Ulcer Of The Stomach.

Part 6
1. Pain
Pain is the most frequent and characteristic of all the
symptoms. In the earlier stage of the disease there is a mere
feeling of weight or tightness in the epigastric region.
Sometimes the patient has the impression as though the food
experienced a stoppage there. From such a dull, continuous
feeling the pain gradually augments into a burning sensation
and at last into a gnawing pain.
In the majority of cases the pain comes on from two to ten
minutes after deglutition of food and remains during the
period of gastric digestion, at the close of which it gradually
subsides and disappears. There are, however, exceptions to
this rule, and we find cases of typical gastric ulcer where the
pains appear half an hour or an hour or two and three hours
after meals. ifferent !inds of food have a mar!ed influence
upon the pain. "oarse substances and many undigestible
foods increase the pain, whereas a liquid diet, especially mil!,
may fail to bring on the pain. The quantity of food is also of
import, a large meal causing more pain than a small one.
The situation of the pain corresponds, as a rule, to the centre
of the epigastrium, or to the median line of the abdomen
immediately below the free extremity of the ensiform process.
The portion of the epigastric region to which the pain is
referred forms a circular area of rarely more than two inches
diameter, some times a mere spot of less than half this si#e.
There are, however, exceptions to this rule, and a spot of pain
may be situated a little more to the right or to the left or also
farther down than the above$described spot. %ccasionally the
pain is associated with a feeling of violent pulsation or
throbbing in the epigastric region. &t times this sensation is
felt independently of the paroxysm of pain.
The dorsal pain, first described by "ruveilhier, is also an
important symptom. It generally appears later 'a few wee!s or
months( than the epigastric pain, and is then almost as
constant and characteristic as the epigastric pain. This pain is
gnawing in character and situated, as a rule, to the left of the
spine corresponding to the eighth or ninth dorsal vertebra,
and extending occasionally to that of the first or second
lumbar vertebra. )i!e the epigastric pain, it has a fixed seat,
generally remaining near the spot of its first appearance
during the whole progress of the disease, although it also
shows lateral as well as vertical deviation from its ordinary
situation. Its worst attac!s generally alternate with those of
the epigastric pain.
The epigastric, pain is increased on pressure. *ven slight
pressure with the finger upon the epigastric region below the
ensiform process produces intense pain. This is the most
important point characteristic of gastric ulcer. To test the
sensitiveness to pressure by means of +oas, algesimeter, or
to exert considerable pressure with the fingers, is not
advisable. I perfectly agree with +rinton,- who says in
reference to the latter point. /It is not altogether superfluous to
add another caution with respect to the above test 'pressure(.
not only must it be applied with great care and delicacy in the
first examination of a supposed case of gastric ulcer, but, as a
rule, we can scarcely be too reluctant to repeat it, even to
verify a presumed amendment. &t any rate, its effects are
sometimes so injurious that it is necessary strictly to prohibit
the patient from all manipulations of the epigastric region, as
well as from all pressure produced by dress 'such as stays in
the female( or wor! 'as is the case with shoema!ers(/.
- 0. +rinton. l. c.
The character of the pain, of becoming increased on
pressure, is, however, not always present, and we find
patients with gastric ulcer in whom the pain is rather subdued
by pressure.