


1905.| wn Gastric Contents in Malignant Disease of Organs. 141 
results were due to minimal amounts of free hydrochloric acid which were 
not determined quantitatively, and the small amount of free hydrochloric acid 
present was almost as good an indication of cancer as its entire absence. 
The entire absence of free hydrochloric acid is not in the nature of things 
to fbe expected in every case, and the amount of such acid, as shown by 
quantitative tests, is the proper subject of enquiry both from the point of 
view of diagnosis and in regard to its relationship to the diseased condition 
itself. 
Before coming to the proper subject of this paper, a little may be said 
with regard to the absence or diminution of the free hydrochloric acid in 
other forms of disease than cancer of the stomach. With the exception of 
atrophy of the gastric mucosa, where the gastric secretion and naturally the 
free acid is absent, there is no other diseased condition of the stomach in 
which the acid is absent in such a high percentage of cases as in cancer. 
Morner* found in 12 cases of chronic gastritis that free hydrochloric acid 
was absent in two, and varied in amount in the other 10 from 0:02 to 
0-12 per cent. 
The free hydrochloric acid appears to be present in normal amount in 
phthisis, except in the last stages of the disease.t+ 
It is often absent in acute infectious diseases, but much less commonly 
in other febrile conditions.t Other conditions in which absence has been 
noted are chronic kidney disease, anemia, neurasthenia, hysteria, tabes, 
Addison’s disease. It is also absent in prolonged inanition, so that in all 
cases the condition of the patient’s appetite should be noted in applying 
tests for free hydrochloric acid. 
Returning to diseases of the stomach in which the free hydrochloric acid 
is absent or greatly reduced in quantity, it may be stated that the conditions 
in addition to carcinoma in which the acid fails are those of atrophy of the 
gastric mucous membrane and chronic gastritis. 
Now, in such cases, there is a very obvious and long continued perversion 
of the activity of the secreting cells, and, hence, it is not difficult to 
understand that continued local irritation on the one hand, or atrophy of 
the cells on the other, can lead to a suppression of the acid secreting function. 
But in cancer of the stomach the absence of free hydrochloric acid may be 
noted before the gastritis becomes chronic, and in cases where gastritis is 
* ‘Upsala Likareférenings Férhandlingar,’ vol. 24, 1889, p. 483; Maly’s ‘ Jahres- 
berichte ti. d. Fort. der Thierchemie,’ vol. 19. 1890, p. 253. 
+ Immermann, ‘ Beilige zu Centralblatt f. klin. Medicin,’ vol. 10, 1889, p. 21. 
{ Gluzinski, ‘Deutsches Archiv f. klin. Medicin,’ vol. 42, 1888, p. 481. 
