The practice of surgery . are at the bottom of most operable gastric dis-orders, but we must name also the complications of ulcer—pyloricobstruction; gastrectasia, or dilatation of the stomach; hemorrhage; PEPTIC ULCER 129 distortion of the stomach (hour-glass stomach); adhesions; there is that curious condition, spasm of the pylorus; stenosis ofthe pylorus in infants; cirrhosis and gastroptosis. PEPTIC ULCER It is probable that 5 per cent, or more of all mankind suffer fromgastric or duodenal ulcer, first and last. The precise frequency of suchulcers seems impossible to determine,
The practice of surgery . are at the bottom of most operable gastric dis-orders, but we must name also the complications of ulcer—pyloricobstruction; gastrectasia, or dilatation of the stomach; hemorrhage; PEPTIC ULCER 129 distortion of the stomach (hour-glass stomach); adhesions; there is that curious condition, spasm of the pylorus; stenosis ofthe pylorus in infants; cirrhosis and gastroptosis. PEPTIC ULCER It is probable that 5 per cent, or more of all mankind suffer fromgastric or duodenal ulcer, first and last. The precise frequency of suchulcers seems impossible to determine, however, and the fact that scarsof old ulcers are often found at operations and postmortem, when thepatient gave no history of symptoms pointing to ulcer, suggests thatpeptic ulcer is more common than has been supposed. The cause of peptic ulcer is still a matter of dispute, though theactual condition present seems to be a_localized necrosis acted uponpersistently by the digestive fluids. Women are afflicted, compared. Fig. 61.—Acute round ulcer with perforation (Warren Museum, Harvard, 8476). with men, in the proportion of six to four. Age has an extremelyimportant bearing on the subject, for peptic ulcer in the young is amore acute and remediable disease than is^peptic ulcer in the middle-aged. Bear in mind always this interesting fact that in 3oung womenof the chlorotic type (more rarely men) one expects acute ulcer. In men(more rarely women) between thirty and fifty one expects cnroniculcer. The acute ulcers are curable b} simple measures, as a chronic ulcers call often for surgical intervention, though bothof these statements are subject to exceptions. A majority of peptic ulcers are found in the pj^loric portion of thest_omach and the first three inches of the duodenum; and such loca-tions have an important bearing upon the complications which mayensue, as well as upon the nature of surgical treatment. Three varieties of peptic ulcer are described: (1) The a
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1910
