
~1905.] in Gastric Contents in Malignant Disease of Organs. 155 
disposing to growth formation, and not as an effect of the growth. In this 
case there persist, even after the growth has gone, the same factors, as indi- 
cated by the absence of the acid, which initially lead to the growth occurring, 
and the patient, on account of this condition, les open to the risks of a 
recurrence. 
It is clear that the study of the condition of the gastric contents with 
regard to acid subsequent to operation carried out in a large number of cases, 
must cast interesting light upon the problem before us, and we are now 
attempting to obtain as many as possible such cases. 
The results of Case XIII, in which recurrence had just begun to be 
obvious, are also interesting from this point of view. 
8. In the table are included two cases of sarcoma, in which similar results 
were found as incarcinoma. It was at Mr. Kelly’s suggestion that such cases 
were included, and we are at present in the position of waiting for further 
material, but if the results in these two cases are confirmed in others, an 
interesting parallelism between the two types of malignancy will have been 
established, pointing to something very common in mode of origin of 
malignant tumours. 
Discussion of Results. 
1. The importance of the marked depression or entire suppression of the 
acid-secreting function, no matter what the situation of the growth, as an aid 
to diagnosis in doubtful cases of cancer, need not be insisted upon. 
It must, however, be pointed out that we have not up till the present beer 
regarding the subject primarily from that point of view, and hence most of our 
cases were well advanced. Accordingly, observations are still required at early 
stages in the disease, before conclusions can be drawn as to the diagnostic 
value of the sign, and such observations should be quantitatively directed 
towards determining amount of free hydrochloric acid, and not merely its 
qualitative presence or absence, as 1s too often done. 
2. The bearing of the results upon the cause and possible prevention of 
the malignant growths is the most important aspect to be considered. Instead 
of regarding absence or diminution of hydrochloric acid in cases of cancer of 
the stomach as being due to some local effect in that organ, we obtain from 
the observations recorded above the information that both in stomach cases 
and all other cases the change in acid secretion is not due to local influence 
on the secreting cells, but to an altered condition of the blood. That the 
reduction of acid-secreting power is a general effect accompanying malignancy 
wherever the growth may occur in the body. 
So far, we are dealing with experimental fact, and not with theory or 
M 2 
