Ulcer Of The Stomach
( Originally Published 1936 )
The general conception of indigestion may be summed up very simply by saying that the common belief is that it is due to inflammation or irritation of the stomach lining and that it is caused by eating the wrong kind of food.
The medical profession would, I believe, unanimously reject both of these propositions.
Inflammation of the stomach—gastritis—either acute or chronic—in the strict interpretation of the term is a myth. In fact, actual disease of the stomach itself—organic disease—is, compared to the entire group of people who complain of indigestion, comparatively rare. Most indigestion is due to reflex, emotional or constitutional abnormalities.
Of the various sorts of actual stomach disease, the commonest by a long ways is ulcer.
"Ulcer of the stomach," people say. You hear many of them saying it. "I have ulcer of the stomach." The medical man who is careful of his words says, "Peptic ulcer." For the ulcer may be in the stomach, in which case it is a gastric ulcer. Or it may be just outside the pylorus or opening of the stomach, in which case it is a duodenal ulcer. Or like those men of the king of France who when they were half way up the hill were neither up nor down, it may be partly in the stomach and partly in the duodenum, in which case it is a saddle ulcer, or a pyloric ulcer, or a gastro-duodenal ulcer.
What causes ulcer? Everybody wants to know that. Any medical man who might happen to read this will probably sneer when he arrives this far, and he will feel very superior because he is aware that no one knows the cause of ulcer.
Perhaps not, but we can make a reasonable guess at it. What is an ulcer anyhow? Ulcers occur elsewhere on the body and there is no reason to suppose that ulcer of the stomach is different from any other sort of ulcer.
An ulcer is a solution of continuity on a mucous membrane. Ulcers of the skin are caused by varicose veins: one cause of ulcer, then, is sluggishness of the circulation. Another form of skin ulcer—perforating ulcer of the sole of the foot—is caused by the plugging of an artery. Ulcers may be caused by destruction of tissue from chemicals. Ulcers, such as those of the cornea of the eye, are caused by infection.
Applying these to peptic ulcer, sluggish venous circulation cannot be demonstrated near peptic ulcer, so it may be discarded as a cause. Plugging of an artery cannot be demonstrated. There is always (that is not too strong a term) an increased amount of hydrochloric acid in the stomach contents in ulcer. Here, then, is a chemical factor, named above as one of the causes of any ulcer. We know the gastric juice destroys dead tissue. If a part of the stomach wall were destroyed by infection, the excessive hydrochloric acid would keep that spot open. Which would be an ulcer.
While there is admittedly no certainty about it, then, the probabilities are that peptic ulcer is caused by infection destroying the gastric or duodenal mucosa and the ulcer is kept open by the excessive hydrochloric acid of the gastric juice.