The diseases of the stomach / by Dr. C.A. Ewald.

  • Carl Anton Ewald
Date:
1900, ©1897
Catalogue details

Licence: Public Domain Mark

Credit: The diseases of the stomach / by Dr. C.A. Ewald. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    43/634 (page 29)
    peptonization. Althougli the presence of lactic acid was proved by the formation of lactates, and was also confirmed by all subsequent writers—Calm and von Mering,* Ritter and Hirsch,f Rosenheim,;]; Leo,* Stintzing, || and von Jaksch,^ to mention only the German writers—and although some of these writers have even traced the lactic acid to the end of digestion, yet I have repeatedly seen cases in which this acid was entirely absent throughout the entire course of digestion. That Martins and Liittke () should have reached the same conclusion did not therefore surprise me; careful investiga- tions with their method (see page 51) showed that the acidity had coincided with that of HCl, and that, so to speak, there was no room for any lactic acid. But I have laid no undue weight upon this fact, which, as stated, was long known to me; first, because, in view of what I have already explained, it was by no means striking; sec- ondly, because it is by no means a constant factor ; and, thirdly, and most important for practical purposes, lactic acid is normally always absent at the height of digestion. It is this relation to the typical course of HCl secretion which is of clinical value, and changes in which may indicate pathological conditions. This fact is by no means altered because several of the above writers could with com- plicated and dehcate tests demonstrate traces of lactic acid even at a late stage of digestion.;^ This can not be done in the ordinary lactic-acid tests, such as Uffelmann's (see page 41), which are not so delicate. But in this lack of sensitiveness lies the value of this test. For we have no method by which an excess of lactic acid could be quickly estimated; hence the value of a reaction which, as in the case here, only becomes evident when there is a patho- logical increase of lactic acid in the stage of digestion under dis- * Cahn und v. Mering. Ueber die Sauren des gesunden und kranken Magens. Deutsch. Archiv f. klin. Med., Bd. xxxix, Hefte 3 u. 4. f Ritter und Hirsch. Ueber die Sauren des Magensaftes. Zeitschr. fiir klin, Med., Bd. xiii, p. 446. X Rosenheim. Ueber Magensaure bei Amylaceenkost. Virchow's Archiv, Bd. cxi, S. 414. * Leo. Diagnostik der Krankheiten der Verdauungsorgane, 1890. II Stintzing. Ueber den gegenwartigen Stand der Diagnostik der Magenkrank- heiten. Mlinch. Wochenschr., 1889, ISTos. 8 and 9. ^ Jaksch. Klinische Diagnostik, 3te Aufl., 1893. (} Martins und Liittke. Loc. cii., pp. 13 and 156. $ I have corroborated this in several cases. See first edition of this work, p. 31.