620 THOMAS R. BROWN AND JOHN H. KING 



intestinal disturbances due to the bacteria and their products with a 

 marked influence on intestinal secretion and absorption; apparently it is 

 due to their influence upon gastric and intestinal digestion rather than to 

 any specific effects that decomposition affects metabolism, and this seems 

 equally true of the rarer products of decomposition or putrefaction some- 

 times met with, such as sulphuretted hydrogen, certain diamines, indol, 

 acetone, etc. ; thus we have heard of no case of sulph-hemoglobinemia 

 secondary to putrefaction of gastric contents. These products of decom- 

 position, however, undoubtedly affect gastric tone, and further impair the 

 already seriously affected motor and secretory functions of the stomach, 

 as well as markedly lessening the desire for food. Decomposition or fer- 

 mentation is certainly less marked in those cases secondary to ulcer, for 

 free hydrochloric acid is, next to an unimpaired motility, the most im- 

 portant factor in lessening bacterial activity, and in fact there is no 

 tissue normally more proof against bacterial invasion than the gastric mu- 

 cosa. There is certainly no proof that certain bacteria are absolutely 

 pathognomonic of special disease processes. 



A great deal has been written about the presence of a specific ferment 

 in the cancer cells and in its secretions, the former bringing about marked 

 cleavage in the protein molecule so that amino-aeids may be found. 

 Whether the cancer cells also secrete a specific toxin cannot be stated 

 definitely although it is difficult to explain certain phenomena in a few 

 cases except on this basis. As to the former, it is of interest to note that 

 certain conditions associated with gastric cancer increase of the soluble 

 protein in the stomach contents, of antitrypsin in the blood, and of colloid 

 nitrogen in the urine arc based on this conception, and this suggests that 

 there are probably slight specific metabolic changes in this disease. The 

 constant increase of the blood sugar as noted by Grove in a small group 

 of these cases, is interesting in this connection. On the other hand, most 

 of the component parts in the picture of cachexia, regarded as suggestive 

 if not pathognomonic of this disease, can be explained by the secondary 

 mechanical, secretory and motor disturbances, such as : 



(1) Malnutrition and weakness from insufficient intake of 

 food: 



(2) Stagnation from mechanical obstruction to the pylorus; 



(3) Secondary putrefaction associated with diminished 

 secretion of HC1 and ferments ; 



(4) Anemia from malnutrition, hemorrhage, infection ; 



(5) Insufficient absorption of food by either cancerous de- 

 generation of important digestive glands or by secondary 

 disease of the intestinal mucous membrane, 



the site of the cancer and its rapidity of growth playing a fundamental 

 role in this connection so that we may define cachexia as the characteristic 



