70 Prager Vierteljahrsch., vol. xvii.
71 Edinb. Med. Journ., vol. iii. p. 4, 1857.
72 Deutsches Arch. f. kl. Med., Bd. 33, p. 237. He recommends for extreme distension of the colon in an adult the introduction, by means of a tube passed up the rectum, of a solution of about 5 drachms of sodii bicarb. and 4½ drachms of tartaric acid—injected not all at once, but in three or four doses at intervals of a few minutes, the tube being cleaned in the intervals by the injection of three ounces of water, so as to avoid generation of gas in the tube. The generation of a smaller quantity of gas would suffice for the purpose here in view.
As a rule, patients with gastric cancer die from gradual exhaustion. In a condition of extreme emaciation and feebleness the patient sinks into a state of collapse, accompanied often with stupor, sometimes with mild delirium. The death-agony is prolonged frequently from twelve to twenty-four hours, and sometimes even longer. On the other hand, death may occur somewhat suddenly in the last stages of gastric cancer, and without satisfactory explanation.
Death from copious gastric hemorrhage does not occur probably in more than 1 per cent. of the cases of cancer of the stomach.
In the rare cases of death from perforation of the stomach the patient is sometimes so exhausted at the time of perforation that the occurrence of this accident remains unrecognized in the absence of any complaint of characteristic symptoms.
The coma which sometimes leads to the fatal termination of gastric cancer has already been sufficiently considered.
Finally, death may be the result of certain complications more or less dependent upon the cancer. Of these the most important are suppurative peritonitis and pulmonary complications, particularly oedema, terminal pneumonia, and embolism of the pulmonary artery.
DURATION.—It is evidently impossible to determine the exact duration of a cancer of the stomach. Doubtless in all cases there is a period of growth of the tumor before it produces symptoms, and the duration of this latent period can never be determined. When symptoms appear they are often at first so mild as to be readily overlooked, and so ambiguous that even if recognized they are not clearly referable to the cancer. Gastric symptoms may have preceded, perhaps for years, the development of the cancer, so as to lead to the assumption of a longer duration of the cancer than is really the case. Estimates, therefore, of the duration of gastric cancer can be only of limited value.
From 198 cases Brinton73 estimates the average duration of gastric cancer as about twelve and a half months, the maximum duration as about thirty-six months, and the minimum as one month. From 36 cases Katzenellenbogen74 estimates the average duration as eighteen months, the maximum as five years and five months, the minimum as one month. From 112 cases Lebert75 makes the average duration fifteen months and the maximum four years. In 4 per cent. of the cases Lebert found the duration less than three months, in 62 per cent. between six and eighteen months, in 42 per cent. between six and twelve months, in 17 per cent. between three and six months, and in the same number of cases between eighteen months and four years.