| VOL. I. | FEBRUARY, 1886. | No. 4. |
ORIGINAL LECTURES.
ULCER OF THE STOMACH.
A LECTURE BY PROF. L. OSER OF VIENNA, AUSTRIA.
[Translated for the Cleveland Medical Gazette by Dr. C. Rosenwasser].
Gentlemen! The disease which we intend to study to-day isone, the traces of which are found much oftener at post-mortemsthan the disease itself in the clinic. A great many cases areoverlooked and improperly diagnosed for reasons which I shallstate hereafter.
It has been called by various names. Round ulcer, perforatingulcer, chronic ulcer, corroding ulcer and simple ulcer areonly different designations for one and the same condition. Iprefer to call it peptic ulcer, as it is always the result of self-digestionof a part of the walls of the stomach, but is not alwaysround, nor perforating, nor chronic, nor corroded; nor is it alwayssimple, several ulcers having occasionally been found in oneand the same stomach.
Pathologists have not yet come to a positive decision on themodus operandi of its origin, but several conditions are mentionedas necessary for its development.
1. The self-digestion of a part of the stomach by the gastricjuice.
2. Disturbances of the circulation of the blood in the wallsof the stomach.
3. The alkalinity of the blood circulating in the walls of thestomach prevents the digestion of the mucous membrane. Ifthis action on the walls of the stomach is prevented in any way,the development of an ulcer is aided. This clause has beenaccepted until recently, when it has been rendered somewhatdoubtful by the results of certain experiments.
The first clause is sustained by the fact that the peptic ulceris only found in those parts which are brought into direct contactwith the gastric juice. It is further proven by the softeningof the stomach so frequently found at post-mortem. But aslong as the circulation of the blood in the walls of the stomachis normal, ulcers do not form. The formation of an ulcer in thestomach presupposes a local disturbance of the circulation. Itis usual to find thrombi and diseases of the bloodvessels in caseswhere ulcers of the stomach occur. For this reason the latteris more common in anaemic persons where the circulation isretarded and the bloodvessels frequently subject to fatty degeneration.
Virchow regards embolism of a small vessel as the origin ofulcer of the stomach. Cohnheim disproved this beyond doubtby showing that there is an abundant circulation in the walls ofthe stomach by which the parts affected are again quickly suppliedwith blood. Klebs takes for granted a spasmodic contractionof single bloodvessels as the cause of the retardation ofthe circulation, while Rindfleich attributes it to the poor anastomoticconnection of the gastric veins. He calls attention tothe frequent coincidence of ulcer and hemorrhagic infarct in thewalls of the stomach. Cohnheim injected chr