The progress of the case is usually rapid when the disease is of a malignant character • the symptoms are unrelieved, or recur with greater severity ; the aspect of the patient becomes wan and sallow, with increasing emaciation ; there is often lowness of spirits and despondency ; and sooner or later, in most cases, the presence of a hard mass in the region of the epigastrium, towards the right side, leaves no doubt of the presence of scirrhus.
Though analogous in the fact of partial closure of the pylorus, the two dis eases run a very different course; the difference being caused chiefly by two circumstances : the one, that along with the stricture there is a morbid con dition of the mucous membrane in cancer, giving rise to irritability and more frequent evacuation, ulceration, grumous vomiting, ice. ; the other, that when the disease is constitutional, the altered condition of blood, which attends its progress, necessarily renders it more rapidly fatal than mere thickening of the pylorus. The non-malignant form of stricture may be recognized by its fre quent occurrence among spirit drinkers ; by the accompanying dilatation, the absence of hemorrhage, the circumstance that no tumor can be felt, and most especially by its slow progress ; if the symptoms have existed for years, or even for many months, without a cachexia being established, the probabilities are greatly against cancer.
The occurrence of hemorrhage in any large quantity, in cancerous disease is the exception. At first, the blood only appears as small black or brownish flakes in the vomit, but at a later period, assumes the character of what is called coffee-ground vomiting, the amount of blood in which may be con siderable : distinct hemorrhage is more probably the result of simple ulcer.
We look with great distrust upon symptoms of uneasiness after food, eruc tations, occasional vomiting, and depression occurring in persons of temperate habits, unrelieved by treatment, or progressively getting worse, and attended with any degree of emaciation and sallowness.
It does not seem possible generally to distinguish different forms of cancer ous growth during life. It is only known that medullary cancer grows much more rapidly : that colloid, even if present in the stomach, is more abundant in its usual site, the mesentery ; and that scirrhus is commonly the most painful of the three. Scirrhus is the most local ; encephaloid and colloid spread more rapidly, the former usually coexisting in the liver; in cases in which scirrhus has spread, it has also been to the liver.
'While we are taught much by the aspect of the patient, we learn little from the state of the pulse, tongue, bowels, &c.: there is generally constipation, in consequence of the small quantity of food which passes downward, and the tongue may be coated at the back ; the pulse is for the most part weak, but seldom accelerated.
b. Ulceration.—But little is known of this disease in its clinical history; the symptoms seldom present any degree of uniformity in the cases which have been watched to a fatal termination; they often fail to suggest the idea of ulceration at all, and at best the conclusion regarding its existence can only be hypothetical. Extreme pain commencing immediately after food is taken, and before digestion can possibly have begun, especially if excited by water or bland fluid, a pain which is localized in a particular spot, and always recurs at the same place, affords perhaps the most conclusive indications. Hiematemesis in an otherwise healthy individual is often due to the same cause; but either may be wanting, and there is nothing to be recognized beyond ordinary dyspeptic symptoms. In some few instances the tongue looks red and raw, or spots of ulceration may be seen on it, or on the lips, indicating a generally depraved condition of the mucous membrane, one manifestation of which may be ulceration of the stomach ; much more frequently, however, this state of the mouth is associated with ulceration, or irritation of the bowels.
It must not be overlooked that simple ulceration of the stomach is not a common pathological state in the bodies of persons dying of other diseases, and therefore we must not hastily predicate it of a person suffering from dyspeptic disorder. Besides the simple ulcer, with the origin of which we are unacquainted, we meet with ulceration associated with malignant disease, at parts distant from the pylorus. The same obscurity of symptoms attends this as the other forma of ulceration, unless grumous vomiting occur to point more directly to its cause, or a tumor be felt somewhere in the epigastnum ; and we may then be puzzled to explain the absence of obstruction. We also find destruction of the mucous membrane, and consequent ulceration remain ing as a permanent result of the corrosion and inflammation caused by irritant poisons, especially the mineral acids and alkalies. The history of recovery from the acute attack, with abiding tenderness of the stomach and inability to take food without great distress, would point out the true nature of such a case.