The treatment of such cases is sometimes very difficult. Much may be done without medicine by methods of feeding. If vomiting after food is a frequent occurrence, then very small quantities of food, chiefly milk, should be given often. Begin with a spoonful, and let it be repeated at intervals, and slowly increased as the stomach tolerates it. The stomach may be coaxed in this way to digest food which it would immediately reject if it were given in any quantity. If the bowels be constipated some medicine is necessary. In such cases nothing suite better than a saline medicine taken in early morning before breakfast. The Carlsbad salts obtained in crystals and dissolved in water (one or two tea-spoonfuls in a tumbler of water) are specially valuable. Failing Carls bad, Hunyadi Janos mineral water (a claret glassful) may be used, or some effervescing saline medicine. Stimulants should not, as a rule, be employed. Some tonic medicine should also be used if the stomach will tolerate it— iron, quinine, and strychnine, or an acid tonic (see PRESCRIPTIONS — TONICS). The person troubled with such an affection should also take mild regular exercise, should avoid salted and highly-spiced meats, and should avoid damp and wet.
Ulceration of the An ulcer of the stomach " is, in the eyes of most people, one of the most hopeless of troubles. Yet it is probable that a very large number of persons suffer front it, the symptoms being chiefly those of dyspepsia, and recover from it, and have no suspicion as to the true cause of their indigestion. Undoubtedly ulcers may end in death after long and painful suffering, but, as undoubtedly, they very often end in recovery.
Women seem more liable to the disease than men, and it is commonly associated in women with derangement of the monthly periods and bloodlessness. It may also be the results of dissipated habits and of syphilis. It is a dis ease of middle life, and the liability to it increases as life advances.
The history of an ulcer of the stomach may vary. It is first limited to the inner coat—the mucous membrane—and may be of such a nature as if a piece of the membrane had been punched out. The tissue surrounding it is increased in amount, through an effort of nature to repair the breach. This effort may be successful, and the rampart of thickened tissue, thrown up, as it were, round the ulcer, may gradually encroach on it, the ulcerated surface narrows more and more till it is obli terated, and nothing may remain but a de pressed puckered scar. Why this does not speedily take place is doubtless due to the constant worrying to which a healing ulcer is subjected in the stomach by the movements of the stomach walls, by the passage of food of all kinds over it every now and again, and by the irritation of the gastric juice, poured out whenever food is admitted into the stomach. The stomach ulcer wants that first requisite for speedy recovery—rest. Doubtless very often the ulcer does not heal because of the general condition of the person's health or the special condition of the blood, a person with bloodlessness (anaemia) or syphilis, for example.
if the ulcer does not heal it may spread, ex tending itself gradually over wider portions of the mucous membrane, and growing more deeply into the stomach walls, the patient, all the time, becoming more and more exhausted, and finally dying of exhaustion. In the course of eating its way through the walls of the stomach, the ulcer may open into a blood-vessel and cause serious bleeding, ending in death either by sudden and great loss of blood, or by exhaustion produced by several attacks of bleeding. The ulcer may eat its way entirely through the walls of the stomach, producing perforation, so that the contents of the stomach escape through the opening into the cavity of the belly and there set up inflammation (peri tonitis), which speedily kills. Instead of mak ing an opening into this cavity, the ulcer may be in such a position that it opens into the large bowel behind, or at the surface of the pancreas, or other part to which the stomach may have become adherent by the inflamma tory process which the progress of the ulcer has set up. In a case where the stomach is adherent at the seat of ulcer to some other organ, actual perforation may be prevented by the adhesions, and peritonitis not arise. In the event of the stomach being adherent to the large bowel behind, the ulcer might eat its way through the adherent walls of both organs, and thus a communication exist be tween stomach and large bowel. Food might thus pass directly from the stomach into the large bowel, and nourishment be thus seriously interfered with. Similarly, faces might pass from the large bowel into the stomach, and be vomited by the person.
The symptoms of ulceration of the stomach are chiefly pain, especially vomiting of blood, and general dyspeptic symptoms. Indeed, at first, the symptoms are chiefly those of dyspepsia, such as have already been described (p. 227), bad appetite and bad digestion, fulness after food, flatulence and uneasiness after food. When the symptoms have grown worse, so that pain is actually developed, it may be felt over the stomach or at the back on a level with the beginning of the lumbar vertebrae, or between the shoulders. The pain is increased on pressing over the stomach. It is aggravated after food, reach ing its greatest intensity about two hours after food. It may be caused by the entrance of food into the stomach, and may arise imme diately or a few minutes after the food has been taken, and is of a burning character. It lasts till the food may be supposed to have passed on to the small bowel, or till vomiting has occurred, emptying the stomach and so producing relief. Vomiting may become so frequent as to occur some time after every meal, and is a serious element in the disease, since the nourishment of the patient is thereby gravely affected.