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one well authenticated case of primary achylia gastrica which I have been able to observe (vide Charts). Comparison of the graphs obtained from these four cases with those obtained from the patients suffering from gastric carcinoma, shows very striking differences in the shape of the graphs obtained from the malignant and non-malignant cases.

Conclusions. As the result of my investigations, the following conclusions have been arrived at. It must be realised, however, that, as it has only been possible to study a limited

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number of cases, certain of these conclusions must not be taken as dogmatic assertions, but rather as expressions of opinion based upon a limited number of results. It will be seen that they are in substantial agreement with the conclusions arrived at by MacLean 2 after his researches conducted on a much wider scale.

1. Gastric carcinoma may be diagnosed or excluded, in the vast majority of cases, by examination of the stomach contents alone.

2. The results of the gastric analysis on which importance should be placed, in the diagnosis of this disease, are

the presence of: (a) Achlorhydria; (b) lactic acid; (c) blood; (d) evidences of stagnation.

3. Absence of free acid and the presence of lactic acid are found in the great majority of patients suffering from gastric carcinoma, and such a dual finding probably occurs in no other condition, with the exception of carcinoma of the œsophagus.

4. The absence of lactic acid in stomach contents which show no free acid, or the discovery of large quantities of free hydrochloric acid, makes the presence of gastric carcinoma exceedingly improbable.

5. The absence of free acid and the presence of lactic acid
is not necessarily evidence of an advanced condition
of the carcinoma, nor is the presence of free acid
necessarily evidence of an early stage in the growth.
6. Lactic acid found in the stomach is not invariably
caused by the fermentation of stagnating gastric
contents, but may be sarcolactic acid produced by
the tissues involved by the growth. It may therefore
occur in the stomach contents when no pyloric stenosis
is present.

7. The Congo-red and dimethyl tests for free hydrochloric
acid in the gastric contents are not trustworthy,
since-(a) They do not indicate free hydrochloric
acid when it is present in very small quantities; (b)
they react to large quantities of lactic acid in the
same way as they react to free hydrochloric acid.
8. Gunzberg's test, when the reagent is freshly prepared, is
an entirely reliable one for the presence of free hydro-
chloric acid.

9. Uffelmann's test for lactic acid is valueless, as it gives
a positive reaction with many other substances, which
may be found in the stomach contents, besides lactic

10. MacLean's test for lactic acid is simple and trustworthy.


1 Hoffman, The Mortality from Cancer throughout the World, 1915.

2 MacLean, Modern Views on Digestion and Gastric Disease, 1925.

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7 Bolton, Brit. Med. Journ., 1923.

8 Ryle, Gastric Function in Health and Disease, 1926.

9 Brown, Contributions to Medical and Biological Research, ii., 1919. 10 Barber and Ryle, Lancet, ii., 1920.

11 Hurst and Bell, Brain, vol. xlv., 266, 1922.

12 Walker, Medical Organic Chemistry, 119, 1919.

13 Fletcher and Hopkins, quoted by Douglas in Lectures at Oxford University, 1923.

14 Martius and Luttke, quoted by Simon, Clinical Diagnosis, 170, 1911.

15 Boas, Diagnostik u. Therapie des Magenkrankheiten, Leipzig, 1920.

16 Von Noorden, Metabolism and Practical Medicine, ii., 1907.

17 Miller, Ueber Garungsvorgange im Vordauungstraktus und der dabei beteieigten Spaltpize, 1885.

18 Dauber, Schwefelwasserstoff im Magen, iii., 177, 1897.

19 Beaumont and Dodds, Recent Advances in Medicine, 152, 1926.

20 Wheeler, Brit. Med. Journ., iii., 1925.

21 Hayem and Lion and Hartmann, quoted by Hurst, Lancet, i., 1923.

22 Bennet, Brit. Med. Journ., ii., 1923.

23 Hunter, Quart. Journ. of Med., 1923.

24 Bennet, The Stomach and Upper Alimentary Canal in Health and Disease, 1925.

25 Ryle, Guy's Hospital Reports, lxxi., 42, 1921.

26 Ryle, Lancet, ii., 1920.

27 Faber, Holst and Norgaard, Acta. Med. Scand., Ixiv., 570, 1926.

28 Hutchison and Rainy, Clinical Methods, 4th Edition, 1908.

29 M'Cracken, M.D., Thesis, Edin. Univ., i., 58, 1926.

30 Mercer, Personal Communication, 1927.

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