40 STUDIES IN DIGESTION 



Hydrochloric Acid Deficient. It is well known that 

 the HC1 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 abolish the HC1. 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. 



THE PHYSIOLOGY OF GASTROJEJUNOSTOMY. 



What effect is produced upon the functions of the 

 alimentary canal by the operation of gastrojejunos- 

 tomy ? We have to ask : (i) Does the food pass 

 through the new opening or by the pylorus ? (2) 

 What is the effect upon the gastric juice ? and, (3), 

 What is the effect upon the absorption of proteins, 

 fats, and carbohydrates ? 



Some light has been thrown upon the first of these 

 questions by watching with the Arrays the course 

 taken by a meal containing bismuth oxide, and it 

 would appear, as might have been expected, that 

 both routes are followed, unless either the pylorus 

 or the artificial opening is or becomes greatly nar- 

 rowed. On this subject the writings of Cannon 

 and Gray may be consulted. 



The effect upon the gastric juice is nil if it has 

 previously been normal ; if hyperchlorhydria was 

 present, an efficient gastrojejunostomy appears 



