Stomach. 213 



the overlying stomach. Hemorrhage in ulcer of the 

 stomach. The gastric vessels along the greater and the 

 lesser curvatures send off branches more or less parallel 

 to one another, and these branches, after piercing the 

 muscular coats, run in the submucous tissue. From these 

 branches smaller vessels ascend in the mucous membrane 

 of the stomach, and, when an ulcer destroys these capil- 

 laries, hemorrhage of a very moderate degree may ensue. 

 When the larger vessels of the submucous coat are in- 

 volved, the hemorrhage may be very profuse, and even 

 fatal. Quickly fatal hemorrhages frequently result from 

 erosion of the main trunks along the curvatures, or from 

 perforation of the splenic vessels, or even the portal vein. 



Pain in ulcer of the stomach may be felt in the epigas- 

 tric region or it may be radiated to the back. The ner- 

 vous path in these cases is through the connection of the 

 splanchnic nerves with the solar plexus, on the one hand, 

 and with the lower intercostals on the other. 



Cancer of the stomach. In 80 % of cases there is 

 present a tumor (Brinton), which may be readily detected 

 by palpation if it involve the anterior surface below the 

 inferior border of the liver, or the lower part of the) 

 greater curvature, or the pylorus, but, if situated on the 

 cardia, or on the lesser curvature, or on the fundus, or the 

 posterior wall, then the tumor may be felt with great diffi- 

 culty, or not at all. 



Dilitation or gastrectasis may cause the greater curva- 

 ture to descend below the umbilicus even as far down as 

 the pubes. Osier states that the pylorus may be palpated 

 in gastrectasis, or in gastroptosis (downward displace- 

 ment) as a transversely-placed body alternately relaxing 

 and contracting, and through which gas is, at intervals, 

 felt bubbling. 



Hour-glass contraction may be congenital or acquired, 

 the latter being due to cicatricial contraction after ulcera- 



