Amidobenzol Test.—To a little of the filtered gastric juice in a test-tube, or to several drops in a porcelain dish, add a drop of 0.5 per cent. alcoholic solution of dimethylamido-azobenzol. In the presence of free hydrochloric acid there will at once appear a cherry-red color, varying in intensity with the amount of acid ([Plate X, C]). This test is very delicate; but, unfortunately, organic acids, when present in large amounts (above 0.5 per cent.), give a similar reaction.
Boas' Test.—This test is less delicate than the preceding, but is more reliable, since it reacts only to free hydrochloric acid.
In a porcelain dish mix a few drops of the gastric juice and the reagent, and slowly evaporate to dryness over a flame, taking care not to scorch. The appearance of a rose-red color, which fades upon cooling, shows the presence of free hydrochloric acid ([Plate IX, 1]).
Boas' reagent consists of 5 gm. resublimed resorcinol, and 3 gm. cane-sugar, in 100 c.c. alcohol. The solution keeps well, which, from the practitioner's view-point, makes it preferable to Günzburg's phloroglucin-vanillin reagent (phloroglucin, 2 gm.; vanillin, 1 gm.; absolute alcohol, 30 c.c.). The latter is just as delicate, is applied in the same way, and gives a sharper reaction ([Plate IX, 2]), but is unstable.
(3) Organic Acids.—Lactic acid is the most common, and is taken as the type of the organic acids which appear in the stomach-contents. It is a product of bacterial activity. Acetic and butyric acids are sometimes present. Their formation is closely connected with that of lactic acid, and they are rarely tested for. When abundant, they may be recognized by their odor upon heating.
Lactic acid is never present at the height of digestion in health. Although usually present early in digestion, it disappears when free hydrochloric acid begins to appear. Small amounts may be introduced with the food. Pathologically, small amounts may be present whenever there is stagnation of the gastric contents with deficient hydrochloric acid, as in many cases of dilatation of the stomach and chronic gastritis. The presence of notable amounts of lactic acid is significant of gastric cancer, and is probably the most valuable single symptom of the disease. In the great majority of cases detection of more than 0.1 per cent. (see Strauss' test) warrants a diagnosis of malignancy.
As already stated, the Ewald test-breakfast introduces a small amount of lactic acid, but rarely enough to respond to the tests given here. In every case, however, in which its detection is important, Boas' test-breakfast should be given, the stomach having been thoroughly washed the evening before.
Uffelmann's Test for Lactic Acid.—Thoroughly shake up 5 c.c. of filtered stomach fluid with 50 c.c. of ether for at least ten minutes. Collect the ether and evaporate over a water-bath. Dissolve the residue in 5 c.c. water and test with Uffelmann's reagent as follows:
In a test-tube mix three drops concentrated solution of phenol and three drops saturated aqueous solution of ferric chlorid. Add water until the mixture assumes an amethyst-blue color. To this add the solution to be tested. The appearance of a canary-yellow color indicates the presence of lactic acid (Plate IX, A, A').
Uffelmann's test may be applied directly to the stomach-contents without extracting with ether, but is then neither sensitive nor reliable.