Gastric Ulcer

The pain and distress that accompany this malady are due to the mechanical and chemical action of foods, and often to an excess of free hydrochloric acid. To give relief, the diet must be prescribed judiciously, and the excess of hydrochloric acid neutralized or reduced by dilution.

Although gastric ulcer is seldom recognized unless there is hematemesis, its presence may be suspected when gastric pain is constantly excited by eating and the stomach persistently contains an excess of free hydrochloric acid. Under these circumstances gastric ulcer is likely to develop, if it does not already exist. Often occult blood can be found in the stools or in the contents of the stomach although it does not occur in quantities which make it visible. As a prophylactic measure an exclusive milk diet should be prescribed for one or two weeks. This will usually suffice to correct the trouble. When hyper-chlorhydria is present - and it exists in these cases to a greater or less degree - it may be necessary to pancreatize the milk or to render it alkaline in reaction by the addition of Vichy or of other appropriate water. Two-thirds milk and one-third Vichy water form a useful mixture.

Most frequently gastric ulcer first comes under medical observation after a hemorrhage. At this time food and fluids must be forbidden, for they may provoke the recurrence of bleeding. If the stomach is filled, the bleeding surface will be stretched and the clots dislodged, starting the hemorrhage again. When resting and empty, the stomach is in the best condition to encourage clotting of blood. Nor is it best to give enemata immediately after hematemesis, since they are apt to excite peristalsis in the stomach, as well as in the intestines. Still, if the hemorrhage has been profuse or prolonged, it may be necessary to maintain strength during the first few days or week by nutritive enemata, but they should be given infrequently. In most cases hemorrhage is not so profuse or continued that the drinking of water may not be permitted in small amounts at a time. To lessen thirst and to act as a styptic, a thin solution of gelatin can be given. It can be made more agreeable by acidulating it slightly with lemon-juice. After thirty-six or forty-eight hours of abstinence from food, a small amount of milk may be given, which will rarely do harm. The amount may be increased slowly. While such dietetic care is necessary to check gastric hemorrhage, it need hardly be said that rest in bed should also be insisted upon. An ice-bag upon the epigastrium will help, too. Styptics taken into the stomach and ergot administered hypodermically must be used in the severer cases.



Hemorrhages are often slight and not repeated. A physician is sometimes not consulted until several days after their occurrence. It is then possible to institute at once the regimen for gastric ulcer. This should consist of rest in bed for from two to eight weeks, except in the mildest cases, in which gentle exercise only and long hours of rest and sleep must be prescribed. In all cases milk should be the only food. If a patient comes under treatment at the time of hemorrhage from the stomach, I am accustomed to order, after forty-eight hours of abstinence from food, milk diluted with lime-water, administered in tablespoonful doses every half or three-quarters of an hour. As a rule, the quantity may be increased rapidly to half a glassful and given at intervals of every two hours. In two or three days a glassful may be taken at a time. To each glass of milk from two to four tablespoonfuls of lime-water or double the quantity of Vichy or Selters water should be added. If the exclusive milk diet is begun in this way, it is but seldom that large curds form in the stomach. The organ is gradually habituated to this food, as it were, and learns to manage it well. On the other hand, if a glassful at a time is taken at the start, it is often curdled into large lumps and rejected. The vomiting increases the danger of renewed hemorrhage. In the mildest cases a quarter or a half glass of milk may be given at first every two hours. The milk may be taken either warm or cold, as preferred by the patient.

The pain and distress of gastric ulcer lessen and cease after the milk diet is begun. This diet should be continued for two or three weeks in mild cases, and must sometimes be continued more than two or three months in severe ones.

Milk is to be preferred to other liquid foods because it does not excite the stomach to energetic muscular action as others do, is very easily digested, helps to neutralize the acids of the stomach, is locally unirritating, and nutritious withal. If the milk diet is begun as has just been advised, even most of those persons who cannot ordinarily digest milk easily find little difficulty in using it. To a few, indeed, it is so distasteful either from the start or after it has been used long, that other foods must be substituted for it in part or altogether. If it coagulates into large lumps of cheese, it may be necessary to peptonize it before it is drunk. Ice cream may be given to those persons who are especially prone to vomit. It is not a sufficient exclusive diet, but may be used exclusively for one or two days and afterward occasionally. Matzoon, kumiss, buttermilk, laban, and other milk preparations will prove nutritious and afford variety. During convalescence Mellin's food, malted milk, and similar liquid foods may be substituted for milk or used in addition to it when a variation of food is begun. If milk cannot be used at all, these foods, and, alternating with them, beef-juice chewed or expressed from meat, or such as is prepared by Wyeth and Valentine, may be substituted for it. Egg-albumen in water can also be taken. Somatose and similar preparations may be added to these foods with advantage.

During convalescence, besides the foods just mentioned, a raw egg in milk, custard made of egg and milk, or scraped meat may be eaten, and, later, squab, the breast of chicken, oysters, fish, Zwieback, pulled bread, rice, tapioca, sago, farina, vermicelli, and broths thickened with these farinaceous foods. A little orange- and lemon-juice may also be allowed, but it should be insisted that at first a few mouthfuls only of solid food be eaten. When a small meal is permissible, these foods should be taken at usual meal-times and a glass of milk at 10 a. m., 3 p. m., and at bedtime. In order to prevent relapses, which are common, a light and very simple diet should be adhered to for several months.

This regimen is usually much aided by a glass of hot water with Carlsbad sprudel salts the first thing in the morning. The salt is important to insure regular and full movements of the bowels, besides being useful to neutralize the acid of the stomach and to cleanse it. It is rarely necessary to give much medicine. Resorcin is a useful adjuvant to diet when there is much abnormal gastric fermentation or nausea.

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