CHRONIC ULCER OF THE STOMACH. 533 



has become adherent to other organs, there seems no doubt that the 

 chief if not the only cause of pain is the obstruction to the peristaltic 

 movements of the stomach, due to cicatricial contraction, or the adhe- 

 sion of its wall to neighboring organs. The larger and rougher the in 

 gesta, the more energetic and continued are the movements of the 

 stomach they excite ; hence the severity and long duration of the 

 paroxysms of pain after eating large pieces of bread, potatoes, and 

 other vegetables, and the comparative ease of the patient after eating 

 soup, milk, and other fluid and mild nutriment. 



Vomiting is almost as constant a symptom as the sensitiveness of 

 the epigastrium and the cardialgic attacks. It is caused by the same 

 circumstances as the attacks of pain, and often terminates these, as it 

 were. Vomiting also occurs a longer or shorter time after meals, ac- 

 cording as the ulcer is near the cardiac or pyloric orifice. It is the 

 more apt to occur, the nearer the ulcer is to the orifice of the stomach. 

 Henoch calls attention to the fact that the same holds good in other 

 hollow organs ; that is, reflex movements are particularly liable to be 

 excited in them by affections near their openings ; he reminds us that 

 severe spasm of the bladder is most apt to occur from inflammatory 

 irritation about its neck; that tenesmus, depending on affections of 

 the rectum, is more distressing the nearer the disease is to the anus. 

 Patients usually vomit their food more or less changed, and mixed 

 with mucus and sour fluids. The state of the substances vomited, in 

 which there are often sarcina, depends principally on the intensity and 

 extent of the coexistent gastric catarrh. Sometimes only quantities 

 of mucus and acid fluids are vomited, while the food remains in the 

 stomach. 



Severe cardialgia and vomiting, occurring regularly after meals, 

 render it very probable that there is a chronic ulcer of the stomach ; 

 the diagnosis is rendered certain, if there be also vomiting of blood. 

 The haematemesis may have various sources : sometimes it is due to 

 capillary haemorrhage, induced by the spreading of the ulcer; more 

 frequently it is caused by the erosion of a large vessel, and this form 

 is pathognomonic of ulcer of the stomach. We shall speak more in 

 detail of haemorrhage from the stomach in Chapter VIIL 



The symptoms of the chronic gastric catarrh which accompanies ul- 

 cer of the stomach unite with the characteristic symptoms of the latter, 

 it is true, but they are more or less decided according to the grade and 

 extent of the catarrh, sometimes being just apparent. Some patients 

 nave decided swelling in the epigastrium, frequent eructation, severe 

 heartburn, complete loss of appetite ; others feel very well during the 

 intervals of their pain ; even their appetite is scarcely impaired. 



The siffns of oral catarrh, which also complicates ulcers of the stem* 



