The patient presents a cachectic and emaciated appearance, while his appetite continues good, and the process of digestion seems little interfered with ; the pulse is more apt to be ac,cele rated when the disease is scrofulous than when malignant, and is always small and weak ; the stools are very often unhealthy, especially when the morbid deposit is situated in the mesentery ; but no distinct characters can be assigned to them. The com plaint may be simply of weakness and emaciation, or of sensations of uneasiness or pain in the abdomen, or of anomalous neuralgia. We search for evidence of the existence of any wasting disease, and by the process of exclusion we are convmced it must be situated in the abdomen ; in scrofulous children we suspect the presence of tubes mesenteries; in adults we may be quite unable to form an opinion of its nature. After a time the belly is either tumid and hard, with nodules of greater or less size, perceptible on thrusting the points of the fingers deeply among the bowels; or it is shrivelled and shrunken, and hard masses are readily to be felt quite In the former there is probably some peritoneal inflammation and effusion, and it requires some care in making the examination to discriminate enlargements of the liver or spleen in the altered positions they sometimes assume. In the
latter there may be some difficulty in distinguishing morbid growths from masses of hardened feces.
Greater mistakes, however, are much more likely to be made on the other side, when complaints of what seem to be only func tional derangements of the stomach and bowels lead us away from considering the possibility of such a serious malady ; or when, if the idea be suggested, and an examination instituted, the dis covery of nothing to confirm the suspicion throws us back again on the idea of functional disturbance, till progressive emaciation and final exhaustion of the powers of life prove that there was something real in the hypothesis.
The largest growths of the kind referred to are those which take place in the omentum when occupied by encephaloid, and especially colloid cancer : they are more likely to be mistaken for enlargement of the liver or spleen than any others. Next in size are encephaloid masses in the mesentery : those which are most apt to escape detection are such as take their rise in the glands close to the spine. Mesenteric disease tends more than any other to excite inflammation and exudation into the perito neum. It seems scarcely necessary to add that scrofulous deposits are more common during the period of growth, and that malig nant diseases usually occur after middle life.