The diseases of the stomach : bring the third edition of the "Diagnosis and treatment of the varieties of dyspepsia" revised and enlarged / by Wilson Fox.

  • Fox, Wilson.
Date:
1872
Catalogue details

Licence: Public Domain Mark

Credit: The diseases of the stomach : bring the third edition of the "Diagnosis and treatment of the varieties of dyspepsia" revised and enlarged / by Wilson Fox. Source: Wellcome Collection.

    221/318 (page 197)
    thi'oUgli -^vliich process large masses may sometimes be thrown off, leaviug irregularities in the substance of the cancer. The same con- cUtion also occurs, but to a less extent, in scirrhus. In colloid, on the other hand, it is seldom observed, and the ulcerative process, if so it can be called in this variety, consists of the rupture of the larger spaces, which thus give rise to a series of pits or depressions on the sm-face. The more rapid and extensive necrotic processes are some- times a source of dangerous hcemorrhage. The ulcers thus resulting are almost invariably distinguishable by their thickened, ragged edge, which is infiltrated and swollen by the morbid growth, and around which warty or polypoid excres- cences are often formed, and also by the presence of cancer structures in their floor. Occasionally such large masses of the growth are thrown off as to have led to the idea that the morbid structure might possibly be eliminated in this manner; but evidence of a cure thus occurring is very defective, and, although cicatricial formation is sometimes found proceeding in one part, it is usually found that the cancer structures are extending in another. In some cases this sloughing action ai)pears, however, to have restored the patency of the pyloric and cardiac orifices, after these had been previously obstructed by the growth. The extension of the cancer through the peritoneal coat is attended with various consequences. Adhesions to neighbouring organs, and implications of the omentum in the cancerous growth, which are most common in cases of colloid, have been already alluded to. General peritonitis^ has sometimes been observed without rupture of the stomach. Partial peritonitis taking place in the same manner is, however, more common. Perforation, leading to a free opening between the interior of the stomach and the cavity of the peritoneum, is less frequent in cancer than in ulcer of the stomach. The data as to the absolute frequency of this event in the former disease are, however, not suffi- ciently certain to allow of an absolute comparison.^ Adhesions to adjacent organs may, however, lead to the invasion of th ese by the cancer, as is observed in the case of the liver, pancreas, spleen, and the lumbar vertebrte, or to fistulous communications formed between the stomach and other parts. Gastro-colic fistula has been already stated to be much more frequent in cancer than in ulcer, while the converse proposition holds true with regard to gastro- cutaneous fistula.^ Perforation of other portions of the intestines ]ias also been noticed, as into the Ueum;* and in other cases the growth extends through the diapliragm into the lungs. 1 Dittrich, loc. cit. 2 Dr. Brinton has estimated the frequency of perforation in cancer as occnrring in l ather more than 4 per cent. In foi;r of his cases the contents of the stomach were fliiscd into a limited sac bounded by the peritoneum. •■' Sec note 4, p. 158. IJrinton, loc. cit. A remarkable case of this natxire, which has its parnllol nmonf; fhn Rocondary conspqnencca oC simpic ulcer, is recorded by Dittrich, Prnger Viertcl-