54:2 DISEASES OF THE STOMACH. 



lactic, butyric, or acetic acids in the vomited matters depends on the 

 causes that we investigated when speaking of simple stricture of the 

 pylorus. Sarcina ventriculi very often occur in the vomited matters, 

 while portions of the cancerous growth are rarely found, This is be- 

 cause, while the cancer ulcerates and breaks down, the characteristic 

 form of its elements is destroyed. Capillary haemorrhage readily re- 

 sults from the breaking down of the vascular growth. The blood 

 poured into the stomach is quickly altered by its acid contents and 

 converted into a black, grumous mass. Hence the presence of " cof 

 fee-ground " masses in the vomited matters is a frequent and impor- 

 tant symptom in cancer of the stomach ; but its diagnostic significance 

 has been much overestimated. The erosion of large vessels, causing 

 copious haemorrhage, is much more rare ; in doubtful cases this symp- 

 tom indicates chronic ulcer of the stomach (see Chapter VIII.) rather 

 than cancerous disease. 



The most important symptom of cancer of the stomach is the pres- 

 ence of a tumor in the epigastrium. It is necessary to know that this 

 symptom may be wholly absent ; this may be readily understood when 

 we remember the relation of the stomach to the liver and ribs. Can- 

 cer of the cardiac portion never causes a perceptible tumor, even when 

 it attains a great size ; that of the small curvature is not felt till it has 

 advanced to the greater curvature. Most of the tumors that can be 

 felt are located at or near the pylorus, the pyloric part of the stomach ; 

 and it is only because cancer affects this portion most frequently, that 

 we almost always find a tumor in this disease of the stomach. HyrtVs 

 description of the position of the stomach is not true ; this is particu- 

 larly the case in the assertion that, on expiration, the point of the ster- 

 num corresponds to the middle of the anterior wall of the stomach. 

 Luschka says, in his classical work (on every page of which the prac- 

 titioner will find valuable information), that an incision made through 

 the median line of the body will divide the stomach, so that five-sixths 

 will lie on the left side, and at most one-sixth on the right. When the 

 itomach is in a normal position, even cancer of the pylorus will give a 

 tumor of the left side. When the diseased pylorus sinks down from its 

 weight, the tumor may be near the navel, usually somewhat above and 

 rather to the right than to the left of this. If it be still farther down, 

 it may be mistaken for ovarian tumor. The size of the tumor varies 

 from that of a pigeon's egg to that of the fist ; if it be very large, it 

 may form a visible prominence in the abdomen ; the surface is usually 

 uneven and nodular. In many cases the tumor is movable, and ii 

 changes position according as the stomach is full or empty ; in othei 

 cases, where there are adhesions, it is immovable. In the same way 

 the sensitiveness of the tumor varies greatly. Sometimes, instead oi 



