CARCINOMA OF THE STOMACH. 539 



more numerous. There is no proof of what has been said of the in- 

 fluence of strong liquors, mental depression, the suppression of erup- 

 tions, or the cure of ulcers (Jl Frank). 



ANATOMICAL APPEARANCES. Cancer of the stomach most fre- 

 quently attacks the pyloric portion of the stomach, less often the 

 cardiac portion or the small curvature, and most rarely the fundus 

 and greater curvature. It always shows a tendency to spread trans- 

 versely, so that cancer of the small curvature extends toward the 

 greater, and that of the pyloric or cardiac portions readily causes annu- 

 lar stricture. Cancerous stricture of the pyloric portion is usually 

 sharply limited by the pylorus, while that of the cardiac almost always 

 affects more or less of the oesophagus. 



Of the various forms of carcinoma of the stomach, the most fre- 

 quent is scirrhus, medullary next, and the least frequent are alveolar 

 or colloid ; the various forms often combine the union of scirrhus and 

 medullary is most common. 



Scirrhus almost always begins in the submucous tissue ; it occasion- 

 ally forms small nodules, sometimes diffuse thickening, which, grow- 

 ing irregularly, gives an uneven appearance. The growth has the char- 

 acteristics of hard cancer, and presents a dull, whitish, dense mass of 

 cartilaginous hardness. The mucous membrane soon unites with the 

 subjacent neoplasia ; it subsequently softens to a black pulp, sloughs 

 off, and the bare surface of the cancer is left. The muscular coat usu- 

 ally becomes hypertrophied, and shows the previously-described fan- 

 like appearance ; it may subsequently atrophy under the pressure of 

 the growth, or may be destroyed by the latter. The serous coat be- 

 comes thickened and clouded by local peritonitis, often unites with 

 adjacent parts, and is frequently covered with milky, laminated de- 

 posits. After the destruction of the mucous membrane, the exposed 

 cancer begins to ulcerate ; at first shallow, later deep excavations are 

 formed, and we have an irregular cancerous ulcer, with hard, callous 

 edges, like those occurring on the skin. In other cases medullary 

 masses spring from the floor and borders of the scirrhous ulcer. 



If the affection of the stomach commence as medullary cancer, the 

 nodules and diffuse thickening of the submucous tissue are softer from 

 the first ; they look like brain-substance, and, after a section through 

 them, we may press out a quantity of the so-called " cancer-juice." 

 Medullary cancer spreads much more rapidly than scirrhous, and soon 

 projects from the inner surface of the stomach as soft, easily-bleeding, 

 spongy excrescences. The middle of the growth usually breaks down 

 into black, soft, ragged masses, while the proliferation continues at 

 the periphery. If the dead masses be thrown off, there is left an ex 

 cavated ulcer, surrounded by elevated, everted, cauliflower edges. 



