3. Retention Of Food Within The Oesophagus

In most instances of cardiac stenosis some of the food particles remain within the oesophagus above the ste--nosed spot. As a rule, they become decomposed and cause an irritation or inflammation of the oesophageal walls. The retention of food within the oesophagus is an important sign, and can be discovered one hour after the partaking of a small meal, in the following way: A tube of ordinary size (not too narrow) is introduced into the oesophagus until about 1 or 2 cm. above the stenosed spot, and the patient ordered to compress his thorax after a deep inspiration. As a rule, some contents now appear through the tube. The opening is then closed, the tube withdrawn and emptied, and the obtained contents examined as to appearance (macroscopical aspect), reaction, whether acid or not, whether containing lactic acid, hydrochloric acid, or the ferments. A tube of thinner calibre which can pass the stricture is then taken, and introduced into the stomach.

By the ordinary expression method the real gastric contents are now obtained. Their macroscopical appearance, as well as their chemical condition - which again refers to acidity, presence of hydrochloric acid, and ferments - is compared with the portion first obtained by means of the thicker tube. In cases of actual retention of food within the oesophagus, the first portion shows the following characteristics: Reaction, either neutral, alkaline, or slightly acid; hydrochloric acid and ferments absent; organic acids occasionally present. The particles of food appear unchanged in any way and are in just the same condition as when swallowed. The second portion, obtained from the stomach, presents the appearance of chyme, shows a decided acid reaction, the presence of hydrochloric acid either in its free state or combined, frequently the presence of ferments, especially rennet, and gives the biuret reaction.

Retention of food within the oesophagus is not pathognomonic of cancer of the cardia, as it is also found in dilatation of the oesophagus, caused either by a benignant stricture of the cardia or by a disturbance of the peristaltic action of the oesophagus. The latter two conditions, however, are quite rare, so that the symptom of retention is of much importance in the diagnosis of cancer of the cardia.

4. The examination with the oesophagoscope often shows a neoplasm.

(6) Pylorus. Subjective Signs

Besides the pains, there exist a decided feeling of fulness and quite frequent attacks of vomiting.

Objective Signs

1. Tumor

A tumor can very frequently be discovered, situated somewhat to the right of the linea alba in the area extending from the navel to the ribs. The methods of diagnosing these pyloric neoplasms have already been described above.

2. Vomited Matter

This consists of large quantities of chyme (one to two quarts or more), and, as a rule, contains food which had been taken a day or two before the act of vomiting. 3. Ischochymia. This condition (retention of chyme) is very pronounced. On examining the stomach in the fasting condition of the patient by means of the tube a considerable quantity of chyme, containing more or less decomposed food from previous days, is found. Very frequently the particles of food are quite coarse and obstruct the openings of the tube. In such instances it is often very difficult to empty the stomach entirely, even by means of washing. This object can hardly be achieved in one sitting.