536 DISEASES OF THE STOMACH. 



have developed and slowly increased after there has been chronic 

 ulcer of the stomach, we must suspect that a cicatricial stricture haa 

 formed. 



We will speak in the following chapter of the diagnosis of chronic 

 ulcer of the stomach, from cancer and nervous cardialgia. 



PROGNOSIS. In accordance with what we have said of the course 

 and results, the prognosis of chronic ulcer of the stomach is, on the 

 whole, favorable ; we must not forget, however, that the disease often 

 has remissions followed by exacerbations, that in the midst of apparent 

 improvement haemorrhages will occur, and that, even after recovery 

 has begun, relapses are always imminent. 



TREATMENT. The disease of the blood-vessels, which, as we have 

 said, gives rise to the partial necrosis of the walls of the stomach which 

 results in round ulcer, can rarely be referred to chronic gastric catarrh ; 

 for topers, who have the most obstinate forms of this disease, rarely 

 have ulcer of the stomach. As we do not know the causes of these 

 affections of the blood-vessels, we have no hesitation in saying that, in 

 the treatment of chronic ulcer of the stomach, we cannot fulfil the 

 causal indications. 



Dietetic rules best answer the indications from the disease. The 

 result of the treatment mostly depends on their being strictly followed 

 out. It is true, we cannot protect the affected portion of the wall of 

 the stomach from injury, as we would an ulcer of the skin ; the intro- 

 duction of even the mildest food excites a hypersemia of the gastrio 

 mucous membrane and irritates the affected part ; however, the coarser 

 and rougher the ingesta, the greater the irritation they excite. From 

 this fact, proved by experiment and confirmed by practice, we deduce 

 the rule that the patients should have the mildest possible, and, pref- 

 erably, a liquid diet. We should then try if an exclusively milk diet 

 will be borne ; unfortunately, this is not always the case. If fresh 

 milk curdles in the stomach to hard, tough lumps, we should always 

 give it with white bread, as advised by JSudd. Some patients, who 

 cannot use fresh milk, have no difficulty with buttermilk, or sour milk. 

 If the patient has a great distaste for milk-diet, or if he cannot take 

 BOUT or buttermilk, we may give rich unskimmed soups, with an addi- 

 tion of Liebig^s meat-extract. The nutrition in the small quantities 

 of these extracts that the patient takes is not great, it is true, but 

 they are strong analeptics. Trommels malt-extract, which has been 

 before described, contains the nutritious constituents of malt in a state 

 of solution, and is to be recommended because several spoonfuls of it 

 may be taken daily without difficulty ; hence it must be regarded as a 

 valuable remedy. I know patients who have taken one or two ounces 

 of Trommels malt-extract daily for years. Vegetables, bread from 



