Is Hydrochloric Acid Secreted by the Hucous flembrane of the Stomach? BY J. A. WESENER, Ph.C., M.D. REPRINTED FROM MEDICINE. GEO. S. DAVIS, Publisher. November, 1895. [REPRINTED FROM MEDICINE, NOVEMBER, 1895.] IS HYDROCHLORIC ACID SECRETED BY THE MUCOUS MEMBRANE OF THE STOMACH? BY J. A. WESENER, Ph.C., M.D., Professor of Chemistry, College of Physicians and Surgeons; Medical Chemist to Cook County Hospital and Columbus Medical Laboratory, Chicago. In the Journal of the American Medical Association of March 2, 1895, Dr. Faulkner makes the statement that hydrochloric acid is formed by the action of lactic acid upon salt; that the gastric juice always contains salt after a test meal; that lactic acid is also present, and that when concentrated and treated with Gunzburg's reagent it gives a reaction for hydrochloric acid. He performed a great many of these experiments with different organic acids and salt, and all responded to the hydrochloric acid test; furthermore he states that hydrochloric acid is not found in the stomach, and if present would seriously injure that organ. According to Ewald, the ideal treatment in chronic gastritis is large doses of dilute hydrochloric acid in as concentrated form as the patient can tolerate. I have had the same experience in these cases giving thirty drops of the dilute acid three times daily. It has seemed to benefit the patients immediately, and to stop fermentation without injuring the stomach. Recent researches have shown that lactic acid is not the normal acid of the stomach. C. Schmidt was the first to show that hydro- chloric was the normal acid. At that time the presence of lactic acid was explained as a product of fermentation-Miller found in the stomach and mouth a number of bacteria that had the property of changing sugar into lactic acid. This would lead to a possible conclusion that lactic acid may be a normal product of gastric digestion. Experi- ments performed in this direction gave positive results with Uffel- mann's reagent; but later it was shown that this test was not reliable, as similar reactions were obtained with lactates, phosphates, and sugar. Lactic acid in solution with the normal percentage of HC1 found in the gastric juice gives no reaction, or a greatly diminished one, with Uffelmann's test. On the other hand, Rosenheim claimed that lactic acid fermenta- tion was always the end product of digestion, notwithstanding that his results were negative with the Ewald-Boas test meal. His explana- tion was that the reaction was hidden by the presence of hydrochloric acid; furthermore he claimed that lactic acid was a normal product of carbohydrate digestion. Cahn and V. Merring express themselves in 2 IS HCl SECRETED BY THE STOMACH? the same way, but not so positively; Leo also holds the same view. In 1892, Kurzen, Von Martin, and Luttke, in their interesting mono- graph Die Magensaiire des Menschens (Stuttgart, 1894), found by analy- sis that the quantity of free HC1 coincided with the curve of total acidity. This work, if accurate, is in itself most positive proof that HC1 is the normal acid of the stomach. Since then Boas' work on this subject proves beyond the slightest doubt that lactic acid is not formed during digestion, and the test used is reliable. Richet has shown in his researches that under normal conditions the stomach contains but one acid, and that is hydrochloric. I have repeated Dr. Faulkner's experiments showing that salt in the presence of organic acids and Gunzburg's reagent, when evapo- rated to dryness, gives a test for hydrochloric acid. The concentration liberates some of the chlorine of the salt, which combines with the hydrogen of the lactic acid to form hydrochloric acid. The same experiments were made with Boas' reagent, and all gave negative results. A 1-per-cent, and a 5-per-cent. solution of common salt, and a 3-per-cent. and also a 6-per-cent. solution of lactic acid, were used. One drop of the 5-per-cent. salt solution with one of 3-per-cent. lactic acid solution, plus two drops of Boas' reagent, were carefully evaporated over a water bath; results for hydrochloric acid negative. The same results were obtained with the stronger salt and acid solutions. Gunzburg's reagent gave a reaction with both of these solutions. The only explanation that can be given, why Gunzburg's gives a posi- tive reaction and Boas' a negative one, is that in the latter the sugar protects the salt from the action of the acid. Several experiments of the same nature wrere tried with gastric juice rich in organic acids. Two