THE DIGESTIVE SYSTEM. 539 



ULCERS OF THE STOMACH. 



Chronic Perforating Ulcer. This form of ulcer is often seen ; according 

 to Brinton, in five per cent of persons dying from all causes. It occurs 

 in females nearly twice as frequently as in males. As regards the age, 

 Brinton concludes that the liability of an individual to become the sub- 

 ject of gastric ulcer gradually rises, from what is nearly a zero at the 

 age of ten to a high rate, which it maintains through the period of mid- 

 dle life ; at the end of w r hich period it again ascends, to reach its maxi- 

 mum at the extreme age of ninety. 



The analysis of 793 hospital cases by Welch ' shows that the ulcers 

 were on the lesser curvature in 288, in the posterior wall in 235, at the 

 pylorus in 95, on the anterior wall in 69, at the cardia in 50, at the fun- 

 dus in 29, on the greater curvature in 27. 



As regards the number of ulcers, two or more are present in about 

 twenty -one per cent ; there may be two, three, four, or even five ulcers. 

 In cases of multiple ulcers these are often developed successively. 



In size the ulcers vary from one-quarter of an inch to five or six 

 inches. They are usually of circular shape, sometimes oval ; sometimes 

 two or more are fused together. 



The ulceration is largest in the mucous membrane (Fig. 312). It 

 may remain confined to this, or extend outward and involve the connec- 



' % 



FIG. 312. CHRONIC ULCER OF THE STOMACH. 

 Showing a section through the stomach wall at the central part of the round ulcer. 



tive tissue, muscular and peritoneal coats, its diameter becoming smaller 

 as it advances. The ulcer looks like a clean hole punched out of the 

 wall of the stomach (Fig. 313). Its floor may show no active inflamma- 

 tory changes. Its edges may be in the same condition, or they may be 

 thickened by the growth of connective tissue and cells. The rest of the 

 mucous membrane of the stomach is apt to be in a condition of chronic 

 catarrhal inflammation. 



The ulcer may perforate directly through the wall of the stomach, and 

 the contents of the latter are discharged into the peritoneal cavity ; or 



1 Welch, Pepper's "System of Practical Medicine," vol. ii., p. 504, 1885. Many im- 

 portant data are to be found in this excellent article. 



