The question is sometimes asked, why don't the stomach digest itself? If an animal or human being be suddenly killed during digestion, the stomach will digest itself to a considerable extent. In the living stomach it is supposed that a continuous supply of fresh blood protects it from its own secretion. It would follow that if the circulation in some part was partially, or wholly destroyed, that the stomach might dissolve itself. In excessive secretion, the strong acid probably erodes the membranes in the stomach, which develop into ulcer, if the causes producing the erosion are long continued.

Probably the principal cause is pressure on the stomach, from a faulty system of dress. Other causes are indigestion, irritating foods, and a general neurotic condition of the system which seems to be closely associated with ulcer. It is most commonly found in females between the ages of twenty and forty.

The common location of ulcer is near the pyloric end of the stomach or on the anterior wall. It is also found in the intestines. The most characteristic symptom is pain at the exact spot of the ulcer, and immediately opposite in the back. The stomach is often sensitive to pressure from other diseases, but in ulcer it is particularly sensitive to pressure at the exact spot where it is located. The pain follows the indigestion of foods, and bread or vegetables give much more than milk or soft eggs. If vomiting takes place, the pain is relieved. One of the symptoms most relied on is hemorrhages, and when blood is vomited, and attended by the other symptoms common to ulcer, it is almost conclusive that ulcer exists. The patient generally grows progressively thinner, unless properly treated, and when fatal dies of starvation or perforation. There is a form of ulcer called peptic ulcer, in which the characteristic symptoms of ulcer are absent. These cases are rare, but extremely difficult to diagnose.

A patient with ulcer of the stomach should be put to bed, and no foood given in the regular way, except sips of ice water or cracked ice. The nourishment must be administered through the rectum, until the ulcer heals. The rectum must first be cleansed by an injection of water, and then about three to four ounces of pancreatin-ized meat powder, milk, or milk and eggs pancreatinized, should be administered. Some use a 20% solution of sugar, beaten with three eggs. Whichever nourished the patient most should be used, but ordinarily eggs and milk, equal parts, with a pinch of salt, will be found most useful. Five or six feedings a day will be necessary, and one of them must be water, to be retained for absorption, as water is as necessary as food.

When the stomach is healed sufficiently, feeding may be resumed by giving a teaspoonful of cold milk to begin with, but it would be advisable to first cleanse the mouth with some antiseptic wash. A few grains of powdered boracic acid with a little water and tooth brush will answer. If a teaspoonful of milk is tolerated, two tea-spoonfuls may be given at the second feeding and so on, increasing slowly, until the patient can take four or more ounces at a feeding, every two or three hours. As feeding by the stomach is resumed, the rectal feeding should be discontinued at a rate of one feeding a day. The principal diet in ulcer is milk and ice cream, which should be plainly made. It would be well not to be too hasty in increasing the diet in ulcer, for it may be necessary to live on milk and ice cream for some months. The first addition to the milk except milk diluents, that is allowable, is one egg beaten and eaten with the milk. Hot dishes are positively forbidden, as they are likely to cause hemorrhage.

During convalescence the diet should be similar to that in excessive secretion.

Cancer of the stomach is so uncommon, as to scarcely deserve mention. Various theories as to its origin have been proposed, but they are purely speculative. The origin is unknown, further than that it appears to be a hereditary tendency in a few families. It usually appears in middle life or old age. In the early stages of cancer it is difficult to diagnose as the symptoms resemble other forms of dyspepsia.

Cancer has one characteristic different from all other diseases of the stomach. It is steadily progressive, and the end soon reached. There is a gradual loss of weight, tumor in the region of the stomach, frequent vomiting, and there may be either constipation or diarrhoea. Nearly all the diseases of the stomach are more or less intermittent, except cancer, and it is usually fatal in less than a year and a half. If the disease has been recurrent, or continued for a much longer time than stated, it is not a cancer. The diet should consist of milk, eggs, meat powder, nut meal, baked apples, cream and nut oils.

The stomach is an elastic pouch, and when it is filled with large quantities of food, water or gas, it becomes distended. This weakens its walls, and whenever it will not contract to its natural size, after being distended, it is said to be dilated. Prior to 1S85, dilatation of the stomach had received but little or no attention, and the relation it bore to many diseases was unknown.

The direct cause is continued over-distention, from either food, water or gas. The injury of over-eating is well known, but over-drinking is equally bad, though not so common a cause of dilatation of the stomach. Distention from gas results from the putrefaction of foods due to indigestion or partial closing of the pylorus, called stricture. Whatever prevents the stomach emptying between meals, will cause abnormal fermentation and distention from gas. These causes have been discussed so thoroughly under causes of disease of the stomach, they need not again be repeated.

The symptoms are both local and general. It often happens that the stomach symptoms are not very pronounced, and both patient and physician are misled. Of the local symptoms, flatulency is the most common. When the stomach is most distended, the abdominal outline is greatly enlarged. If this be due to gases, the enlargement begins at the lower end of the sternum, but when due to the use of large quantities of water and beer the enlargement of the abdomen is lower. The different aspects compared with the natural outline (side view of male form) are illustrated in figure VI. Dotted line at A shows prominence of dilated stomach, beginning at end of the sternum, while dotted line at B merely shows distended abdomen. Where both conditions exist, the enlargement begins at A, and extends with increasing prominence to abdomen. We have seen a few cases where the stomach was so greatly dilated, that it would hold over four gallons. A simple way to estimate the size of a patient's stomach is to administer seidlitz powders unmixed, or by inflating with inserted stomach tube. Have the patient lie flat on the back. This will indicate the marginal outlines of the stomach.