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On Free Hydrochloric Acid in Gastric Contents in Disease. 139 
eancer of the stomach he obtained a clear reaction even with this indicator in 
13 cases, a doubtful reaction in 5 cases, and no reaction in 5 cases. 
In a reply to this, von den Velden* stated that he had only claimed, in the 
original paper, the absence of free hydrochloric acid in cancer of the stomach, 
leading to pyloric stenosis and accompanied by typical dilatation ; and that he 
had stated that it still remained to investigate, as to the stage of the develop- 
ment of the disease at which the free hydrochloric acid disappears, if all forms 
of carcinoma of the stomach are alike in this respect, and if it makes any 
difference on which part of the stomach the growth is localized 
Kredel,f in 17 cases of dilatation not due to carcinoma found free hydro- 
chloric in every case, and in 19 cases of dilatation due to carcinoma that the 
free acid was invariably absent. 
The next important contribution was made by F. Riegel,t who found in 
observations of the free hydrochloric acid repeated in the same cases over a 
period of several months, that von den Velden’s rule was nearly always true. 
In a later paper Riegel stated that he found that more forms of gastric 
disease give an increase than a decrease in the amount of free hydrochloric 
acid, for example, in 128 cases, 19 showed an absence of free hydrochloric 
acid, 69 a hyperacidity, while the remainder gave an approximately normal 
amount of free hydrochloric acid. Of the 19 cases which showed absence 
of free hydrochloric acid, 16 were undoubtedly carcinoma, one amyloid 
degeneration of mucosa, and in one a backflow of bile was the cause. 
A. Cahn and J. v. Mering$ as a result of finding free hydrochloric acid in 
about normal quantity in eight cases of caremnoma ventriculi, denied that 
absence is the rule. On the other hand, E. Korczynski and W. Jaworskill 
affirmed that for the great majority of cases the rule is absence of free 
hydrochloric acid. 
The experimental methods of Cahn and v. Mering were subjected to 
adverse criticism by G. Honigmann and C. v. Noorden,/ and their results 
shown to be due to organic acids being mistaken for free hydrochloric acid. 
In 14 cases of gastric cancer, Honigmann and v. Noorden showed that the 
acids present were chiefly organic, only traces of hydrochloric acid being 
present, and that free hydrochloric acid, added to the gastric contents in such 
* ‘Deutsches Archiv f. klin. Medicin,’ vol. 27, 1880, p. 186. 
+ ‘ Zeitsch. f. klin. Medicin,’ vol. 7, 1884, p. 592. 
{ * Deutsches Archiv f. klin. Medicin,’ vol. 36, 1884, p. 100; ‘ Berl. klin. Wochensch.,’ 
1885, No. 9; ‘ Zeitsch. f. klin. Medicin,’ vol. 12, 1887, p. 426. 
§ ‘Deutsches Archiv f. klin. Medicin,’ vol. 39, 1886, p. 233. 
|| ‘ Deutsches med. Wochensh.,’ 1886, Nos. 47 to 49. 
“| ‘ Zeitsch. f. klin. Medicin,’ vol. 13, 1887, p. 87. 
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