CHRONIC ULCER OF THE STOMACH. 537 



unbolted flour, roast potatoes, potato salad, etc., are particularly to be 

 avoided, while pure"e of potatoes does well. 



The therapeutic use of the alkaline carbonates has a wonderful 

 effect in chronic ulcer of the stomach. Among the mineral waters con- 

 taining alkaline carbonates and purgative salts, the warm springs are 

 preferable to the cold. Patients whose circumstances allow it may be 

 sent to Karlsbad. If there be insuperable obstacles to a trip to the 

 springs, Karlsbad, Marienbad, Tarasper, and similar waters may be 

 prescribed at home ; they should be properly warmed before drinking. 

 In some cases I have seen patients wonderfully improved by the treat- 

 ment at Wildbad, and other Akrato-therma, after they had taken the 

 waters of Karlsbad and Marienbad without benefit ; but am not con- 

 vinced that the use of water from warm springs can replace the treat- 

 ment at Karlsbad, as Professor Sock claims in the " Gartenlaube." I 

 am sorry that so clear and shrewd a person as Bock should permit 

 himself to spread a dangerous half-knowledge among the laity ; I have 

 more than once found that people, under the impression that they had 

 learned enough from BocUs writings to judge of their cases and treat 

 themselves, have done themselves great injury. The rules of the 

 water-cures contain some superfluous and finikin regulations, but it is 

 not well to shake faith in these, or else even the rational rules may be 

 less carefully followed. Among the latter I place in the first rank, 

 that patients should not eat later than seven o'clock, and then only 

 soups, that they should not breakfast for at least half an hour or an 

 hour aftei their last glass of water. It is certain that very much 

 depends on the warm mineral water going into an empty stomach. 

 If under the treatment just described, contrary to our expectations, 

 there be no improvement, we may give nitrate of silver, or subnitrate 

 of bismuth. From the effect that these remedies, particularly the for- 

 mer, are seen to have on ulcers of the skin, or of other mucous mem- 

 branes, then* use appears perfectly rational, and in some cases the 

 results attained with them are surprising. In other cases, on the con- 

 trary, they do no good. For the mode of administering these rem- 

 edies and their dose, we refer to what was said in the treatment of 

 chronic gastric catarrh. 



The treatment of symptoms, first of all, requires the relief of the 

 cardialgic attacks. There are but few cases of chronic ulcer of the 

 stomach where we can dispense with the use of narcotics ; these usually 

 have an instantaneous and brilliant effect on the attacks of pain. 

 Even a few minutes after the administration of a small dose of mor- 

 phia, there is relief or even complete freedom from pain. This seema 

 to show that the pain is chiefly induced by tension of the stomach. If 

 .t depended on irritation of the walls of the stomach by the ingosta, or 



