In about 76 per cent, of all cases abdominal pain is experienced during some period of the disease. It varies greatly, however, in its character and severity. As a rule, it does not amount to more than a sense of fulness and oppression after meals, such as commonly ensues from gaseous distension of the stomach; but in about 15 per cent, of the recorded cases it was described as having been severe and increased shortly after meals. It is interesting to observe that in most of these either the growth was ulcerated or there was considerable invasion of the pancreas or retro-peritoneal glands. Constant and severe suffering is usually indicative of perigastritis or secondary infection of the liver. The solid tumours (fibroand myo-sarcomata), unless ulcerated internally, are more often accompanied by sensations of weight and dragging than by actual pain.

Vomiting is usually a later symptom, unless the pylorus is contracted. At first it occurs at intervals, but as the stomach becomes dilated it is repeated more frequently, and the ejecta are found to present the usual features which characterise stagnation and decomposition of the food. Vomiting occurring soon after meals and preceded by pain usually indicates ulceration of the growth, while the attacks of incessant retching, attended by the expulsion of mucus, which are apt to appear from time to time, and are often so severe as to preclude the administration of food, result from secondary inflammation of the mucous membrane. In the case of the large solid tumours, vomiting is a less frequent phenomenon (48 per cent.), and seldom appears until after the lapse of from five to seven months. Faecal vomiting is usually an indication of a gastro-colic fistula.

Haemorrhage from the stomach is seldom a prominent symptom of round-cell sarcoma, owing to the comparative infrequency of ulceration of the growth. It is probable, however, that capillary oozing is of constant occurrence, since the gastric contents removed by a tube are often found to be mixed with coffee-ground material; while careful examination of the stools may demonstrate the existence of altered blood (Schlesinger). In the spindle-cell variety of the disease repeated attacks of haematemesis were observed in nearly half the cases, and in two instances a severe haemorrhage was the first symptom to attract attention.

Physical Signs

A palpable tumour connected with the stomach is an inconstant sign of round-cell sarcoma, and was observed in only about 30 per cent, of the recorded cases. In most instances it is produced by a local thickening of the gastric wall in the region of the pylorus, and was described as a round or oval mass, occupying the right hypochondriac or epigastric region, smooth on the surface, somewhat tender on pressure, and often freely movable. Rapid increase in size can sometimes be observed. In other instances the tumour consists of the entire stomach, and more than once the concomitant enlargement of the spleen has been mistaken for a malignant mass. In the fibroand myo-sarcomata a tumour is almost always present, and is often so large as to occupy the greater part of the abdominal cavity. If the growth is situated near the great curvature, it is usually detected in the umbilical, left hypochondriac, or lumbar region, where it forms a smooth, firm, painless mass which is dull on percussion and freely movable in all directions. This latter peculiarity affords a marked contrast to the behaviour of a carcinomatous growth in the same position, which soon becomes fixed by extensive adhesions to the neighbouring viscera. In two cases where the tumour was attached to the posterior wall of the stomach it filled the lesser sac of the peritoneum, and was consequently covered by the stomach and transverse colon, although being somewhat pedunculated it could easily be moved from side to side.

Dilatation of the stomach can be detected in every case of sarcoma of the pylorus, and when the orifice is contracted the peristaltic movements of the enlarged viscus are usually visible. When the organ is affected by diffuse infiltration its cavity is contracted and its outlines are obscured by the transverse colon.

Metastatic deposits in the skin constitute an important feature of the disease. As a rule they appear in the form of one or two small nodules in or around the umbilicus; but occasionally they are very numerous and are scattered all over the abdomen, chest, and back. They vary in size from a milletseed to a small bean, and at first are freely movable in the subcutaneous tissue, but after a time they become adherent to the skin and may even give rise to ulceration. Enlargement of the supra-clavicular and cervical glands is rarely observed, while sarcomatous infiltration of the tongue is still less common. In one case a correct diagnosis was made by the discovery of a secondary growth in the rectum. Generalisation of the disease is occasionally accompanied by the symptoms of purpura (Eedtenbacher).

Chemical examination of the contents of the stomach affords similar results to those met with in gastric cancer. Free hydrochloric acid disappears at an early stage of the complaint (Fleiner, Schlesinger), and fermentation of the food often produces an excess of lactic acid (Dreyer, Maass, Hammerslag). Sarcinae may or may not be present, and Schlesinger has been able to demonstrate the presence of the Oppler-Boas bacillus, which was supposed to occur only in cases of cancer. The sulphocyanide of potassium in the saliva gradually diminishes as the disease progresses, and finally disappears about one month before death.

Duration And Complications

It is difficult to estimate the exact duration of a disease which commences so insidiously and is often unaccompanied by definite physical signs for many months. It would appear, however, from a study of the recorded cases, that although the round-cell sarcomata often run their course in three or four months, the average duration of the disease is about fifteen months; while in the case of the spindle-cell and myo-sarcomata life is prolonged on the average for two years and eight months. It will be observed that in both instances the duration of the disease is greater than that of cancer, a result which probably depends upon its lesser malignancy and its lesser liability to produce ulceration of the mucous membrane and stenosis of the pylorus. Death usually occurs from exhaustion, and is often preceded by a semicomatose state lasting for several days. Perforation of the stomach, followed by general peritonitis, occurs in 10 per cent, to 12 per cent, of the cases of round-cell sarcoma, and may even take place in the spindle-cell form (Ewald), but owing to the absence of adhesions a perigastric abscess is exceptional. Fatal hemorrhage is very rare. In two instances general sarcomatosis tended to shorten the period of life, while in one an attack of tetany similar to that met with in cicatricial stenosis of the pylorus was immediately responsible for the fatal termination (Fleiner). Excessive ascites, albuminuria, portal thrombosis, and pneumonia all accelerate the natural course of the disease.