to three drops of gastric juice, mixed with salt solution and Boas' reagent, gave negative results. The analysis in one case after Ewald's test meal gave a slight reaction for HC1, but this when handled as above gave no HC1 reaction. According to Ewald, Boas' reagent is just as delicate as Gunz- burg's, and therefore is always to be preferred - for the reasons already given. EXPERIMENT I. Case A. Age, 24; diagnosis, dilatation of the stomach of one year's duration. Analysis of stomach contents after Ewald's test meal gave a total acidity of 70, and of lactic acid a slight trace. The patient was ordered to appear at the Clinic with an empty stomach (ten hours after taking a meal), when it was found on examination that the stomach was not empty. The stomach contents were tested IS HCl SECRETED BY THE STOMACH? 3 for hydrochloric acid with Boas' reagent and found to be negative. The stomach was thoroughly washed with hydrant water and the last of the washing tested for hydrochloric acid, with negative results. The gyromele was then introduced and rapidly revolved for two minutes, and the stomach contents withdrawn and tested. Boas' reagent gave a positive reaction. The quantitative estimation for free hydrochloric acid was done as follows: 5 Cc. of filtered contents, plus silver nitrate and strong nitric acid, precipitated all the chlorine as silver chloride; the precipitate was collected on a paper of known ash, washed with distilled water until the reaction for silver disappeared, and then dried in the oven, ignited in a crucible, and a few drops of hydrochloric acid added to convert the reduced silver back to silver chloride. The crucible was cooled over sulphuric acid and weighed as silver chloride; this weight equals the combined chlorides and free hydrochloric acid in 5 Cc. of gastric contents, and multiplied by 20 gives the percentage of silver chloride. From this answer the per cent, of total chlorine was found to be 0.155. The next step in the operation was to estimate the combined chlorides: 5 Cc. of stomach contents were evaporated to dryness over a water bath (this drives off all of the hydrochloric acid), the residue redissolved in distilled water, silver nitrate and nitric acid added, and then the experiment was carried out the same as in the above analysis. This gave 0.0027 as the weight of the combined chlorine in the 5 Cc. of gastric contents; 100 Cc. of stomach contents would thus contain 0.054 of combined chlorine. This deducted from the above answer (of combined chlorides and free hydrochloric acid), leaves the chlorine combined with hydrogen: 0.155 - °-°54 = -IO1 °f ffee chlorine; or .103 of free HC1. Case B. (Dr. Turck's Post-Graduate Clinic.) Age, 51; diagnosis, gastritis glandularis chronica, with beginning atrophy. At the outset of treatment there was no HC1, no rennet, and only a slight peptone reaction. At the end of four months the empty stomach was thoroughly cleansed with hydrant water, the gyromele* introduced and revolved three minutes, the contents withdrawn and tested as above. The amount of HC1 found was 0.106; combined chlorides, 0.059. Case C. (Dr. Turck's Post-Graduate Clinic.) Normal stomach experiment conducted same as in A and B. Distilled water instead of lake water used to wash; the last washing tested for chlorine with silver nitrate was negative. The amount of HC1 in 100 Cc. was 0.099; combined chlorides, 0.0024. The use of distilled water accounts for the low percentage of combined chlorides. ♦Turck's gyromele consists of a steel cable, to which is attached a spiral covered with sponge; the cable passes through a stomach-tube and is then attached to a surgical drill; turning the drill revolves the cable. 4 IS HCl SECRETED BY THE STOMACH? A control analysis was made of same contents: 5 Cc., plus 5 Cc. of saturated solution sodium carbonate, were evaporated to dryness and gently fused; the residue dissolved in distilled water; nitric acid and silver nitrate added; the precipitate of silver chloride collected upon a filter of known ash, washed with distilled water, and then handled the same as in Case A. The result gave 0.08 of chlorine. Another 5 Cc. of the same gastric juice was first evaporated to dryness (thus driving off all free hydrochloric acid); 5 Cc. of sodium carbonate solution added and gently charred; the residue redissolved in distilled water; nitric acid and nitrate of silver added; and the process then carried out as above. The combined chlorides, .0018, subtracted from total chlorine (.08 - .0018) = .0782 chlorine combined with