

1905.] in Gastric Contents in Malignant Disease of Organs. 143 
if ch observations have been made that they have excited so little 
attention. The literature on carcinoma is so enormous that it is possible such 
observations, although unknown to me, may have been made already, but 
such search as I have been able to make has revealed none, and if they do 
exist they have been awarded so little attention that they have been quite 
forgotten, and so it needs no excuse to publish the results of the observations 
eiven below.* 
On placing the view outlined above before my colleague Dr. Alexander, 
he agreed to superintend the clinical side of the work. 
The cases have been collected, under Dr. Alexander’s directions, the 
administration of the test meals superintended, and the gastric contents 
obtained by Mr. Kelly. 
The chemical analyses have been carried out in the bio-chemical laboratory 
of the university by Mr. Kelly, Mr. Roaf, and myself. 
I desire here to express my thanks to my co-workers in the research, whose 
energetic co-operation has rendered the task of combining clinical and 
laboratory work an easy one, and also to those physicians and surgeons in 
Liverpool who have assisted us with further clinical material. 
Methods of Kxamination. 
The test meal given in each case was that recommended by Ewald 
of a pint of tea without sugar or milk, and a round of dry toast. Except 
in Case IX, where the toast could not be taken on account of the situation 
of the growth, and the test meal was a pint of gruel and two pints 
* When the series of observations had been nearly completed, in a search through 
the literature in Maly’s ‘Jahresberichte iiber die Fortschritte der Thierchemie’ (from 
which most of the quotations given in this paper have been cited on account of the 
inaccessibility to me at present of the original papers), I came upon a remarkable footnote 
by Maly to an abstract of the paper by Kredel, quoted above. The note occurs in 
vol. 14, p. 288, and is as follows :—‘‘ The fact that the portion of the mucosa of the 
stomach still intact secretes no hydrochloric acid is impossible to understand. If the 
carcinoma itself does not secrete an alkaline or neutralizing secretion, which ought to be 
observable in such new growths in other situations, a plasma richer in alkali must be 
considered as probable in cases of carcinoma. So that a failing acid formation may 
represent not so much a consequence as a cause or accompanying condition of cancer. 
Systematic investigation of urine, blood-serum, etc., in carcinomatous cases in regard to— 
the alkali and acid relationships compared with those of normal individuals are 
accordingly much to be desired.” It is curious that in spite of this view, which is 
practically the same as that which independently suggested the observations recorded in 
the present paper, no experiments were made in the direction suggested by such a 
distinguished physiological chemist as Maly, and that the matter sheulls have been 
allowed to remain dormant for so many years. 
