53-4 DISEASES OF THE STOMACH. 



ach, are somewhat different from the usual state of the mouth in 

 chronic oral catarrh. The acid fluids that rise into the mouth appear 

 to dissolve the epithelium and the vomiting to clear it away ; at least, 

 instead of the thickly-coated tongue, which is rarely absent in simple 

 chronic catarrh of the stomach, we usually find the tongue red and 

 furrowed, and this state is almost always accompanied by increased 

 thirst and habitual constipation. 



Regarding the general health of the patient, chronic ulcer of the 

 stomach may soon impair the nutrition, so that the patient is rapidly 

 debilitated, and has a pale, cachectic look ; in other cases, the nutri- 

 ,ion is very little deranged. 



Except in the first-mentioned cases, where the round ulcer proves 

 fatal in a few days or weeks, the course of the disease is usually very 

 tedious; and it may run on for years, the patient suffering many 

 alternations of comfort and distress. Not unfrequently, in the midst 

 of apparent convalescence, vomiting of blood suddenly occurs ; or the 

 affection returns with its former severity years after it had disappeared. 



Recovery is the most frequent termination of chronic ulcer of the 

 stomach. The sufferings of the patient gradually subside, the nutri- 

 tion is fully restored, all disturbance ceases, and, when the patient has 

 died of some other disease, we find the characteristic cicatrix as the 

 sole remains of the ulcer. 



Secondly, the result in incomplete cure is not infrequent. The 

 symptoms of chronic gastric catarrh disappear, it is true ; often also 

 the periodical vomiting ; the patient may become fresh and healthy- 

 looking ; but every meal is followed by cardialgia, which occasionally 

 becomes more severe than usual. In such cases the ulcer has healed, 

 and the gastric mucous membrane has become relatively healthy ; but 

 there is a cicatrix or more frequently an adhesion of the stomach to 

 some neighboring organ, which limits its movements at some point, 

 and keeps up the cardialgic attacks. Stricture of the pylorus, with 

 dilatation of the stomach, is a common sequel to chronic gastric ulcer, 

 whenever the seat of the ulcer has been near the pyloric orifice, or 

 when the disease has been complicated by chronic catarrh with hyper- 

 trophy of the gastric walls. 



In other cases ulcer of the stomach causes death. This may occur 

 (a), from perforation of the walls of the stomach, and escape of its 

 contents into the abdominal cavity. In such cases patients sometimes 

 die before the occurrence of peritonitis, or before this has developed 

 sufficiently to be regarded as the cause of death. Along with the sud- 

 den occurrence of fearful pain in the abdomen the skin becomes cool, 

 the pulse small, the countenance sunken ; and the patient collapses and 

 dies in this state. If the heart's action becomes weaker, the filling of 



