symptom, the distaste for meat, leading to certain disturbances in protein 

 metabolism even when the total intake of food is sufficient for the energy 

 requirements of the body. The nutritional picture differs somewhat in 

 the primary cases and in those developing upon an old ulcer base in the 

 former achylia coming comparatively early, in the latter free hydrochloric 

 acid, sometimes even in excess of the normal figures, being present for 

 a considerable period of time. The tendency to spasm is not so great as 

 in ulcer, the tendency to secondary gastritis and atony greater, while 

 in some cases of carcinoma of the lesser curvature, hypermotility may be 

 marked and the frequently associated diarrhea produce rapid loss of 

 weight. In most cases, however, motor disturbances are not prominent 

 except those due to obstruction. Usually anemia is present; often pro- 

 found, and more often, the result of slight persistent bleeding rather than 

 large hemorrhages, although in some cases it is hard to escape the con- 

 clusion that there is a toxic factor also present ; in other cases secondary 

 infection also plays a role. If high fever is present, usually the result 

 of a severe secondary infection, in a few cases of rapidly growing neo- 

 plasms unquestionably due to a specific toxemia, we find the metabolic 

 changes characteristic of fever increased protein and fat destruction, 

 especially changes in the blood, etc. In all cases associated with pyloric ob- 

 struction, motor insufficiency and stasis, decomposition of the gastric con- 

 tents takes place, and if, as is usually the case, hydrochloric acid is ab- 

 sent, we find lactic and butyric and other organic acids, Oppler-Boas and 

 other bacilli, sometimes yeasts and infusoria, with inevitable secondary 



