Ulcer of the stomach is the most important of the idiopathic diseases of that organ, both from its frequency, limn the facility with which it may be detected during life, from the fact that at any period of its protracted course it may prove suddenly fatal, and from its usually curable. The first and most characteristic symptom of this disease is pain, which commences as a mere dull feeling of weight or tightness, then gradually augments into a burning sensation, and at last assumes a gnawing character, and occasions a kind of sickening depression. This pain comes on in from two to ten minutes after the ingestion of food, and lasts for an hour or two; vomiting often ensues, after which the pain ceases. The place of its most common appearance and greatest intensity is the center of the epigastric region, or slightly below the free end of the ensiform cartilage of the sternum; and the painful spot is usually of a circular form, with a diameter varying from one to two inches. The pain in this region is succeeded, in the course of a fens, weeks, by a. gnawing pain in the back, ranging in position from the eighth dorsal to the second lumbar vertebra, and most commonly lying between the two shoulder-blades. The pain in both the epigastric and the dorsal region is almost always much increased by pressure; it is also specially affected by certain kinds of food and drink, being in creased by the ingestion of hard and indigestible substances, and lessened by a bland and pulpy diet. As a general rule, the pain is aggravated by tea, beer, and hot food; although exceptions occur. The next symptom in this disease is vomiting or regurgitation, expelling the food previously taken, or a glairy alkaline fluid. The vomiting usually occurs when the pain is most intense, and is a dangerous symptom, since it tends to starve the patient, and to increase the fatigue of an already weakened frame. At this stage the disease is sometimes terminated by the occurrence of perfora tion, ending in rapidly fatal peritonitis; and if this accident does not occur, the dyspep tic symptoms become complicated by hemorrhage from the stomach, sometimes so rapid that it distends the stomach and a ljneent small intestine with a single gush, and causes fainting and almost immediate death; but more commonly occurring as a slow and inter mittent drain of blood, giving rise to anemia. If death from the above causes (inanitim, perforation, or hemorrhage) does not terminate the disease, the symptoms frequently subside in something like the inverse order in which they occurred, and recovery, often after many years' suffering, ensues. With regard to frequency of ulcer of the stomach, Dr. Brinton, who has carefully studied this disease, states that this lesion may be de tected in (on an average) 5 per cent of persons dyingfrom all causes; that it occurs twice as frequently in females as in males, and that it is specially a disease of middle and advancing life-27 being the average age in females, and 42 in males. Nothing is known with certainty regarding the causes of this disease, except that advancing age, privation, mental anxiety, and intemperance so frequently coincide with it, that they may be regarded in some degree as producing it. In relation to treatment, strict attention to diet is of the first importance. When the symptoms are urgent, the patient should main tain the recumbent position, and should be fed on lukewarm milk, thickened with biscuit-powder, given in doses of one, or, at most, two table-spoonfuls every two hours. The pain is often relieved by the application of a mustard poultice to the painful spot; and benefit is frequently derived from the internal administration of bismuth (in doses of ten grains), either given alone or combined with the compound kino powder (in five-grain doses). When there is hemorrhage small lumps of ice may be swallowed; and if all food is rejected by vomiting, beef-tea injections must be thrown into the lower bowel. Aperients Lre sometimes required, but they must be given with caution; and if castor oil can be taken without increasing the pain or vomiting, it is the most harmless remedy of its class.
Cancer of the stomach is a disease of much interest, from its being obscure in its symp toms and difficult of detection in its early stage, frequent in its occurrence, and always fatal in its termination. The typical course of this disease is graphically sketched by
Brinton in the following paragraph; " An elderly person perhaps hitherto free from dyspepsia, begins to suffer from a capricious. and soon a diminished appetite; which is by and by associated with occasional nausea. or even vomiting, and with a sense of uneasiness or distension of the stomach. His complexion, already pale and unwhole some, a muddy. yellowish, or faint greenish hue. his gastric symptoms now increase; often by a sudden and marked augmentation, which corresponds to what is in other cases their first appearance. Vomiting, if already present, becomes more fre quent and urgent; local"tineasiness deepens into pain; and both these symptoms are excited or increased by taking food. At a somewhat later period hemorrhage generally occurs. usually but scanty in amount, and therefore depending to a great extent on casual circumstances for its detection. About this time, a tumor often becomes porcep tible near the middle of the epigastric region of the belly. As the local symptoms increase, the cachexia of the patient also augments; and is evidenced not only by the color already mentioned, but also by debility and emaciation; and at last by prostration, which ends in anasarc* delirium, and denth."—Op cit., p. 225. From the records of 600 cases, Dr. Brinton finds that most deaths occur between the ages of 50 and 00 years. The form of cancer which most frequently attacks the stomach is the scirrhus or hard cancer. Out of 180 cases, scirrhus occurred in 130 (or nearly three-fourths of the whole), medullary or encephaloid cancer in 32, colloid in 17, mei:mode deposit in 3, and vinous cancer in 1. In the treatment of this formidable disease, more good is done by careful attention to the diet than by any medicine. Good milk or strong beef-tea thickened with biscuit-powder may be given in the same manner as recommended in ulcer; and milk mixed with a little old Jamaica rum will sometimes stay on the stomach when everything else is vomited. If there be pain, opiates must be'given, and they may be prescribed either in the ordinary way, or as enemata, the latter having the advantage of not inducing constipation.
Hcinatemeeis, or tomiting of blood, must be looked upon rather as a symptom than a disease. Thus, it may occur by the ulcerative destruction of the walls of a com paratively large blood-vessel, as in gastric ulcer and in cancer; but it generally is of the kind termed capillary. The latter kind of hemorrhage happens under various circum stances, of which the following are the principal: 1. The bleeding may be idiopathic, or unaccompanied by any structural change. This variety is extremely rare. 2. It may take the place of some habitual hemorrhage, or, in other words, be vicarious. Thus it frequently takes the place of the menstrual discharge. 3. It is often a consequence of i disease or injury of the stomach; for example, it frequently occurs after the ingestion of strongly irritant poisons, or even an immoderate dose of alcohol into the stomach. 4. It may be a consequence of disease in adjacent viscera, occasioning an overloading of the veins of the stomach; thus it is frequently caused by enlargement of the spleen, and occurs in those states of the liver in which there is obstruction of the portal circulation; and under this category we must place the gastric hemorrhage which not unfrequently occurs in the advanced periods of pregnancy, in consequence of the pressure exerted by the enlarged uterus on the venous circulation of the abdomen. 5. It may result from changes in the composition of the blood, such as occur in scurvy, minium, and yellow fever. The treatment must be directed against the disease on which the hemorrhage depends, rather than against the mere symptom; but from whatever cause it arises, if it is proceeding to a dangerous extent, the patient should he kept perfectly quiet in bed, and should swallow small pieces of ice. Hot applications may also be applied to the extremities, with the view of directing the blood to those parts. The medicines most likely to be of service arc acetate of lead, gallie acid. dilute sulphuric acid, and oil of turpentine; but they should only be given on medical authority.
Some of the other affections of the stomach are discussed in special articles. See