Free Hydrochloric Acid—Is Its Absence from 
the Stomach a Sign of Cancer? 
BY RICHARD B. FAULKNER, M.D. 
ALLEGHENY, PA. 
REPRINTED FROM 
THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 
MARCH 2, 1895. 
CHICAGO: 
American Medical Association Press. 
1895. Free Hydrochloric Acid—Is Its Absence from 
the Stomach a Sign of Cancer? 
BY RICHARD B. FAULKNER, M.D. 
ALLEGIUtfiUS**"#*?" 
REPRINTED FROM 
THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 
MARCH 2, 1895. 
CHICAGO: 
American Medical Association Press. 
1895. FREE HYDROCHLORIC ACID—IS ITS AB- 
SENCE FROM THE STOMACH A SIGN 
OF CANCER? 
It is important to know whether free hydrochloric 
acid is secreted by the stomach. It is important to 
know whether its absence from the stomach is an 
indication of cancer of that organ. Prof. Wm. Osier, 
of the Johns Hopkins University, in his excellent 
work on “The Practice of Medicine,” published in 
1892, states that, “great stress has been laid of late 
years upon the absence of free hydrochloric acid in 
the secretions. As an outcome'of the enormous num- 
ber of observations which have recently been made, 
it may be said that free hydrochloric acid is absent 
in a majority of cases of cancer of the stomach. This 
defect is associated with impairment of the secreting 
function of the organs. The examination should be 
made repeatedly by the methods already referred to, 
and with our present knowledge the persistent ab- 
sence of HC1 in the stomach contents, taken in con- 
junction with other symptoms, may be regarded as 
highly suggestive of cancer. As Kinnicutt expresses 
it, ‘the presence of HC1 in the stomach in repeated 
examinations in doubtful cases is of the greatest di- 
agnostic value, and points very certainly to absence 
of cancer.’ Rosenheim has very recently shown that 
in cases in which cancer develops in the base of an 
old ulcer HC1 may be present throughout the course.” 
Kinnicutt’s statement can not be proved. 
Rosenheim contradicts Osier. If “the absence of 
free HC1 is associated with impairment of the secret- 
ing function of the organ,” then why should a can- 
cer situated at the base of an old ulcer form an ex- 
ception to the rule when, as a matter of fact, the 4 
ulcers themselves impair and often destroy the secre- 
ting function? If Rosenheim is right, then free HC1 
is absent in cancers not seated at the base of old 
ulcers. If cylindrical-celled epithelioma and enceph-- 
aloid cancers constitute a major portion of all 
cancers affecting the stomach, as is stated by Osier, 
and if they have always a particular tendency to 
develop at the site of ulcers, scars and injuries, ac- 
cording to Paget, Holmes, Erichsen and others, then, 
if Rosenheim is any authority, are we not to con- 
clude that free HC1 must be present in the majority 
of cases of cancer of the stomach? 
To obtain the gastric fluid for chemic examination, 
Ewald’s test-breakfast is advised by the leading text- 
books. This consists in giving a roll of white bread 
and one glass of water or a cup of tea. One hour 
later, the contents of the stomach are removed with 
a rubber tube. No rule, no instruction of any kind, 
is given in any text-book whereby we may positively 
know that the stomach is actually empty at the time 
the test is applied. And in cases of stenosis of the 
pylorus it is not only possible, but probable, that the 
stomach is not entirely empty. However, as a result 
of Ewald’s test, “free HC1 should be present, but lac- 
tic acid absent.” (Prof. Wm. Pepper, “An American. 
Text-book of the Theory and Practice of Medicine,” 
published in 1894, vol. ii page 735). “Should con- 
tain free hydrochloric acid; should not contain suf- 
ficient lactic acid to be recognized by the ordinary 
tests.” (Osier, page 345). Does it not forestall the 
judgment to proclaim what should be present? The 
usual object of a test is to ascertain what is present. 
