The Oxford medical adviser for the home / by John D. Comrie.

  • John Comrie
Date:
1931
Catalogue details

Licence: In copyright

Credit: The Oxford medical adviser for the home / by John D. Comrie. Source: Wellcome Collection.

    352/414 (page 334)
    produced, and there is then little or no secretion of gastric juice. ULCER OF THE STOMACH, Gastric ulcer, or Perforating ulcer, is of frequent occurrence, and is a serious disease. Symptoms.—First among the symp¬ toms is pain, which is markedly in¬ creased after food. This pain is situated either in front, at the lower end of the breast-bone, or frequently behind, about the middle of the back. It is often severe, and is usually accompanied with much tenderness to touch, and also with a sense of oppression and inability to wear tight clothing. The pain is largely due to the spasmodic contractions of the stomach set up by the presence of the food. Cases are, however, occasionally met in which there is no complaint of pain. Accompanying the pain there is frequently vomiting very soon after the food is swallowed which tends to relieve the pain and discomfort. Vomiting of blood (hae- matemesis) is a frequent symptom. It may show itself either to a slight extent, and in the form of a brown or coffee-like mixture, or as a copious discharge of pure blood of dark colour and containing clots. Blood is also found mixed with the discharges from the bowels, rendering them dark and ‘ tarry '-looking. The general con¬ dition of a patient with gastric ulcer is as a rule that of ill-health, showing pallor, more or less wasting, and debility. The course of a case of gastric ulcer is very variable. In most instances recovery is rapid. In others, how¬ ever, the disease is chronic, lasting for months or years, and incomplete healing may take place and relapses of the symptoms occur from time to time. Occasionally, though rarely, the dis¬ ease proves fatal by sudden haemor¬ rhage, or by perforation of the stomach and the escape of its contents into the peritoneal cavity setting up peritonitis or causing severe shock, and followed. as a rule, by death within two days unless operative measures be adopted immediately. Should the stomach be¬ come adherent to another organ, or be deformed by the scar of the ulcer, a permanent condition of dyspepsia may result, due to interference with the natural movements of the stomach during digestion. Treatment.—Most important is the careful adjustment of the diet. Milk forms the most suitable food, and while there may be instances in which it fails to agree, even when mixed with lime-water or previously boiled, these are comparatively few. Milk and cream mixed in equal parts are par¬ ticularly well borne and should form the staple of the patient’s diet for several weeks or months. The patient is kept at rest in bed for two or three weeks, and for the first week takes 3 ounces of the milk and cream mixture every hour or 6 ounces every two hours, during the day. Alkaline powders containing magnesia and soda, or carbonate of lime and soda, taken after every meal, help to lessen the acidity of the stomach and pro¬ mote healing of the ulcer. Towards the end of the first week the patient may receive in addition to the milk and cream, one soft-boiled egg in the forenoon and 3 ounces of porridge or boiled rice in the afternoon. Later another egg is added and 3 ounces of some cereal food are given three times in the day. About the end of the third week the milk with cream is reduced, and he is allowed food, such as eggs, toast, cream soups, mashed potatoes, custards, jellies, whipped cream, and cooked fruits. Subse¬ quently creams of fish, chicken, etc., are allowed. Whatever food is given, the quantity, the intervals between the times of administration, and the temperature demand careful atten¬ tion. In severe cases, where the presence of any food in the stomach gives rise to much suffering or to haemorrhage, nourishment by the bowel is had recourse to, and if the