I 



GASTRIC VLCEm. 435 



-5 A.M. UnsuceesstuI attem2:)ts had been made to reduce the 

 liernin. At 7 P. 31. operation, followed by relief. 0]i the even- 

 ing of Dec. 5, an enema was followed by a copious stool of a 

 dark-brown colour ; on the 6th another stool was passed, con- 

 •sisting of black, altered blood. During the night between the 

 Cth and 7th, nausea and retching ; on the morning of the 7th 

 vomiting of lumps, streaked at first with bile, and later with 

 blood; this frequently recurred throughout the day, and la.^* .x'l 

 with brief intermissions until the patient's death at 9 p.m. At 

 the post-mortem examination, performed one hour after death, 

 the stomach presented, besides several hannorrhagic infarctions 

 of smaller dimensions, two circular foci of equal size, symme- 

 trically disposed on either side of the middle line of the lesser 

 curvature ; of these, one was a perfect example of a simple ulcer, 

 while the other presented the appearance of a hannorrhagic in- 

 farction of the gastric mucous membrane of corresponding size. 



For prolix hypotheses concerning the possible or probable 

 mode of origin of gastric ulcer, which would outrun the limits 

 of this manual, I substitute the above plain record of a case with 

 a post-mortem. And this I do, partly in order to substantiate 

 the view which I have adopted, partly also to point out how 

 very unstable all those theoretical arguments must be, seeing 

 that the results of a single post-mortem are still of such import- 

 .ance in the settlement of the question. 



§ 374. The simple ulcer accordingly originates in a ha-mor- 

 rhagic infarction. This involves the entire thickness of the 

 mucous membrane. In fine sections through the above speci- 

 men, I was everywhere able to demonstrate the bodies of the 

 tubular glands bathed in blood-corpuscles, as though embedded 

 in the clot. The solution and removal (digestion) of the infarc- 

 tion by the gastric juice, leaves a corresponding loss of sub- 

 ^;tance ; the simple ulcer is complete. It may get bigger, it may 

 go on to the dreaded issue of perforation ; or it may, on the 

 other hand, contract and cicatrise ; I re^^eat however, that it is 

 d'omplete in all essential particulars the moment the infarction is 

 iletached. 



First amono^ its essential features is its circular outline. I 

 ought to say, the circular outline of its base, for its shape as a 

 whole is that of a very shallow cone, whose base is directed 

 towards the surface. of the mucous membrane, while its apex is 



