ULCER OF THE STOMACH. 571 



spontaneously. When there is copious bleeding the disease must have progressed 

 deeply, and we consequently feel less sanguine as to the result. The loss of blood 

 is dangerous, moreover, on account of the exhaustion it produces. When per- 

 foration occurs we must fear the worst, although the case is by no means 

 hopeless. Severe persistent vomiting, and long tormenting pain are unfavourable 

 signs; .they ultimately exhaust the strength, and so impair the prospect of 

 recovery. 



We have no specific remedy for ulcer of the stomach. We can no more cure an 

 ulcer by the administration of any one particular medicine than we can mend a 

 broken leg by the same means. The only way in which we can effect a cure is to 

 follow a ration al and systematic course of treatment. It must always be remembered 

 that the ulcer will heal by itself, unless prevented from so doing by external causes, 

 and our endeavour should be to place the diseased organ under such conditions that 

 all causes which interrupt the curative process are as far as possible eliminated. This 

 fundamental law of treatment is, however, always violated, unless we make it our 

 first rule to allow no solid food to be taken, or at least none which cannot by masti- 

 cation be converted into a soft pulpy mass. One of the best articles of diet in these 

 cases is milk. It contains in itself all that is necessary for the nutrition of the 

 body, and has, moreover, the special advantage in the treatment of ulcer of the 

 stomach, that the soft clot which it forms is far less irritating to the ulcerated 

 surface than are other substances, such as hard-boiled eggs, pieces of meat, bread, 

 cabbage, potato, &c. The success which attends the practice of restricting the 

 patient to an exclusively milk diet is very great. The milk should be given in 

 small quantities, rarely exceeding a tea-cupful at intervals of two hours, and in 

 severe cases, where there is frequent vomiting, the amount must be restricted to 

 table, dessert, or even tea-spoonfuls. Long fasting is undesirable, and it is 

 advisable that the patient, if awake, should take the milk at intervals during the 

 night. The milk is often better borne when mixed with a little well-boiled arrow- 

 root or biscuit powder, since its coagulation in the stomach in masses is thereby 

 prevented. The milk should not be taken too hot, but there is no objection to its 

 being tepid, unless, indeed, there is a tendency to bleeding, when of course everything 

 must be cold. Butter-milk may be used as a substitute for milk when it in its 

 ordinary form appears to disagree, or it may be diluted with water, or with soda 

 water which has been allowed to stand till the greater part of the effervescence has 

 subsided. In certain cases the milk is not easily digested, but gives rise to 

 flatulence, acidity, increased pain, and even vomiting. In elderly people milk 

 occasionally fails to nourish, and unless a different diet be adopted emaciation and 

 loss of strength are apt to ensue. 



There is another article of diet which is even less likely than milk to inflict 

 injury on the stomach, and that is essence of beef. We append several formulae for 

 the preparation of this substance. 



Essence of Beef , tfo. 1. Take one pound of fresh beef, free from fat, and pour 

 over it half a pint of soft water, or rather less ; add five or six drops of pure hydro- 

 chloric acid, obtained from the chemist's, and half a teaspoonful of common salt. 

 Stir it well, and leave it for three hours in a cool place. Then pass the fluid through- 



