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                              === THE ===

                       Cleveland Medical Gazette

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  _VOL. I._                _FEBRUARY, 1886._                    _No. 4._
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                          ORIGINAL LECTURES.

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                         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 is one, the
traces of which are found much oftener at post-mortems than the disease
itself in the clinic. A great many cases are overlooked and improperly
diagnosed for reasons which I shall state hereafter.

It has been called by various names. Round ulcer, perforating ulcer,
chronic ulcer, corroding ulcer and simple ulcer are only different
designations for one and the same condition. I prefer to call it
_peptic ulcer_, as it is always the result of self-digestion of a part
of the walls of the stomach, but is not always round, nor perforating,
nor chronic, nor corroded; nor is it always simple, several ulcers
having occasionally been found in one and the same stomach.

Pathologists have not yet come to a positive decision on the _modus
operandi_ of its origin, but several conditions are mentioned as
necessary for its development.

1. The self-digestion of a part of the stomach by the gastric juice.

2. Disturbances of the circulation of the blood in the walls of the
stomach.

3. The alkalinity of the blood circulating in the walls of the stomach
prevents the digestion of the mucous membrane. If this action on the
walls of the stomach is prevented in any way, the development of an
ulcer is aided. This clause has been accepted until recently, when
it has been rendered somewhat doubtful by the results of certain
experiments.

The first clause is sustained by the fact that the peptic ulcer is only
found in those parts which are brought into direct contact with the
gastric juice. It is further proven by the softening of the stomach so
frequently found at post-mortem. But as long as the circulation of the
blood in the walls of the stomach is normal, ulcers do not form. The
formation of an ulcer in the stomach presupposes a local disturbance
of the circulation. It is usual to find thrombi and diseases of
the bloodvessels in cases where ulcers of the stomach occur. For
this reason the latter is more common in anaemic persons where the
circulation is retarded and the bloodvessels frequently subject to
fatty degeneration.

Virchow regards embolism of a small vessel as the origin of ulcer of
the stomach. Cohnheim disproved this beyond doubt by showing that there
is an abundant circulation in the walls of the stomach by which the
parts affected are again quickly supplied with blood. Klebs takes for
granted a spasmodic contraction of single bloodvessels as the cause
of the retardation of the circulation, while Rindfleich attributes
it to the poor anastomotic connection of the gastric veins. He calls
attention to the frequent coincidence of ulcer and hemorrhagic
infarct in the walls of the stomach. Cohnheim injected chromate of
lead into the gastric branch of the splenic artery in animals, and
when he succeeded in cutting off the arterial supply of the mucous
and subm