A remedy which nearly always proves effective in all forms of stomach ache is the application of hot poultices, which should be renewed as often as possible. Hot-water bags, or bags filled with hot sand, are very useful. It should be borne in mind that pains in the stomach are by no means always associated with some gastric disease. Gall-stones, or other internal affec tions, may give rise to such pains.
Ulcer of the Stomach.—This is one of the most frequent gastric affec tions, and the early recognition of this disease is of great practical importance with regard to the treatment. The causes of gastric ulcers are only imper fectly known. Occasionally, they arise as a result of external injury to the region of the stomach (blows, falls, etc.) ; but more frequently they are due to internal injuries to the mucous membrane lining the organ. Burns caused by the ingestion of very hot food or beverages may give rise to ulceration. Poor blood conditions are frequent causes ; but very often it is beyond the physician's power to determine the actual factor.
Ulcer of the stomach develops most frequently between the fifteenth and the twenty-fifth year of life, and much oftener in women than in men. In women it is not infrequently a complication of chlorosis. The growth is very slow and chronic. The affection is almost invariably preceded by hyperacidity of the gastric juice, a condition which, therefore, always deserves serious consideration. Hyperacidity manifests itself by sour eructa tions, heartburn, and stomach-ache, especially before meals. Spasms of the stomach are also occasional results of the corrosive action of an excessive amount of hydrochloric acid.
Gastric ulcer usually begins in the form of small punctiform losses of mucous membrane, which gradually increase in size. The size of an ulcer varies between that of a sixpence and that of a half-crown ; in some cases they even attain the size of the palm of the hand. The ulcer, particularly if of long duration, occasionally eats through the stomach-wall and perforates into the abdominal cavity. Owing to the exudation of matter from the stomach, this unfavourable event is usually followed by a purulent and rapidly fatal inflammation of the peritoneum (peritonitis). Such perforations, however, are fortunately rare occurrences. In the majority of cases the ulcer heals with a scar ; but it frequently happens that this scar does not become sufficiently firm, so that it is liable to reopen when the mucous membrane. is again irritated by the ingestion of food. The greater number
of recurrences must be regarded as the consequences of dietary indiscretions.
The onset of gastric ulcer is generally concealed under various indis tinct disturbances of digestion, more definite manifestations developing gradually. Stomach-ache is a constant symptom, usually occurring between fifteen minutes and an hour after a meal. At a later stage of the affection, painfulness sets in, even after the ingestion of small quantities of liquids, so that the patient becomes afraid of eating at all. This causes impairment of nutrition, and consequent emaciation. The gastric pains are often accompanied by spasms, sour eructations, heartburn, and vomiting. The vomitus often contains blood, and such sudden are frequently the first symptoms which point to the presence of an ulcer. If the prevailing symptoms arouse suspicion as to the presence of a gastric ulcer, an examina tion by a physician should at once be made. This will tend to furnish more exact points of support for the diagnosis, by demonstrating a circumscribed painful area in the region of the stomach. Constipation is generally present in this condition. The symptoms often persist for years, the disturbances being alternately more or less severe. An ulcer which has healed may recur after five to fifteen years. In some cases several ulcers may develop in close proximity to each other.
The treatment of gastric ulcer requires great care, on the part of the physician as well as on that of the patient. When the presence of an ulcer has been recognised with certainty, it is best for the patient to remain quietly on his back for several weeks. In order to give the stomach absolute rest, only liquid nourishment (milk, soups, etc.) should be taken at the beginning. In case of recurrences it is practical to administer food by rectal enemas. It requires at least two weeks for an ulcer to become covered with a thin, superficial membrane. When this has taken place, the patient must maintain a strict diet for several weeks ; and not until two or three months have elapsed should he return to his usual fare. Hot, dry poultices may be advantage ously applied for the relief of the stomach-ache. Hot-water bottles are very practical and efficient. The poultices also assist in the healing of ulcer.