Physiologic chemistry contains no problem more 
difficult than the determination of free hydrochloric 
acid in the gastric juice. Many authors assert its 
presence as a normal constituent, and of the analyses 
quoted, in Foster’s “Physiology” for example, no two 
agree; they vary in the proportion of free acid all 
the way from .05 to .5 per cent. 
The method of chemic analysis commended and 5 
relied upon by two of America’s foremost teachers 
let us critically and briefly examine. “The best and 
simplest test,” says Osier, “is that of Gunzbiirg: 
phloroglucin, 2; vanillin, 1; absolute alcohol, 30. 
To a drop of the gastric contents (better filtered) add 
a similar quantity of the reagent on a porcelain plate. 
On evaporation gradually to dryness over a flame, a 
beautiful rose-red color begins to appear at the edges 
if HC1 is present. This is merely a test for a free 
mineral acid, but HC1 is the only one present in the 
gastric juice. This test is extremely delicate, and is 
not interfered with by albuminates, acid salts, or 
organic acids.” (Pepper, vol. n, page 735). The sim- 
plicity of Gunzbiirg’s proceeding would be valuable 
if the test were reliable. But color tests as a rule 
are unreliable; and this of Gunzbiirg forms no 
exception. 
Gunzbiirg's test is not a test for free hydrochloric acid. 
It will show the presence of free HC1 where none 
existed previous to its application. Sodium chlorid 
is a constituent of the gastric juice. If lactic acid is 
present in the stomach contents, evaporation of a 
drop over a flame will concentrate the acid, which 
will then attack the sodium chlorid and form free 
HC1. Other concentrated acids will do the same. 
Gunzbiirg's test is not a test for a free mineral acid. 
The identical rose-red tint will be obtained when no 
free mineral acid is present. Many foods that con- 
tain no acid, mineral or other, taken into the stom- 
ach will produce precisely the same rose-red tint of 
the supposed test. Again, there are acids formed in 
the body, not mineral acids, that will produce the 
same brilliant rose-red tint of the so-called test. For 
example, in those who possess the oxalic diathesis, 
oxalic acid is formed in the living body by oxidation. 
Oxalic acid decomposes dry sodium chlorid when 
heated, with evolution of hydrochloric acid (Fownes’ 
“Chemistry,” page 658; Brande and Taylor, page 
384). 
Oxalic acid responds perfectly to the Gunzbiirg test 6 
in the presence of sodium chlorid. Oxalic acid 
exists in many of our food plants, as a salt of potash, 
and is widely distributed in vegetation. Bin-oxalate 
of potash is found in common sorrel, wood sorrel, 
and in garden rhubarb associated with malic acid 
(Fownes,’ page 659). It exists in great abundance 
in tomatoes and in many other acid fruits. 
Gunzburg''s test is utterly, absolutely worthless, as 
proved by the following experimentation : 
Experiment 1. With a minute quantity of bin- 
oxalate of potash, sodium chlorid and lactic acid, 
Gunzbiirg’s test yields on evaporation over a flame a 
rose-red tint identical with that produced in the 
presence of free hydrochloric acid. 
Experiment 2. With a minute quantity of bin- 
oxalate of potash, sodium chlorid and tartaric acid, 
the same brilliant rose-red tint is obtained when 
evaporated over a flame in the presence of the Gunz- 
biirg test solution. Baking powders contain tartaric 
acid. A biscuit or a roll of bread, as in the Ewald 
test-breakfast raised with baking powder, contains 
tartaric acid. And wines contain tartaric acid. 
Experiment 3. Bin-oxalate of potash and sodium 
chlorid, dissolved in water, and Gunzbiirg’s test added, 
yield when heated over a flame a rose-red tint iden- 
tical with that produced by free hydrochloric acid. 
Experiment 4. Tartaric acid and sodium chlorid, 
dissolved in water, and Gunzbiirg’s test added, yield 
when heated over a flame a rose-red tint identical 
with that produced by free hydrochloric acid. 
