Progressive emaciation is an invariable symptom. At first the loss of flesh is only slight, and if it attracts attention is usually attributed to the indigestion or loss of appetite; but with the progress of the complaint the weekly loss steadily increases, until it may amount to five pounds or more. In our hospital cases the total loss was found to vary according to the duration of the disease, the situation of the growth, and the sex of the patient. Thus, in the male cases the average weight at the time of death was 111 pounds, and in the female ninety-one pounds ; and since the average weight of a healthy male at fifty years of age is 148 pounds, and of a female 128 pounds, there was loss in the former sex of 25 per cent., and in the latter of 29 per cent, of the total weight of the body. In both sexes the loss was greater when the disease occurred below the age of forty-five years than after that period. The emaciation was also more severe when the orifices of the stomach were affected than when the body of the viscus was the seat of disease. Thus, with growths of the cardia and pylorus the average weight in males at the time of death was 109 and 110 pounds respectively, while in disease of the central region of the organ it amounted to 114 pounds. The occurrence of multiple deposits in the liver and other viscera appeared to compensate in some degree for wasting of the soft tissues, since in these cases the average weight at death amounted to 115 pounds. It must be borne in mind, however, that the production of metastases always hastens the fatal termination, and consequently curtails the period of emaciation. The average loss of weight per week in the various cases was as follows :
Under 1 pound in .
1 to 2 pounds in
2 to 3 pounds in
3 to 4 pounds in
4 to 5 pounds in
In 15 per cent, of the entire number an initial gain was observed, which lasted from ten days to three weeks and varied in amount from two to eleven pounds. In all these cases the patient was suffering from obstruction of the cardiac or pyloric orifice, so that the improvement which was manifested may be ascribed to the better methods of feeding which the patients enjoyed when they entered the hospital.
Occasionally this improvement is of much longer duration and the gain in weight is considerable. In a case recorded by Keen and Stewart the patient put on sixty-three pounds of flesh within four months of an exploratory laparotomy which confirmed the existence of carcinoma. In other instances an increase of appetite, renewed hope of recovery, the employment of rectal feeding, or the performance of gastrostomy or gastroenterostomy is followed by a steady gain, which lasts for several weeks. On the other hand, extension of the disease to the oesophagus or pylorus rapidly augments the progress of the emaciation. A sudden increase of weight usually indicates effusion of fluid into the peritoneal or pleural cavities or a rapid invasion of the liver.
As a rule the superfluous fat of the body, and especially that situated in the omentum and mesentery, is the first tissue to undergo absorption. In consequence of this stout people will frequently remark upon their diminution in girth before their attention is attracted to the wasting of other parts. Next to the abdomen, the mammae, neck, cheeks, and hips exhibit the earliest loss of substance, and the skin becomes loose, flabby, and devoid of elasticity. All the voluntary muscles become attenuated, the first to show signs of atrophy being the adductors of the thighs, the pectorals, the gastrocnemii, the interossei in the hands, and the temporals. Among the internal viscera, the heart and spleen are more affected than the liver and kidneys (p. 72). The diminished power of absorption and the excessive quantity of fluid lost by vomiting also contribute to the general loss of weight, and produce the sunken appearance of the eyes and the shrivelled claw-like hands, which invariably attract attention during the later stages of the complaint. In many cases the failure of nutrition is accompanied by a rapid whitening or falling out of the hair, and occasionally the long bones grow thin and brittle and are unduly prone to fracture.