A polisher, forty-four years of age, was admitted into hospital with the symptoms of chronic gastritis. He was extremely intemperate in his habits, and the gastric disorder was consequently attributed to chronic alcoholism. After the lapse of some months he succumbed to pulmonary tuberculosis. At the necropsy a chronic ulcer was found in the stomach near the pylorus, and close to it an oblong mass of stone which measured ten centimetres in length and five in width, and weighed seventy-five grammes. Chemical examination showed the concretion to be composed of shellac, and it was afterwards ascertained that the man had been accustomed to drink the polish he used in his work, which consisted of shellac dissolved in alcohol.-Manasse.

Diagnosis

It is probable that small concretions not infrequently occur in young girls who bite or suck their hair ; but when the habit is discontinued, as it usually is after the hair has been dressed in the adult style, the material is gradually evacuated without the production of serious consequences. In one very obstinate case of dyspepsia which came under our notice the sides of the forehead had been quite denuded of hair by this pernicious habit, and it was only after the dangers attending a hair-tumour had been explained to the young lady, and measures adopted to prevent a repetition of the practice, that the gastric complaint gradually disappeared. It is, therefore, advisable that in every case of obstinate dyspepsia in a girl careful inquiries should be instituted with regard to her habits and occupations, and that, whenever an abdominal tumour is discovered in a young adult, the possibility of a foreign body in the stomach should be borne in mind.

If pain and vomiting are prominent features of the case, the discovery of a tumour in the abdomen is usually suggestive of malignant disease of the stomach or intestine. In such cases three points deserve special attention, namely, the age and sex of the patient, the duration of the complaint, and the character of the tumour. Cancer of the stomach is very rare before the age of thirty, and its precocious development is chiefly met with in men, while hair-tumours commence at or before puberty and are practically confined to women. The malignant disease is seldom preceded by symptoms of indigestion, and usually runs such a rapid course in young persons that life is destroyed within seven months ; gastric concretions, on the other hand, are usually attended for a long time by pain and sickness after meals, and seldom prove fatal in less than ten years. Lastly, a cancerous tumour is irregular, nodular, tender, more or less fixed in position, and of rapid growth, while in most instances the stomach is dilated, marked cachexia is present, and the gastric contents are devoid of free hydrochloric acid. A hair-tumour, on the other hand, is globular or crescentic in shape, situated principally in the left side of the abdomen, is smooth, hard, and painless on palpation, and so freely movable that it may be pushed under the left costal margin. There is no ascites or jaundice, the outlines of the stomach are indistinguishable from those of the tumour, and a tube cannot be inserted more than two inches into the viscus.

A painless tumour in the upper part of the abdomen, which is not attended by special symptoms and has been discovered in an accidental manner, is most likely to be confused with an enlarged spleen, a floating kidney, or a faecal accumulation in the colon.

If the stomach happens to be dislocated, as in Russell's case (fig. 66), the diagnosis from an enlarged spleen is extremely difficult. It may usually be observed, however, that the tumour is exceptionally movable, and that its length is out of proportion to its breadth. The inner margin is less distinct than in the case of a spleen, the characteristic notch is absent, and the passage of a soft tube or inflation of the stomach will at once show that the tumour is gastric in origin. A loose kidney on the left side can usually be displaced downwards as well as upwards, and its point of attachment is much lower than that of an enlarged stomach. It also lies behind the intestine, so that the percussion-note is resonant rather than dull, and manipulation is often attended by pain. In case of doubt, inflation of the stomach should be practised, when the relation of that organ to the tumour can easily be ascertained.

A faecal mass in the colon is more irregular in shape and less definite in outline than a gastric concretion. It is less hard to the touch, and may even be soft enough to indent with the finger, while other tumours of a similar character may be found in the caecum, sigmoid flexure, or rectum. The passage of a tube shows that the stomach is empty and situated above the tumour, and the administration of several large enemata will either diminish the size of the mass or remove it altogether.

Treatment

If the tumour is small in size, it may be possible to secure its evacuation by an emetic ; but this method is always fraught with a certain amount of danger, on account of the ulceration of the stomach which is often present. In the case of large tumours medicinal remedies are valueless, and recourse must be had to an operation. In the cases reported by Knowsley Thornton and Schonborn the mass was successfully removed after the nature of the tumour had been determined by an exploratory incision, while in that recorded by Schreiber a correct diagnosis of phytobezoar was made by the physician and the concretion extracted.