470 APPENDIX 



tests for free HC1 are made, one from gastric contents and washings taken in the 

 morning before taking any form of food. Then give the albumin of 2 hard boiled 

 eggs, finely minced in 150 c.c. water. One hour later remove the contents and ex- 

 amine for free HC1. Then give a meal of broth, lightly broiled steak, mashed 

 potatoes and bread and three hours later remove contents with stomach tube and 

 test again for free HC1. 



For lactic acid a modification of Strauss' method is quite satisfactory. Shake, 

 in a test-tube, 5 c.c. of gastric contents with 20 c.c. of ether, allow to settle and 

 pour off 5 c.c. of the supernatant ether into another test-tube. To this ether add 

 20 c.c. of water and 2 drops of a i to 9 solution of ferric chloride and shake well. 

 The presence of i% of lactic acid will give an intense greenish color. 



Total Acidity. Having determined the presence or absence of free hydrochloric 

 or lactic acid, we should make a quantitative test of the various determinations of 

 the acidity of gastric juice (a modified Topfer test). These are: i. Free HC1. 2. 

 Combined HC1. 3. Acid salts, and 4. Total acidity. 



To 10 c.c. of filtered gastric contents, in a beaker, add 3 drops of dimethyl-amido- 

 azo-benzol solution (a 1/2% solution in 95% alcohol). In the presence of "free 

 HC1 the fluid becomes a rich carmine pink. 



After reading the burette run in N/io NaOH solution until the pink color is 

 discharged and a light yellow color is obtained. This reading multiplied by 10 

 gives the' amount of free HC1 in degrees, a degree corresponding to i c.c. N/io 

 NaOH. Next add 6 drops of a 1/2% alcoholic solution of phenolphthalein to the 

 light yellow fluid in the beaker. Again titrating the same preparation we add 

 N/io NaOH until a faint but distinct pink color is produced. The number of 

 cubic centimeters added for the free HC1 plus the number to give the pink color 

 when multiplied by 10 gives the total acidity in degrees. (For example: 2.5 c.c. 

 N/io NaOH used to obtain yellow color 2.5X10 = 25 or acidity due tofreeHCl. 

 After adding the phenolphthalein, 4 c.c. N/io NaOH required to produce pink 

 color 4+2.5X10 = 65 or total acidity in terms of acidity. This means that it 

 would require 65 c.c. N/io NaOH to neutralize 100 c.c. of gastric juice. A total 

 acidity of 60 is about normal. To obtain percentage in HC1 multiply by 0.00365; 

 thus, 65X0.00365 = 0.23% HC1.) 



Having determined the total acidity add 3 c.c. of 10% neutral calcium chloride 

 solution to the gastric contents already in the beaker. As a result of the formation 

 of acid calcium phosphate the pink color is discharged. Again add N/io NaOH 

 from the burette until the pink color is restored. The number of cubic centimeters 

 used gives the amount of acid salts present. 



From the figures for the total acidity subtract the sum of that for free HC1 and 

 for acid salts and the remainder will give the acidity due to combined HC1. 



WOLFF AND JUNGHANS' TEST 



This is an important test as distinguishing benign achylias from those associated 

 with malignant disease of the stomach. Of course, where the carcinoma originates 

 in the lesion of an ulcer or when small or in the region of the pylorus there may not 

 be an achylia, free HC1 being present. 



While interpretation of increased albumin in those cases of carcinoma showing 



