Vomiting of blood (hcematemesis) is an occur rence of ulceration owing to some blood-vessel being opened into. A large and sudden loss of blood may in this way occur, tending to cause the speedy death of the person by collapse, or frequent bleedings may take place, which very quickly reduce the patient's strength. The ordinary vomit consists of the food pirtly di gested and of mucus ; but, if mixed with blood not in sufficient quantity to be recognized as such, there is the appearance of "coffee grounds," due to the blood being altered by the action of the gastric juice.
If the ulcer open into the cavity of the belly it will be known by sudden severe pain, great prostration and anxiety, and the speedy occur rence of inflammation of the whole cavity of the belly, the symptoms of which are described under the heading PERITONITIS (p. 265), which speedily ends in death. This termination of the disease may be provoked by a large meal, or by some exertion which exerts pressure on the wall of the stomach, and so bursts through its weakened portion.
Treatment of ulceration of the stomach de mands the care and skill of a physician. Of course the recognition of the disorder equally requires a well-trained physician. The symp toms that have been mentioned will enable anyone to recognize a serious condition requir ing careful attention. But for the treatment it is not enough even to be sure of the fact that an ulcer of the stomach exists. For the treatment of this disease, as of almost all others, requires the consideration of many other circumstances. It is often a difficult question even for a skilled physician to give an opinion as to the presence or absence of ulcer ; but even though he is convinced of the existence of ulceration, the question of treat ment may be one of difficulty. Therefore, if this condition is even suspected, medical aid should at once be sought. The principles that have been already laid down in detail on p. 227 apply very fully to the treatment of gas tric ulcer. The food is probably best given tepid, and never hot or cold, to avoid stimulat ing the stomach. This diet may be reinforced by nourishing injections. (See list of nourish ing injections, Vol. II., pp. 15 and 406, and for use of injection apparatus refer to APPLIANCES FOR THE Sicx-Room, p. 20, Vol. II.) In some cases the use of raw pounded beef, given also in small quantities, has proved useful.
The methods of relieving pain and vomiting are stated on p. 229.
If bleeding occurs, no food is to be given for one or two days, nourishment to be maintained by injections, ice to be sucked, and doses of 10 grains of gallic acid, or 15 drops tincture of steel, to be given every six hours, to cause contraction of the bleeding vessels, the person being all the time kept perfectly quiet.
Perforation of the wall of the stomach, oc curring as the result of ulceration, is known by sudden severe pain, followed by collapse or great prostration. The pain rapidly spreads over the whole belly, owing to the occurrence of inflammation of the lining membrane of the cavity—the peritoneum (see p. 265). Death may occur a few hours after the perforation, unless the nature of the occurrence is imme diately recognized, and an operation under taken. An operation in such circumstances is attended by great risk, but in the hands of a skilful operator is very often attended by re covery.
Operation is often quite properly undertaken, in prolonged cases of gastric ulceration, as a means of cure, when no such urgency exists as when perforation has occurred. It is often, indeed, necessary when an ulcer, by its con traction or by the formation of adhesions, has narrowed the stomach outlet, and is causing dilatation, and stagnation and retention of food.
The common operation in such a case is that of gastro-enterostomy, by means of which a new opening is made between the stomach and bowel, permitting the food to pass into the bowel without passing over the ulcerated sur face, which thus gets the opportunity of heal ing. It is one of the most useful of the modern operations in gastric surgery in suitable cases.
Cancer of the Stomach is not an uncom mon disease, though it seldom occurs before the age of forty. It may exist in any of its various forms. (See p. 556.) Life is seldom prolonged beyond two years after its com mencement.
Its symptoms are not always marked, and may be those of dyspepsia such asmight arise from chronic catarrh. Many cases are recorded of death from cancer, in which there were no symptoms which could have led anyone to sus pect the true nature of the disease. In most cases it is, therefore, a question of great diffi culty for even a skilful physician to decide whether a person is affected with cancer of the stomach or not. Apart, consequently, from such skilled opinion, no one ought to conclude that he or she is affected with this disease, .