The diagnosis and treatment of diseases of the stomach and intestines / by William Fitch Cheney.

  • Cheney, William Fitch, 1866-1941.
Date:
[1936], ©1936
Catalogue details

Licence: Public Domain Mark

Credit: The diagnosis and treatment of diseases of the stomach and intestines / by William Fitch Cheney. Source: Wellcome Collection.

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    are found in gastric and extragastric disease, (a) In the first group probably the most common one is chronic gastritis, easily recognized by gastric analysis, by x-ray films and by gastros¬ copy. Cancer of the stomach ultimately produces achlorhydria in many cases but not in all and never until late in the course of any case. Too much emphasis has been placed in the past upon this sign in the diagnosis of gastric cancer. X-ray films of the stomach furnish much more reliable proof. In syphilis of the stomach absence of acid is the finding usually described, but before it is accepted as the cause there should be found also a positive blood reaction, an x-ray film showing extensive defect in stomach contour, response to specific therapy and possibly histological examination of tissue removed at operation. It is well to recall the fact that this is one of the rarest forms of gastric disease. In gastroptosis achlorhydria may be found per¬ sistently with or without other evidence of chronic gastritis. Here it is probably a true neurosis of secretion due to associated neurasthenia. Proof that the patient has gastroptosis is sup¬ plied by physical examination and by x-ray films, but it is prob¬ able that depression of nervous energy has more to do with the abnormal secretion than has the low position of the stomach in the abdomen. Finally with gastric polyps almost invariably achlorhydria has been found associated. X-ray films and gas- troscope will tell whether this is the cause. (b) Among the second group of extragastric diseases pro¬ ducing achlorhydria or connected with it, the most interesting instance is pernicious ancemia. The association of these two is now generally accepted as essential, so that no case that shows free HC1 in the gastric contents can be properly diagnosed as pernicious anaemia. Blood counts and smears, however appar¬ ently characteristic, are looked upon with suspicion unless