CARCINOMA OF TEE STOMACH. 541 



case. At the same time they have no pain on pressure in the epigas- 

 trium ; they have little appetite, but the food taken is not vomited, and 

 examination of the abdomen reveals no tumor. It is necessary to 

 know that cancer of the stomach may occur without the last-mentioned 

 symptoms, and remember the possibility of its being the cause of the 

 excessive marasmus ; but an absolute diagnosis is impossible. If such 

 a patient die and at the autopsy a large cancerous ulcer of the stom- 

 ach be found, inexperienced physicians are usually greatly astonished, 

 and cannot understand how a disease so severe and so far advanced 

 could be mistaken. 



In other cases we can make an approximative diagnosis of cancer 

 of , the stomach. A patient, far advanced in life, complains of loss of 

 appetite, of a feeling of pressure and fulness in the epigastrium, of 

 eructation and other dyspeptic symptoms ; but, along with these mild 

 symptoms, the patient rapidly loses his strength, acquires a dirty-yel- 

 low cachectic color of the face, and finally oedema of the ankles occurs. 

 If, in such a case, we can exclude other diseases, which might explain 

 the cachexia and marasmus, we have cause to suspect that there is not 

 a chronic catarrh, but a malignant disease of the stomach, even if there 

 be no actual pain, vomiting, or characteristic tumor. 



In most cases the symptoms of cancer of the stomach are much 

 more decided, and can scarcely be mistaken. Besides the dyspepsia 

 and symptoms of cachexia and marasmus, there is tenderness in the 

 region of the stomach. This is increased by pressure, and also after 

 eating ; but does not usually attain the severity of cardialgic attacks. 

 Almost as often there is vomiting. When the cancer is in the smaller 

 curvature, the vomiting only occurs now and then, but comes after 

 every meal, when it constricts the pyloric or cardiac orifices. In stric- 

 ture of the pylorus the vomiting does not usually come on till several 

 Hours after eating ; in stricture of the cardiac orifice it occurs imme- 

 diately after or during eating. Occasionally it happens that, after the 

 vomiting has recurred regularly for a time, it gradually becomes less 

 frequent, ceases altogether, or is replaced by a sort of chewing the 

 cud. This occurrence is explained when the autopsy shows that by 

 breaking down of the cancer the contracted part has become larger, or 

 that the stomach, being enormously dilated or structurally changed, is 

 evidently not in condition to contract and perform its part in the act 

 of vomiting. In other cases the autopsy gives no explanation of the 

 cessation of vomiting. The vomited masses consist sometimes of the 

 'bod, enveloped in a thick coat of mucus, which is little changed, if the 

 cancer be at the cardiac extremity, but is often greatly altered when 

 the pylorus is affected ; sometimes they consist only of quantities of 

 mucus and variously-colored sour and bitter liquid. The presence of 



