The Pylorus, indifferently at all parts of its circumference, is known to be the chief seat of primary fibrous and areolar cancer of the stomach. From this point the degeneration extends chiefly along the lesser curvature over the pyloric half of the stomach; in many, though rarer cases, it affects the entire stomach, attacking the fundus last, which however generally remains partially free. The parietes of the stomach may attain an inch in thickness, being rigid and generally tuberculated on their inner surface; the cavity of the stomach will at the same time be diminished in size. The cardiac orifice of the stomach is rarely the seat of cancerous degeneration, and it is singular that cancer of the pylorus is accurately bounded by the pyloric ring, and never extends to the duodenum; whereas when cancer occurs at the cardia, excepting, of course, those cases in which it descends from the oesophagus, it invariably involves a portion of the latter.

The Scirrhous Pylorus

The Scirrhous Pylorus is commonly bound down by the degeneration of the tissues that lie behind it; but exceptions occur which require the more to be known, as they materially affect the diagnosis. The degenerated pylorus may remain unattached, and will then, owing to its increase in weight, descend to a lower region of the abdomen, even down to the symphysis pubis, causing a hard, very movable tumor, which easily gives rise to mistakes.

In proportion as the parietes increase in size and thickness, the stenoses of the pyloric channel will be more or less considerable; nodose protuberances, uneven contraction of the tissues, and corrugation of the parietes, give rise to inflections presenting a more or less acute angle. The greater the stenoses, and the more the cancerous degeneration is limited to the pylorus, the more considerable will be the dilatation of the stomach, which sometimes reaches an enormous size, and presents a more or less hypertrophied state of its muscular coat.

It is very frequently found to contain the well-known chocolate-colored fluid resembling coffee-grounds, the origin of which is apparent from the various conditions of the inner gastric surface we have above examined.

Cancer of the stomach in most instances is uncomplicated, but it is also found coexistent with cancer of the liver, of the lumbar glands, of the intestine, and especially of the rectum, of the uterus, the perito-nium, the ovary, etc.