A man, forty-nine years of age, was admitted into the London Hospital for incessant vomiting of three days' duration. It appeared from his history that for several months he had suffered from indigestion and loss of appetite, and latterly had vomited every third or fourth day. He had also lost much flesh. Three days previously the sickness had become incessant, and was accompanied by a dull pain at the epigastrium. On examination the man appeared profoundly ill, the eyes being sunken, the extremities cold, and the pulse hardly perceptible. About every ten minutes he was seized with urgent retching, and rejected about an ounce of an opalescent, alkaline, mucoid fluid. The stomach was dilated, and an ill-defined tumour could be felt in the region of the pylorus. Death occurred from syncope within twelve hours of admission. The necropsy showed cancerous infiltration of the pylorus, in the contracted orifice of which a damson-stone was firmly impacted.
Ulceration of the growth may give rise to a species of vomiting similar to that which occurs in simple ulcer. In such cases the lesion is usually situated near the pylorus, though it need not necessarily obstruct the orifice. Epigastric pain is either excited or increased by the ingestion of food, and is only partially relieved by the evacuation of the gastric contents. This form of frequent vomiting rarely persists more than a few months. As a rule, either it merges into that which characterises pyloric stenosis, or the attacks become less frequent as the disease progresses and metastases in the liver present themselves. The ejecta consist entirely of undigested food mixed with mucus, and perhaps with altered blood. Free hydrochloric acid is usually absent, but lactic acid may be present in excess.
Diffuse infiltrations of the stomach also produce frequent vomiting by contracting the organ and destroying its muscular tissue. In such the patient feels that the capacity of his stomach is limited, and any attempt to overtax it is followed by regurgitation of the surplus quantity. Should the pylorus be stenosed, periodic vomiting may also occur, the only difference from the usual type being that the vomit is comparatively small in amount. If ulceration exists, pain as well as sickness may follow the administration of food.