Constipation almost always accompanies the onset of the disease, and becomes gradually more and more pronounced as the case proceeds. As an early symptom it existed in 79 per cent, of our cases where the pylorus was affected, and in 36 per cent, of those in which the cardiac end of the stomach was primarily involved. It is probable that the inactivity of the bowel depends partly upon the diminished quantity of food which enters it, and partly upon the loss of fluid entailed by excessive vomiting. In nearly 4 per cent, of our cases the constipation was eventually replaced by intestinal obstruction. As a rule this condition was the result of direct invasion of the transverse colon by the malignant growth, but occasionally it was due to the formation of an abscess between the stomach and the bowel, to occlusion of the duodenum, or to cancerous peritonitis. In one case a second primary growth in the rectum gave rise to a stricture.
Diarrhoea constituted an early symptom in 4 per cent, of our pyloric cases, and in 13 per cent, of those where the disease involved the cardia. It is probably due to chronic irritation of the intestine by the acid products of fermentation. When diarrhoea replaces constipation at a late period of the complaint, it usually arises either from sloughing of a pyloric growth or from the establishment of a gastro-intestinal fistula.