570 THE TREATMENT OF DISEASES. 



impaired, and the sufferer may for a long time remain fat and plump, so that 

 the serious nature of the illness is apt to be overlooked. When, however, 

 these symptoms go on uninterruptedly for years, as they are apt to do, the 

 sufferer gradually loses flesh and strength, and becomes more and more pale 

 and wasted. 



Gastric ulcer is almost invariably accompanied by a confined state of the 

 bowels. It would seem, probably, that there is a kind of sympathy between 

 the stomach and bowels, and that the sluggishness of the latter is induced 

 by the condition of the former. There is often considerable mental depression ; 

 in fact, in a disease which usually lasts for months or years, which at every 

 meal reminds the patient of his condition, which is constantly exhausting his 

 strength, causing him violent pain, and disturbing his rest, it is but natural 

 that there should be some depression of spirits. 



There are certain complications of ulcer of the stomach which merit a brief 

 consideration. In the first place the ulcer may eat its way right through the walls 

 of the stomach and allow the contents to be poured out into the abdominal cavity. 

 Under these circumstances death nearly always occurs in two or three days from 

 shock. Sometimes by good fortune the ulcer may have become adherent to some 

 other organ, as the liver or spleen, so that when perforation occurs the fluid is 

 prevented from being poured out, and no great damage is done. In exceptional 

 cases perforation is the first indication of the existence of the hitherto latent disease. 

 The occurrence of this condition, is indicated by the onset of severe pain at the pit 

 of the stomach, which soon spreads over the whole belly j the abdomen becomes 

 swollen, and there is great anxiety, with rapidly increasing prostration. These 

 indications of the giving way of the coats of the stomach usually occur after a full 

 meal, or perhaps from some sudden exertion, as that produced by vomiting, 

 coughing, sneezing, &c. Another complication is the occurrence of consumption. 

 People who have ulcer of the stomach sometimes become consumptive, but whether 

 these two conditions stand in the relation of cause and effect, we cannot say. 



It must be admitted that it is not always an easy matter to distinguish ulcer of 

 the stomach from other diseases. In many cases the nature of the complaint is 

 perfectly clear, but in others it is far from being so. One often meets with pale 

 sickly girls or women who complain of menstrual disorders, and have indigestion, 

 and pain, and tenderness at the pit of the stomach. The great problem to be solved 

 is whether they have ulcer of the stomach, or are only fanciful and hysterical. In 

 any doubtful case it is much better to act upon the supposition that they have the 

 more serious disease ulcer. This is perfectly justifiable, because in the morbid 

 conditions which are liable to be mistaken for gastric ulcer, the strict diet, and other 

 measures adopted for its treatment are likely to prove, on the whole, beneficial. It 

 is often extremely difficult to distinguish between ulcer and cancer of the stomach ; 

 we have considered the chief points of difference between them when speaking of 

 the latter disease. (See CANCER OF THE STOMACH, p. 169.) 



Ulcer of the stomach is undoubtedly a serious complaint, but the large majority 

 of patients completely recover. It is probable, as we have said, that many cases 

 never come under the care of the physician at all, and that healing occurs 



