. A practical treatise on medical diagnosis for students and physicians . iu^, its absence dependiug largely but apparently not en-tirely on an associated atrophy of the gastric tubules. Lactic acid, onthe other hand, is commonly present even in the earliest stages, and whenassociated with absence of HCl is very diagnostic. For an accurate diag-nosis repeated examinations must be made. (See page 595.) Other gen-eral and local conditions, as fevers on the one hand, or dilatation on theotlier, are attended by occasional absence of hydrochloric acid; in carci-noma it is the persistent abse
. A practical treatise on medical diagnosis for students and physicians . iu^, its absence dependiug largely but apparently not en-tirely on an associated atrophy of the gastric tubules. Lactic acid, onthe other hand, is commonly present even in the earliest stages, and whenassociated with absence of HCl is very diagnostic. For an accurate diag-nosis repeated examinations must be made. (See page 595.) Other gen-eral and local conditions, as fevers on the one hand, or dilatation on theotlier, are attended by occasional absence of hydrochloric acid; in carci-noma it is the persistent absence of HCl and presence of lactic acid thatare diagnostic. Other important signs are the presence of Oppler-Boasbacilli and, according to Strauss, of pus. Pepsin is usually diminishedin this as well as in most other conditions almost in direct proportionto the diminution of HCl, while the milk-curdling ferment disappearslast of all. The Urine. Indican is increased in amount, acetone and diaceticacids may be present in the urine; otherwise there is no change. Fig. Site of pain in gastric ulcer is marked at O. Diagnosis. In the diagnosis of gastric cancer the following must beborne in mind : 1. The age of the patient. 2. The occurrence of cause-less dyspepsia without relief. 3. Rapid loss of flesh and strength, withcachexia. 4. The occurrence of pain in the epigastrium, continuous,increased by food, but not relieved by vomiting as in ulcer, and not dis-tinctly localized. 5. Tumor—hard, circumscribed, followed by the phys-ical signs of dilatation, if at the pylorus. 6. Vomiting is necessarilyassociated with the taking of food, in which fragments of cancer may be-found; blood-cells are common ; they may be detected on microscopicalexamination, or by the test for hsemin. 7. Examination of stomach con-tents : (a) except in dilatation the fasting stomach is empty; (6) hydro- ULCER OF THE STOMACH. 1035 chloric acid is often absent, whereas lactic acid is present; (c) delayedabs
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