hydrogen, which would be .081 of free HC1-.018 less of HC1 than was found in the original analysis. This slight error is due no doubt to the fusion. As the stomachs examined were demonstrated to be entirely free from HC1, and no food was taken, and as HC1 was undoubtedly present after brushing, there is no other conclusion possible but that the acid was secreted by the stomach. Again I wish to emphasize that Boas' reagent does not give HC1 when present only from decom- position. THE MEDICAL AGE. *>gical in* bates in r physi- cs the ne.as- ae was ' .nihil- rastic jed by ed dis- ipostle , celain- -eipzig various g. "5/w* ginal with zormulated acelsus. Of mann much the time of e earlier por* and that still Cranioscopy or is doctrines at expelled, oined by )re of a doctrine d it was eim that gland, sumed along- 'hat MEDICINE. This is the title of a new medical monthly magazine that has made its appearance upon our exchange table, and which we most heartily welcome. It is the result of the en- terprise of Mr. Geo, S. Davis, the well known medical publisher, ably seconded editorially by Doctor Harold N. Moyer, of Chicago, and a staff of expert collaborators and contribu- tors, representing the foremost and best medical talent of the Northwest. Medicine, moreover, is representative of no college, Clique, publishing house, or manufacturing concern, but is merely a high class cosmo- politan medical publication. Such names as Moyer, W. L. Baum, D. A. K. Steele, Hobart A. Hare, G. F. Lydston, W. S. Christopher, S. S. Bishop, N. S. Davfs, Jr., J. B. Herrick, G. H. Weaver, H. T. Patrick, M. D. Ewell, Henry Gradle and Norman Bridge associated therewith give abundant assurance of char- acter for the future. The April number pre- sents original articles on ."Herpes Zoster Gangrenosus," "Sarcoma of the Kidney in Children," "Cardiac' Sedatives," i( Prostatic Tuberculosis," "Medical Septicaemia," and "Effects of La Grippe on the Nose, Throat, and Ear." A notable innovation, one we heartily commend, is the absence of "editori- •als," since it is to be presumed the editor will give expression to his opinions in direct per- sonal contributions'. A journal of such complete independence and high literary standing as Medicine has long been needed. 'CDICAL HISTORY. ANr MEDICINE A Monthly Journal of Medicine and Surgery. HAROLD N. MOYER, M. D„ EDITOR. JUNE, 1895. ,«,<£. CONTENTS. ORIGINAL ARTICLES. SOME CONSIDERATIONS CONCERNING THE LOCATION AND DETECTION OF MISSILES. Uy Roswill Park, A M . M U » THE SURG1CAI AND MEDICAL TREATMENT OF CHOLELITHIASIS. By John B. Murphy, AM.. MO 1* RELATION OF INFECTION TO THE NERVOUS SYSTEM. By Harold N. Mover. M D i44 THE TREATMENT OF EPILEPSY. By T. P. Stanton. M.D tjh BOOK REVIEWS. A System of Legal Mri»h ink. By Allan McLane Hamilton. M D . and Lawrence Godkin. Esq 161 Atlas des MknsCiiliciibn Gciiirns und des FAseRvaRLAUfHS. Von Dr. Edward Fiatau 16J Notes on Naw Books . . PROGRESS OF MEDICAL SCIENCE. MEDICINE. Comparative Antiseptic Action of Phenyl-Substi* Early Diagnosis ol Carcinoma of the Stomach 16$ tuted Fatty Acid 180 Action ol Salt on Stomach Digestion, and of Acids SURGERY. on Saline Digestion 181 New Method of Inducing General Narcosis. 167 The L'aeof Mercury in Acromegaly < 1S1 IS OBSTETRICS AM, A New Haemostatic -. tW The Parietal Incision In Abdominal **urgcry 181 Mechanism of Death In Cocaine Intoxication. Freund's New Operation for Vaginal Prolapse ila Sarcoma Complicating a lucent Fracture ioq A Case of Ch'on c Inversion ot the Uterus Success- Spina Bifida 160 fully Treated with Elastic Pressure 18J ••Button" ra. Absoii»able Plate i6*J Wandering Dermoid Tumor 184 PATHOLOGY. The Prophylactic Treatment of Blennorrhea Neo- Acute Yellow AUoch, o< ,he Liver. with Special A " 1" I "1" " " I. 1st Reference to the Regenerative Changes Observed. 170 THERAPEUTICS. NEUROLOGY AND PSYCHIATRY. Disinfection of the Sputa of Tuberculous Patients The Differential Diagnosis of Brain Tumors........ 18c by Means of Wood Vinegar 176 Anxiety Neurosis 188 Thyroid Gland in Treatment ol Goitre 177 OPHTHAl MOI OflV Hepatic Symptoms Resulting from the Use of Fluid wmri*i.iwuw. Extract Male-Fern as a Vermifuge 178 Parenchymatous Keratitis and Tubercular Disease The Dangers ol Thyroid Feeding 179 of the Eye 190 Sodium Salicylate in Exophthalmic Goitre 179 Atropine In the Treatment of Gastric Hypersecre- FORENSIC HEDICINt. lion ...... 180 Responsibility ol Physicians 191 COPYRIGHT 1895. CEO. S. DAVIS, Publisher, DETROIT, MICH. Entered at the Poet-office at Detroit, Mich., as second-class matter.