36 STUDIES IN DIGESTION 



any other fermentation acids, also acid phosphates, 

 and is of no great importance. 



The most reliable test for the presence of HC1 is 

 Gunsberg's (phloroglucin and vanillin) ; this is too 

 well known to need description. It is merely a 

 qualitative test. 



By whichever method the estimation is made, it 

 would appear that diet exercises little or no effect 

 on the percentage of active hydrochloric acid, 

 although it so markedly affects the pepsin, as we 

 have seen. Nevertheless, the percentage of acid is 

 liable to change, and the changes are of great 

 value for both diagnosis and treatment. 



Increased relative amount of HC1 is particularly 

 common in gastric ulcer, so much so that an analysis 

 of a test-meal is of diagnostic importance. It is 

 also seen in duodenal ulcer, and, as has recently been 

 pointed out, in many other affections of the alimentary 

 canal, such as appendicitis. It is probable that the 

 cases which have been diagnosed as simple hyper- 

 chlorhydria have usually some latent disease, if not 

 in the stomach or duodenum, then in the gall-bladder 

 or appendix, and removal of the offending organ will 

 cure the hyperchlorhydria. The characteristic sym- 

 ptom of this condition is " hunger-pain," that is, 

 a feeling of gnawing of the stomach, which may 

 be only a discomfort or may amount to positive 

 pain ; it occurs two or three hours after a meal, 

 and is relieved by food or alkalies. It is probably 

 due to the spasmodic contraction of the pylorus set 

 up by the acidity. Another view is that it is caused 

 by incipient self-digestion of the stomach. This is 



