In the great fields of Medical and Surgical Diagnosis, there are two subjects which have
always appeared to me to present to the ordinary
general practitioner, no matter how shilled he may
be, almost insuperable difficulty in their early recognition. I refer to Gastric Carcinoma and Acute
Suppurative Osteomyelitis. With the former of
these, more especially its earlier recognition, it
is my intention to deal in this Thesis. The presence of Gastric Carcinoma in the vast majority of
cases is only suspected when a palpable epigastric
tumour and, unfortunately, in some cases, a visible
epigastric tumour is discovered. When one reflects
that the common sites for such neoplasms to develop
are towards the pylorus and on the lesser curvature
(regions in health anatomically impalpable), it can
readily be imagined that by the time such tumours are definitely, superficially palpable, not to mention
visible, implication of surrounding important structures, glandular invasion, and secondary metastatic
deposits, all too plainly account for the deplorable
condition of the average patient who is sent to the
surgeon for relief. Those "living skeletons", emaciated, sallow, feeble and anaemic, with subnormal temperature, lungs peculiarly susceptible to any chilling effect (the mere giving of an anaesthetic often
hastening their end), with hearts enfeebled and tissues devitalised, cannot be expected to stand, and,
as can be shown from the results of most surgeons, do
not stand, any operation performed with a view to cure
and frequently not even one performed merely with a
view to palliate their distress.
The question then surely suggests itself -
what can we do to correct or better this regrettable
state of affairs?
In the following thesis, I have thought fit * to divide these cases under the two
A. " Gastric embracing carcinomata in
the region of the cardiac orifice, the fundus and.
the body of the organ. with regard, to those affecting the cardiac, orifice, I have not discussed whether
they were primarily oesophageal or gastric.
B. "PYLORIC" - embracing carcinomata of
the pyloric' antrum and region of the pyloric orifice.