ULCER OF THE STOMACH. 371 



clinically has no distinctive feature by which it can be 

 recognized. 



ULCER. 



Ulcer of the stomach may occur in the course of acute and 

 chronic gastritis; or independently ; not infrequently it is found 

 post-mortem when no symptoms had existed during life to 

 indicate its presence. It is stated that in 5 per cent, of 

 deaths from all causes either an open ulcer or a resulting 

 cicatrix can be found. 



It is rare before the age of ten years, though it has been 

 met with in infants at birth ; it is much more frequent in the 

 female than male. 



Circulatory disturbances arteriosclerosis, thrombosis, and 

 embolism are undoubtedly important etiological factors, as are 

 likewise general anaemia and malnutrition. The frequent asso- 

 ciation clinically of hydrochloric-acid superacidity in 80 or 

 90 per cent, of cases is suggestive of autodigestion, and it is 

 maintained by many that without this excessive acidity of the 

 gastric secretions ulcer does not occur. At least it must be 

 admitted that it could make the production of ulcer easier 

 when factors interfering with the nutrition of the stomach- 

 wall, at a given point, are present; and also might subse- 

 quently seriously interfere with the healing of such a lesion. 

 At first it was asserted by Rigel that this superacidity was 

 constantly present in ulcer. The small percentage of cases in 

 which it is not, might be accounted for by an associated gastritis 

 that has gone on to glandular atrophy. On the other hand, 

 it is intelligible that the superacidity may be excited by the 

 ulcer in a manner possibly analogous to the hypersecretion 

 of tears produced by a corneal ulcer. 



Trauma alone cannot produce gastric ulcer ; other factors 

 are necessary. It is generally conceded that gastric ulcer 

 artificially produced in lower animals heals promptly; and in 

 man pieces of the mucous membrane have been torn away by 

 suction of the stomach-tube, the lesion healing without the 

 formation of an ulcer. But if a high degree of anemia is 

 first produced in dogs by the gradual withdrawal of blood, 

 ulcers can be produced by various irritants, which heal very 

 slowly ; and so, clinically, ulcer is especially frequent in chlor- 



