ULCER OF THE STOMACH. 569 



the menstrual function, although there seems to be some doubt on this point. Cases 

 are indeed recorded of suppression of the menses through cold having been 

 immediately followed by symptoms of ulceration of the stomach. Respecting the 

 causes of ulcer of the stomach we know very little.' Many theories have been 

 advanced, but as there is none which is universally accepted, it is needless to enter 

 into a discussion of the subject. It has been thought that moral emotions, bad or 

 insufficient food, excessive indulgence in spirituous drinks, and exposure to extreme 

 cold may act as exciting causes, but this, to say the least, is problematic. 



The ulcer is rarely smaller than a fourpenny-piece or larger than a crown ; its 

 shape is usually circular or slightly oval, and the edges are often sharp, as if a pi (<> 

 of the tissue had been punched out. Usually there is only one ulcer, but 

 occasionally there are two, three, or even more. These facts are, of course, ascer- 

 tainable only by a post-mortem examination, for as these ulcers are actually in the 

 stomach, and not on the surface of the body, we have no means by which we could 

 see them during life. 



"We must now consider the symptoms to which ulcer of the stomach gives rise. 

 None is so constant as pain, and this, unfortunately, is only in very exceptional 

 cases absent. It varies considerably in character and intensity, but possesses no 

 distinctive character. It is usually experienced from a few minutes to a quarter of 

 an hour after eating, and is especially apt to occur after taking indigestible food. 

 It does not cease until digestion is completed, or until the food is rejected by 

 vomiting. It may also be excited by exposure to cold, mental excitement, or 

 severe bodily exertion, and is usually increased by external pressure and by tight 

 clothing. The pain is often felt at the pit of the stomach, or a point a little above 

 this, or it may even be experienced in the middle of the back. 



Another symptom is vomiting, which is absent in very few cases. It is almost 

 always accompanied or preceded by pain in the stomach, which is relieved by 

 the vomiting. The vomit usually consists of food in different stages of digestion. 

 Haematemesis is much less common, but when blood is thrown up in large 

 quantities mixed with food, it is, with certain limitations, indicative of the 

 complaint now under consideration. Slight bleeding often escapes notice, because 

 the effused blood does not induce vomiting, but passes off in the stools, which are 

 scarcely ever examined unless there is some special reason for so doing. In copious 

 haemorrhage a portion of the blood always escapes by the bowels as a blackish 

 tarry-looking substance. When hsematemesis has once occurred it nearly always 

 returns, either because the clot which is formed is dissolved out by the gastric 

 juice, or forced out by the movements of the stomach, or because fresh tissue 

 is opened up by the extension of the ulcer. Small bleedings do not materially 

 disturb the general health, but a copious haemorrhage may produce fainting, or 

 even death. Nothing is more likely to favour bleeding than the congestion of 

 the stomach, resulting from over-indulgence in food, or some other similar cause. 



Dyspepsia, or difficult digestion, as shown by lack or perversion of the appetite, 

 by increased thirst, unpleasant taste in the mouth, weight at the pit of the 

 stomach, flatulence, and eructation of acid fluids, is very common. Notwith- 

 standing these digestive derangements, the nutrition is by no means always 





