OF THE ALIMENTARY CANAL 115 



without also exploring the appendix and gall- 

 bladder. Soltau Fenwick states that of 112 cases 

 of hyperchlorhydria, in 34 the stomach and duodenum 

 were normal ; in 22 of these the appendix was 

 at fault, and in 12 gall-stones were present. In 

 9 cases appendix trouble complicated gastric or duo- 

 denal ulcer. In 66 patients an ulcer was present in the 

 stomach or duodenum ; 4 of these were malignant. 



It is a remarkable fact that severe and repeated 

 haemorrhage from the stomach may take place in the 

 absence of any ulcer. Out of seven cases recently 

 operated on for hjematemesis at the Bristol Royal 

 Infirmary, in only two was an ulcer found. A con- 

 dition of universal weeping of blood, called " gastro- 

 staxis," occurs in these cases, and with the 

 gastroscope the mucous membrane may be seen to 

 ooze blood wherever it is touched. 



Hydrochloric Acid Deficient. — It is well known that 

 the HCl in the gastric juice is deficient or absent in 

 cases of cancer of the stomach, but the practical 

 value of this is lessened by the fact that old-standing 

 gastritis, or cancer of other organs than the stomach, 

 may aboUsh the HCl. On the other hand, cancer 

 more often than not is preceded by ulcer, and there 

 will be a stage in which the hyperchlorhydria has 

 not yet passed off although cancer is already present. 

 Nevertheless, we cannot afford to neglect the chemical 

 test in the diagnosis of cancer of the stomach, as the 

 other early signs are often equally dubious. 



In persons beyond middle age, absent hydro- 

 chloric acid is not uncommon without any apparent 

 cause or consequence. 



