Ulcer Of The Stomach

Synonyms

Ulcus pepticum seu rodens; ulcus ven-triculi rotundum; ulcus simplex; ulcus ventriculi chronicum perforans.
Definition

Gastric ulcer la a disease characterized by a more or less deep destruction of the mucous membrane of the stomach, exhibiting no tendency to healing, and attended with symptoms of pain, vomiting, and hemorrhage. Cruveilhier' in 1829 was the first to describe this affection.
Etiology

The etiology of ulcer of the stomach has not yet been definitely elucidated. Age and sex seem to play a prominent part in its development. It is of quite frequent occurrence. According to Brinton 2 ulcer of the stomach is found (either open or cicatrized) in about five per cent. of persons dying from all causes. He further states that ulcer is more frequent in the female than in the male sex, the proportion being nearly as two to one. As regards age, the liability of an individual to become the subject of gastric ulcer gradually rises from what is nearly zero at the age of ten to a high rate, which it maintains through the period of middle life at the end of which it again ascends to reach its maximum at the extreme age of ninety. Ulcer of the stomach is especially, though not exclusively, a disease of middle and advanced life. According to Ewald,1 ulcer of the stomach occurs most frequently between the twentieth and fortieth years, while its mortality is highest between the ages of forty and sixty. 1 Cruveilhier: "Anatoniie pathologique," 1829-1835, Livraison 2 W. Brinton: l. c. The frequency of ulcer of the stomach seems to vary in different localities. Thus Berthold 2 gives the percentage of ulcer of the stomach for Berlin as 2.7 per cent.; Nolte for Munich as 1.23; Gries for Kiel as 8.3; Stark for Copenhagen as

13. Von Sohlern 3 has lately called attention to the fact that the Roen Mountains and the Bavarian Alps (Germany) and the greater part of Russia are nearly exempt from gastric ulcer. He further stated that the inhabitants of these territories exist almost exclusively on a vegetable diet. As such a diet is very rich in potassium salts (containing nearly one-third more of this salt than a mixed diet), and as the red blood cells are to be regarded as the chief carriers of potassium, von Sohlern claims that this increased amount of potassium represents the cause of the relative immunity of the above-mentioned inhabitants from ulcer of the stomach. On the basis of this theory, von Sohlern recommends the administration of potassium salts and of foods rich in vegetable matter as a prophylactic measure against ulcer. His theory however, lacks the support of examination of the blood which alone could prove the correctness of the above statement. 1 C. A. Ewald: 7. c.. p. 234. 2Cited from Ewald: "Diseases of the Stomach," p. 233. 3 Von Sohlern: "Der Einfluss der Ernahrung auf die Entstehung des Magengeschwurs." Berl. klin. Wochenschr., 1889, No. 14. It has been furthermore asserted, especially by the English writers, that the frequency of gastric ulcer is greatly dependent on the various callings of life. Thus every one is familiar with the belief that cooks are especially subject to this malady. Shoemakers, porcelain makers, etc., are also mentioned as frequent sufferers from ulcer. These statements, however, are not based on correct data. Ewald, for instance, is of the opinion that even in cooks gastric ulcer is not more common than in other people. Numerous writers have endeavored to study the etiology of ulcer by the way of experiments on animals. They have produced lesions of the gastric mucosa by cutting out a piece of the inner layer or by subjecting it to different caustic chemicals, but the investigations of Griffini and Vassale' showed that the mucous membrane of the stomach of such animals quickly replaces the defect experimentally produced and that after a short while the lesion is entirely healed. Thus

these acute defects of the mucous membrane cannot properly be called ulcers, for they show no tendency to spread. From these experiments it has been concluded that in the production of the gastric ulcer there must be not only a lesion of the mucosa, but also some anomaly in the condition of the blood. Quincke and Daettvyler2 made animals anaemic by venesection and produced. 1 Griffini und Vassale: "Beitrage zur patholog. Anat." von Ziegler und Nauwerck, Bd. 3, Heft 5, p. 425. 2 Quincke und Daettvyler: Correspondenzbl. f. Schweizer Aerzte, 1875. p. 101.