We attended the autopsy of an elderly gentleman who was supposed to have died from some mysterious disorder of nutrition. For nearly a year he had progressively but slowly lost flesh, and had become feeble, lacking in mental and physical energy, and very despondent. There had never been any pain, discomfort after food, vomiting, or other indication of disease of the stomach, nor could any abnormal physical signs be detected in the various organs of the body. Death had occurred very gradually from exhaustion. Upon opening the stomach an ulcerated carcinomatous growth, measuring three inches by two, was found upon the posterior surface near the pylorus. The glands along the lesser curvature were enlarged, and numerous small nodules were scattered through the substance of the liver.
(5) The presence of organic disease in some other important organ of the body is not only apt to mask the symptoms arising from carcinoma of the stomach, but by the prominence of its physical signs may distract attention from those that accompany the malignant complaint. Thus, in the case of a patient who suffers from cough and expectoration, and who presents the indications of lung disease, any complaint of debility, want of appetite, indigestion, or loss of flesh, will be ascribed without hesitation to the pulmonary mischief ; while the existence of general oedema with albuminuria, or of anaemia with venous thrombosis, will naturally direct attention to the state of the kidneys or the blood rather than to that of the digestive organs. It consequently happens that under these and similar circumstances carcinoma of the stomach may run its entire course without exciting the least suspicion of its existence in the mind of the patient or his medical attendant.