A man aged forty-eight became gradually affected with difficulty of swallowing, which in a few weeks prevented him from taking any solid food. Mouthfuls of milk and other liquids were easily disposed of, but if drunk hastily or in bulk the fluids gave rise to oppression at the chest, and were partially regurgitated. The insufficient nutrition produced rapid loss of flesh, and within a few months extreme debility necessitated his confinement to bed. The appetite was bad, and hiccough and gaseous eructations were a constant source of annoyance. Haematemesis was absent, and there was no complaint of pain.
On examination the stomach was found to be normal in size, and no tumour or localised tenderness could be detected in the abdomen. There were no signs of aneurysm or other thoracic tumour. A fullsized tube was passed without difficulty into the stomach, and a pint of milk introduced by it was retained without difficulty. Notwithstanding the absence of a stricture, the patient continued unable to swallow, and forcible feeding (gavage) was instituted. For two or three weeks this proved very successful, and he rapidly put on weight, but subsequently discomfort ensued after each meal, and occasionally vomiting occurred. The stomach was now found to be dilated, and a sense of resistance was detected in the region of the pylorus. The food regurgitated after the tube was withdrawn, emaciation set in, and death ultimately occurred from exhaustion about five months after the onset of the dysphagia. At the necropsy the stomach was found to be moderately dilated, and the pylorus affected by a cancerous infiltration, which had produced slight stenosis. The cardiac orifice was patulous, but showed no sign of disease. The oesophagus was normal.
Nausea is present in 68 per cent, of all cases, and is usually experienced after meals or immediately prior to an attack of vomiting. A constant feeling of sickness constituted one of the earliest symptoms of the disease in 27 per cent, of our cases, and was usually accompanied by anorexia and loss of flesh, and occasionally by giddiness and retching in the early morning. It was most frequent and severe when the cardiac region was the seat of the growth, or where the pylorus was involved without the production of stenosis. The marked distaste to tobacco and fats often causes the nausea to be mistaken for ' biliousness.'