A. General Symptoms

These are partly subjective, partly objective, and may be enumerated as follows:

1. Anorexia

Anorexia, or loss of appetite, is a very frequent although not very characteristic symptom of gastric cancer. Numerically Brinton found it present in eighty-five per cent. The appearance of this symptom is sometimes delayed until a comparatively late period. Anorexia in this instance is not caused by any fear of pain the ingested food may invoke, but is attributable to a direct lesion of the nerve centre of hunger. There is a real loss of appetite, or no desire, no inclination to take food. In some instances there exists an actual aversion for food, especially with reference to all kinds of meat and food rich in albumin. Sometimes there is present in these cases a craving for highly seasoned articles, such as pickles, herring, and so on.

2. Pain

Pain is the most constant of all symptoms. It is present, according to Brinton, in about ninety-two per cent, and according to Katzenellen-bogen in a still larger percentage of cases. The situation of the pain does not always correspond to the site of the lesion. Thus a pyloric cancer may cause pains referable not only to the right hypochondrium, but also to the sternum or the left hypochondrium. The pain most characteristic of this condition is usually of a lancinating character. It begins at a comparatively early date, and soon assumes a marked severity. Often it becomes so intense that all other symptoms are relegated to the background. It is characteristic of the pain of gastric cancer that it never entirely disappears. There may be remissions in the severity of the pain, but there are never really free periods. Unlike the pain of gastric ulcer, it is either little or not at all affected by the ingestion of food. Never is it relieved at the end of gastric digestion or after vomiting. The character of the pain is sometimes described by the patients as dull, gnawing, or burning; sometimes as being attended by a sense of weight, oppression, tightness, or distention in the epigastrium; sometimes, again, by soreness or tenderness to pressure in this region.

Exacerbations of the pains are frequently caused by ulcerative processes taking place on the surface of the cancer; sometimes, again, by inflammatory adhesive processes with the neighboring organs.

3. Vomiting

Vomiting is likewise one of the most frequent symptoms. Brinton found it present in eighty-seven and one-ninth per cent of his cases, and Arnold in eighty-six per cent. The frequency of this symptom is largely dependent upon the situation of the cancer, occurring much oftener in those cases in which the cancer occupies either the pylorus or the eardia. But it may exist even when the cancer has no connection whatever with the orifices of the stom-ach. The vomiting takes place either sometimes after the ingestion of food or independent of it. Thus some patients vomit in the morning when arising, and eject either a quantity of mucus or, more frequently, some undigested and decomposed food particles. The ejected matter often has an offensive smell, and as a rule contains numerous micro-organisms, sarcinse, yeast cells, and sometimes changed blood.