(C) Stomach Proper. Subjective Symptoms

1. Pains. A constant gnawing pain in the scrobiculus cordis radiating to the back is frequently found present. 2. Anorexia is very marked.

Objective Symptoms

1. Tumor. The presence of a tumor situated to the left of the linea alba (see page 294). 2. Vomiting of small quantities of food, frequently presenting a blackish color. 3. Ischochymia of a slight degree. The examination by means of the tube of the stomach in the fasting condition reveals the presence of a small quantity of chyme, the particles of food therein being quite minute.

Diagnosis

The diagnosis of cancer of the cardia is made from a study of the above-described symptoms and the results of the examination with the tube. Cancer of the pylorus and stomach proper is diagnosed in the same manner. Although the hope of finding certain pathognomonic characteristics in the chemical condition of the gastric contents with cancer of the stomach has not been realized, still the chemical analysis reveals several points which certainly aid in establishing the diagnosis of the affection in question. Van den Velden,1 in 1879, first stated that hydrochloric acid is absent in gastric cancer. He made use of certain aniline dyes (Congo and methyl violet) for the detection of this acid. Cahn and von Mering 2 made use of an exact analytical method, and found that in some cases of gastric cancer the stomach contents revealed considerable quantities of hydrochloric acid. Ewald justly mentions in his book that the question as to the presence or absence of hydrochloric acid in gastric cancer had been experimentally broached as far back as 1842 by the English physician Golding Bird.3 In a man forty-two years old, with pyloric cancer and dilatation, this writer determined the relation of hydrochloric and the organic acids in a series of examinations of the vomit.

The results of these examinations led Bird to conclude that "during the most irritative stages of the disease free hydrochloric acid is present in the vomit in considerable quantities, but it gradually diminishes in proportion to the patients loss of strength, and that the organic acids increase proportionally as the free hydrochloric acid diminishes".

In forty cases of gastric cancer Boas 4 found an absence of hydrochloric acid in thirty-five, while in the remaining five free hydrochloric acid was discovered. Among the cases of gastric cancer that I have seen during the last few years, I know of six in which free hydrochloric acid was present, either in normal or in greater quantities. These cases of gastric cancer in which hydrochloric acid is found to exist certainly lessen the value of Van den Velden's symptom for the recognition of the disease; but this symptom loses still more in importance if we consider that absence of free hydrochloric acid is associated with many other conditions besides cancer. Severe forms of gastric catarrh, and especially achylia gastrica, will undoubtedly furnish a greater contingent of cases with absence of hydrochloric acid than cancer of the stomach itself.

1 Van den Velden: Arch. f. klin. Med., Bd. 22, p. 369. 2Cahn und von Mering: Berl. klin. Wochenschr., 1885. 3Golding Bird: "Contributions to the Chemical Pathology of some Forms of Morbid Indigestion." London Med. Gazette, 1842, p. 891. 4Boas: l. c.