Therefore, if a patient suffering from a cancer of 
the stomach were to eat a little rhubarb or tomato 
or take a drink of wine and Gunzbiirg’s test were to 
be applied to his gastric contents, it would be con- 
clusively proved that he had no cancer! ! 
Uncombined hydrochloric acid is not found in 
nature, except as an occasional volcanic product 
(Brande and Taylor, page 216). No mineral acid is 
necessary in the process of digestion. Pavy (“Food 
and Dietetics”) states that HC1 has no particular 7 
property in rendering the digestive power of the gas- 
tric juice more energetic. The presence of free 
hydrochloric acid as a normal constituent of the 
gastric secretion has never been demonstrated. The 
only way to positively prove its presence is to sepa- 
rate the acid; just the same as you would be re- 
quired to separate arsenic from the contents of the 
stomach in a supposed case of poisoning by that 
mineral. 
The absence of free hydrochloric acid as a normal 
constituent of the gastric secretion has been repeat- 
edly proved by the most competent authorities, in- 
cluding such original investigators as M. Claude 
Bernard, the profound French physiologist, Robin, 
Verdeil, and Professor Rogers, the able chemist of 
the University of Pennsylvania. Our illustrious 
American physiologist, John C. Dalton, taught that 
lactic acid is the normal acid constituent of the gas- 
tric secretion. He neither taught nor acknowledged 
the presence of free HC1. 
Prof. Carl Seiler records a series of highly inter- 
esting experiments in the Philadelphia Medical Times, 
Feb. 6, 1875, which go far to prove that no hydro- 
chloric acid is present in the gastric secretions. 
The most remarkable line of experimentation ever 
conducted upon the gastric secretion remains unno- 
ticed by any author, compiler, or text-book, within 
our knowledge. These extraordinary experiments 
seem to have been forgotten. These experiments, 
unquestionably the most exhaustive, as well as the 
most authoritative upon this subject, were conducted 
under circumstances both exceptional and fortuitous, 
in the physiologic laboratory of the University of 
Pennsylvania. The gastric contents were those of a 
criminal (Heidenblutt). He was of strong physique, 
and was executed two hours after partaking of a hearty 
breakfast. Immediately after the execution, his 
stomach with its contents were removed to the lab- 
oratory of the University. The lining of the stom- 
ach was carefully scraped, and this with the contents of the stomach were macerated, filtered and distilled. 
The examination was made by Robert M. Smith, and 
to quote from an article in the Philadelphia Medical 
Times, Feb. 13,1875 : “The following deductions con- 
firm entirely those obtained by Profs. F. G. Smith 
and Rogers of the University, from the analysis of 
the gastric juice of Alexis St. Martin : 
“1. The gastric juice presents an acid reaction both 
before and after filtration and distillation. 
“2. The acidity in this instance was not due to the 
presence of hydrochloric acid. 
“3. Lactic acid did exist. 
“4. Acid phosphate of lime showed no evidence of 
its presence. 
“5. Neutral phosphate of lime did exist, and was 
held in solution by the lactic acid. 
“I would take this opportunity of expressing thanks 
to Mr. Geo. Hay, a member of the class, and a gen- 
tleman of great experience as an analytical chemist, 
under whose careful supervision these experiments 
were conducted.” Hay states that “free HC1 is never 
present in the human stomach, unless introduced 
from without; that it would seriously damage it if 
present; and that it is impossible for it to be found 
in the stomach, for the reason that its liberation from 
a salt of any kind requires the presence of a concentrated 
acid, and any concentrated acid in the stomach would 
quickly destroy the organ. Concentrated acids are 
not secreted by the stomach. Free mineral acid is not a 
product of the stomach of man or animal. Its absence 
is not a sign of cancer.” The researches of Bernard, 
Robin, Verdeil, Dalton, Smith, Rogers, and Hay, all 
original investigators, entirely agree,