The well-known fatality and popular dread of cancer render it advisable that very guarded terms should be employed in the designation of the complaint until the diagnosis can be made with certainty. This is the more important as the mental depression which invariably accompanies it is often replaced by actual melancholia when the patient realises the true nature of his malady, and not only is the duration of life curtailed by his refusal to partake of food or to undergo the usual palliative treatment, but it may be cut prematurely short by suicide. We have known several instances in which the patient destroyed himself a few days after being informed that he was suffering from cancer of the stomach. So far as may be consistent with insuring his appreciation of the serious nature of his disease, it is therefore wise to avoid the use of such popular terms as ' cancer,' ' growth,' or ' malignant disease.'
During the early stages of the complaint the patient should be encouraged to perform his usual avocations, and when this becomes impossible it is better that he should dress and recline upon a couch than remain in bed. Change of air is seldom advisable, since any slight benefit that might accrue from a bracing atmosphere hardly compensates for the loss of home comforts entailed by residence in an hotel or lodginghouse. When the stomach is much dilated, vomiting is often relieved and the sense of weight and fulness diminished by the application of a firm bandage to the abdomen in such a manner as to afford support to the enlarged viscus. Massage and electricity are of no value when gastrectasis arises from a growth of the pylorus, and the recourse to these and other so-called ' cures' is inevitably followed by much disappointment and financial loss. It is possible, however, that further experience may show that the Rontgen rays exercise a beneficial effect. The severe pain in the abdomen which ensues from perigastritis or the development of metastases in the liver and peritoneum may often be relieved by stimulant or sedative applications to the skin. In chronic cases the repeated use of small blisters to the epigastrium, followed by dusting of the raw surfaces with a powder composed of acetate of morphine (gr. 1/2) and hydrochlorate of cocain (gr. 1/4), is of the greatest value; but in the more acute conditions hot fomentations or poultices, with a liniment of belladonna or tincture of opium sprinkled upon them, are more beneficial.
Lavage may be employed with advantage in the majority of cases, but it is chiefly indicated when obstruction of the pylorus has given rise to dilatation of the stomach. The benefit derived from its use is of a threefold kind. In the first place, stagnation and decomposition of the food are controlled, the tendency to secondary gastritis is diminished, and the progress of the dilatation retarded. Secondly, the systematic cleansing of the surface of the stomach from the thick mucus which adheres to it tends to promote secretion and to aid absorption of the food. Thirdly, the periodic removal of the products of fermentation relieves such symptoms as acidity and vomiting, and often stimulates the appetite to a remarkable degree.
In order to obtain the best results lavage should be commenced as soon as possible and performed in a regular and efficient manner. Opinions differ as to the period of the day when it should be employed, and it is probable that each case requires to be considered upon its own merits. In most instances the stomach is most conveniently washed out just before the patient retires to bed or about three hours after his last meal, as by this means the retention of food during the night is obviated and the insomnia which so often arises from nocturnal indigestion is prevented. As the disease progresses a single lavage is seldom sufficient, and it is advisable that the patient be taught to empty and cleanse his stomach both morning and evening. For this purpose warm water containing bicarbonate of sodium (2-5 grains to the ounce) is usually all that is required ; but if an antiseptic is considered necessary, boracic acid (2 per cent.), salicylic acid (3 per cent.), benzoate of sodium (2 per cent.), resorcine (3 per cent.), thymol (0.5 per cent.), or lysol (0.1 per cent.) may be employed. It is important to empty the stomach completely at the termination of the operation, since the retention of any of these solutions may give rise to serious toxic symptoms. A soft tube is also of value as a means of introducing food into the stomach in cases of carcinoma of the cardiac orifice. The subjects of this complaint should not be permitted to exist solely upon what they can manage to swallow, but from the onset of the dysphagia their nutrition should be maintained by forcible feeding or nutrient enemata. The tube should be soft and of moderate calibre, and be introduced with the greatest caution. As soon as it has entered the stomach a pint and a half of peptonised milk, egg and milk, clear soup, or other form of liquid nourishment is poured in through a funnel and the instrument withdrawn. This procedure must be repeated every six or eight hours, and as the stricture becomes more pronounced the size of the tube should be reduced.
The chief contra-indication to the employment of a tube for lavage or feeding is the existence of haemorrhage. When the vomit constantly contains altered blood, or attacks of haematemesis occur at short intervals, the growth is invariably ulcerated and often extensive. In such cases the careless employment of an instrument may produce serious results, and we have more than once seen profuse and dangerous bleeding ensue after its use.
Rectal feeding is of great value when gastric intolerance is an important feature of the complaint, and in cases where it is necessary to increase the nutrition with a view to the performance of gastrostomy or gastro-enterostomy. The oldfashioned method of administering two ounces of milk every two hours should be abandoned in favour of much larger injections at greater intervals of time. By the adoption of this procedure the patient is spared a great deal of pain and inconvenience and the tendency to irritation of the bowel is greatly reduced. In every case the rectum should be irrigated with normal saline solution each morning, and the enemata be administered through a large soft tube, which is inserted as far as possible into the bowel. During the operation the patient reclines upon his left side, with his buttocks raised upon a pillow, and the reservoir containing the nutrient liquid which is attached to the tube is suspended about three feet above the level of the couch.
Atmospheric pressure being the only force used in the administration of the enema, the operation requires threequarters of an hour for its due performance; and if this time is always allowed the whole quantity is absorbed without the least discomfort. As a rule peptonised milk is the best form of nourishment, and fifteen to twenty fluid ounces may be given in the manner described every six or eight hours. The use of peptone and of the various meat essences is not attended by any special benefit, nor is an emulsion of meat and pancreas either more convenient or useful than milk. The majority of the so-called nutrient suppositories merely act as foreign bodies in the rectum, and are either expelled or discovered unaltered in the bowel after death. If a diffusible stimulant is required, a tablespoonful of brandy or whisky may be added to each enema. Eggs are apt to create an unpleasant odour of sulphuretted hydrogen in the sick-room.