Ulcer of the Stomach.
THE, stomach is normally supplied with pure hydrochloric acid manufactured by glands in its mucous membrane. Should, for any reason, this acid become either too strong or too great in quantity, its action in addition to that of the food, would be on the stomach itself. In early or mild cases perhaps the trouble would be no more than that of a bad attack of indigestion or dyspepsia, but as the process continues, the pain becomes more severe and other symptoms follow which shows the severity of the trouble. If it is asked why the stomach walls are not thus digested if they are capable of absorbing the food that is being digested in it, the answer, while not satisfactory, is perhaps the best that can be given, that the vital forces which keep the tissue living, owing to constant circulation of blood, prevent the action of the juices upon the body. The ulcer of the stomach is fairly common, more so in England than in the United States, and is found most commonly between twenty and thirty years of age. Women are more affected than men and the occupation of servants, cooks, and waiters seem to increase cases. After some obscure dyspeptic symptoms, we have pain after eating with a constant gnawing when the stomach is empty, together with vomiting, many times of blood, and general failure of health with loss of flesh and strength. Food when taken into the stomach seems to relieve the pain, which returns as soon as digestion has taken place and the stomach is empty again. The hemorrhage from the stomach is the true result of the erosion or eating away of a blood vessel in the ulcer, and this erosion may go so deep that a perforation will be caused and a peritonitis will result. As partial healing of this ulcer may occur a cicatrix or scar in the stomach may be formed which will cause a contraction, which if occurring at the outlet will prevent food leaving the stomach as it should. Therefore, in addition to the distressing symptoms associated with gastric ulcer, we have as a consequence three serious additional possibilities: Death from hemorrhage or from peritonitis, due to perforation or inability of the food to leave the stomach on account of closing of the pylorus, which would cause excessive enlargement of the stomach and death by starvation.
Treatment. - Where competent surgeons are not obtainable, the treatment must be by medicine to counteract the excessive acidity. We give bicarbonate of soda in 10 to 15 grain doses several times a day, or any other simple alkaline. We are careful to have the diet consist of material that can be easily digested and not leave much residue to pass over the ulcer. Owing to the constant motion which the stomach and bowels perform in the endeavor to pass the food onward, the surface of the ulcers are being continually scraped by food passing over them. Healing is, therefore, retarded unless some method is devised to stop the irritation. The best treatment is by nutrient food thrown into the rectum by means of a syringe. Milk, eggs and digested juices can be absorbed by the rectum almost as well as by the stomach. Six ounces at a time may be used and this quantity given four times in twenty four hours. With care and when given by a person practiced in its use, larger amounts can be tolerated. The writer kept a young female patient for three weeks on nutrient feeding by the rectum, with complete recovery from extensive ulcer of the stomach ' the only liquid that passed the lips being sips of water. Milk digested with peptonizing powders was used, a pint at a time, and the recovery from a bad ulcer which had caused so much loss of blood that the patient almost bled to death. An operation with brilliant results is now being done by surgeons. This operation goes under the title of gastro enterostomy and consists in cutting off the small intestine where it leaves the stomach, especially if a constriction is present, but in any case a new opening is made in the stomach and the new portion of small intestines is sewed to this opening in the stomach. By this means, food is passed almost directly from the gullet across one end of the stomach into the small intestine and the remainder of the stomach is left in a state of rest. The operation has given great promise and in chronic cases is a wen recognized procedure, especially after perforation.
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