CHRONIC ULCER OF THE STOMACH. 529 



M' the wall of the stomach from cutting off its nourishment is analo- 

 gous to the localized softening of the brain, infarction of the lungs, 

 spontaneous gangrene of the toes, caused by cutting off the circula- 

 tion. In the above-mentioned experiments on animals, the obstruc- 

 tion of the gastric vessels was induced by introduction of emboli. 

 This mode of development of the round ulcer is rare in man, but there 

 are some cases where certainly it has been observed (I myself have 

 seen a most exquisite example of it within a few years.) The ob- 

 structing clots usually form at the very site of the ulcer, and their 

 formation seems to depend on disease of the walls of the vessel. The ' 

 gastric juice quickly causes softening and entire dissolution of the 

 dead portion of the wall of the stomach, which cannot withstand its 

 action, so that we rarely have the opportunity of seeing the first stage 

 of the process on post-mortem examination. The predisposition to 

 chronic ulcer of the stomach is very extended. JaJcsch and others 

 have given us statistics of its frequency at different ages, in different 

 sexes, and in different employments, etc. In the accounts of two thou- 

 sand three hundred and thirty post-mortem examinations, Jalcsch 

 found round ulcers mentioned fifty-seven times, and cicatrices fifty-six 

 times ; so that, to about every twenty bodies, there was either an 

 ulcer or a cicatrix. "Willigan, JBrinton, and others came to similar 

 conclusions. Round ulcer is rarely found in children, but, on the other 

 hand, it is quite frequent about puberty. Females are much more dis- 

 posed to it than males. I think there is no doubt that poverty of the 

 blood and chlorosis, those frequent results of sexual disturbances, have 

 great influence in causing the round ulcer, and that they do so because 

 abnormal states of the blood induce diseases of the walls of the ves- 

 sels, and hence favor the formation of thrombi. In other cases acute 

 or chronic catarrh of the gastric mucous membrane appears to cause 

 disease of the walls of the vessels, and consequently thrombosis. 



The exciting causes of round ulcer are entirely unknown. We can- 

 not deny the possibility of its being induced by the injuries usually 

 named ; such as the use of very hot or very cold food and drink, the 

 misuse of liquor, and other errors of diet. But it is very remarkable 

 that, in spite of the frequency of chronic gastric catarrh in topers, they 

 rarely have the round ulcer. 



AXATOMICAL APPEARANCES. -The ulcer which we are considering 

 occurs almost exclusively in the stomach or upper part of the duodenum, 

 while it is only rarely seen in other parts of the intestinal canal. It is 

 most frequently situated in the pyloric portion of the stomach, oftener 

 in the posterior than in the anterior wall ; and almost always at the 

 small curvature or its vicinity ; it is rarely seen at the fundus. Usual- 

 ly there is only one ulcer, occasionally two or more, and not unfre- 

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