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.
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![cussion. I am therefore justified in maintaining the value of this procedure in spite of the objections raised by Martins and Liittke.* [During the past few years much has been written f on the sub- ject of the relations of lactic acid, especially since Boas claimed a diagnostic significance for the presence of large quantities of this acid in cancer of the stomach. By using new methods (vide infra) for detecting lactic acid, Boas found that lactic acid is not produced during any stage of di- gestion, and that bread and all the substances which are usually given in test meals contain lactic acid or lactates ; he therefore pro- posed that in all tests for lactic acid the test meal given should con- sist of an oatmeal soup or gruel, which is made by boiling a table- spoonful of oatmeal flour with a quart of water, the only addition being a little salt. The stomach contents obtained after this gruel contain no lactic acid. On this point, however, Boas has gone too far; for it has been shown by many observers that the amount of lactic acid or lactates iu the roll of a test breakfast is so insignifi- cant that it may practically be discarded, since, as he himself ad- mits, in all cases in which lactic acid has any significance it must be present in such large quantities that Uffelmann's test will give us sufficiently reliable results.] The practical outcome of these considerations is, that the simple fact that the stomach contents are acid does not indicate upon what the acidity depends. It is simply a sum total which must be re- solved into several factors, in doing which we must always remem- ber that the height of the acidity does not necessarily coincide with the height of the secretion of HCl, and that secretion, acidity, and chlorhydria must be carefully distinguished from one another. Furthermore, under pathological conditions, the acidity is also de- pendent upon the products of fermentation of the carbohydrates and fats—i. e., lactic, acetic, and butyric acids, and even alcohol. ISTevertheless it is always important to ascertain how acid the stom- ach contents are—i. e., to test the acidity with volumetric solutions and the hurette (titration). * Log. cit., p. 56. f [The full literature on this subject may be found in elaborate. papers by Langguth, Boas' Archiv, Bd. i, p. 355, and De Jong, ibid., Bd. ii, p. 53. Also see](https://iiif.wellcomecollection.org/image/b21223026_0044.jp2/full/800%2C/0/default.jpg)
