II. Cancer of the Stomach, like that of the oesophagus, seldom affects anyone under fifty years of age. Little is known about the antecedents of such a case, but there are reasons for suspecting the pre-existence of an ulcer in a large proportion of the cases. The symptoms which attend the disease are not characteristic of cancer. They are those of a bad dyspepsia - viz., pain after food, vomiting, regurgitation of sour or fermented food, and tenderness of the stomach. The most important symptom is progressive loss of flesh; this always occurs, and may be very rapid. If pain after food is combined with rapid loss of flesh and the vomiting of blood or "coffee grounds," there are serious reasons for believing the trouble is due to cancer. If to these symptoms is added a peculiar tint of the skin, a dirty yellow, earthy, or fawn colour, and especially if enlarged glands can be felt under the skin of the abdomen, groin, or axilla, or a growth is perceived in the stomach, the diagnosis of cancer is pretty certain.

If it is known that the cancer does not affect the outlet or pylorus, that is to say, there is no obstruction to the passage of food, the patient may have free choice of food, because it is probable that the duration of life will not be very great. Nevertheless, it is advisable to guide the patient's choice in the direction of digestible foods. Moreover, there is one feature of the case which suggests a limitation of certain foods; this feature is the well-known deficiency of hydrochloric acid in the gastric juice of all cases of cancer, and the probable development of organic acidity due to fermentation. The correct and scientific diet for such persons, therefore, is that previously detailed for cases of organic acidity and hypochlorhydria.

If, however, the pylorus is affected, and the exit of food is hindered, the diet should contain an excess of animal foods and very little starchy material. In such a case we should forbid the consumption of bread, biscuits, oatmeal, farinaceous foods, potatoes and vegetables, and even milk puddings, because they cannot be thoroughly digested in the stomach and their outward passage is hindered. Their consumption would lead to fermentation, flatulence, acidity, vomiting and dilatation of the stomach. The occurrence of dilatation would probably cause the stomach to become prominent, and thus distinguish cancer of the pylorus from that of the oesophagus. The food, therefore, must consist of substances which will be digested and absorbed in the stomach. The basis of the diet should be milk, and a saltspoonful of citrate of soda could be added to each pint to prevent the formation of curds. We may also give raw eggs, meat-powders (Mea-tox, Mosquera's beefmeal), Plasmon, or other milk-powders, somatose, junket, custard and jelly. Extracts of meat are useful by promoting a flow of gastric juice, and a little strong soup may be given now and then for the same purpose. It is seldom, however, that the pylorus is absolutely closed ; liquids and liquefied foods will pass through it. Therefore Mellin's food, whey and other liquids containing sugar, extract of malt, or dextrin, may be given. Possibly some arrowroot combined with Taka-diastase to digest it would pass through; it can be tried, and if it is successful in passing through may be given every day. The fat of milk is extremely fine and will usually pass the pylorus. Sugar of milk, golden syrup, extract of malt, will also go through. Jelly would be liquefied in the stomach and pass as easily as other liquids. Vegetables can be boiled, and a few ounces of the liquid containing some of the substance rubbed through a sieve can be tried. A considerable amount of time and care must be spent in the preparation of animal food. A fine mincing machine is better for this purpose than anything else; but cooked meat or fowl can be reduced to a pulp with a pestle and mortar. If the latter method were adopted considerable assistance would be derived from cutting the meat or fowl into very thin slices before pounding it. When it is reduced to a paste, the addition of some cream, butter, or strong soup would render it palatable ; pepper and salt can be added. Various commercial pastes of meat, fowl, or fish would be useful.

When the obstruction of the pylorus is very great the stomach loses its power of absorption to some extent, the secretion of hydrochloric acid is correspondingly diminished, and digestion is thereby weakened. We must now rest our hopes on predigested foods, peptonized milk, Leube's soluble meat, somatose, panopepton, Carnrick's peptonoids, Bovinine, Darby's fluid meat, Valentine's meat juice, Brand's essence of beef, and other preparations which require no digestive effort. If haemorrhage occurs, the patient should be fed by the rectum for a few days until all bleeding ceases. The rest obtained by the stomach may lead to a relaxation of the stricture, and when stomach-feeding is again begun foods previously found impassable now pass through easily.

In such cases the operation of gastro-enterostomy, by forming a new aperture between the stomach and duodenum, may afford considerable relief. This operation will make the patient more comfortable, feeding will become an easy matter, and his life will be prolonged. These advantages show the desirability of such an operation being performed as soon as a well-marked obstruction of the pylorus is discovered; and the tendency of the present day is to secure every advantage which can be obtained in this manner.