THE TREATMENT OF GASTRIC AND DUODENAL ULCERS


Permit me to bring a few examples of our treatment. A patient complained of pain in the gastric region for a year and a half, which occurred two hours after eating and often at night, and was aggravated from smoking. The X-ray examination showed an ulcer on the anterior wall of the bulbous duodeni with gastritis. The benzidine test was twice positive, the guaiac test showed always negative.


AT THE STUTTGART HOMOEOPATHIC HOSPITAL.

(From The Pacific Coast Journal of Homoeopathy).

Argentum nitricum is also frequently used by the old school, especially if severe gastritis is accompanying. We had the best results from the 5th potency. Its most important symptoms are : pain when stomach is empty and better from the least food. Frequent eructations relieve. Desire for sweets, which however aggravate; eructations, pyrosis, flatulency, pain in stomach, which latter is of a crampy nature, radiating from the epigastrium upward. This remedy has the nervous constitution; aggravation from fright and excitement.

Bismuthum subnitricum we use less often, usually in the 2nd to 4th trituration potency; it has stomach pains immediately after eating, relieved somewhat by bending backward.

Carbo vegetabilis has full feeling and pressure in stomach after eating; distress, and tightness in abdomen; even the clothes feel uncomfortable. Temporary relief is had from eructation and passing of flatus. This is aversion to fat and fat pork; burning pains. We use the 6th potency.

Ignatia has improvement of symptoms from eating; aside from the “empty stomach pain”, there is a feeling of a lump in the throat, which cannot be swallowed. It is especially suitable for nervous children and women of changeable moods. Like Nux vomica, it has constipation with ineffectual urging. We use the 4th potency.

Anacardium orientale is the third remedy which has “empty stomach pain”; it acts on irritable, maniacal choleric patients. The stool is hard and dry without mucus, and tears fissures. It has headache with tight feeling.

Often in stomach troubles the acidity predominates. Everything, as soon as it gets into the stomach sours, sour eructations and vomiting, causing teeth to feel dull. This picture is found in Iris versicolor and Robinia, which we use in the 6th potency.

Capsicum is one of the most important remedies in this trouble, especially if burning pain is present, which is often found in the penetrating ulcers. The patients are usually indolent, shun companions, mentally and physically inactive. We prefer the 3rd or 4th potency.

Arsenicum also has the burning character of pain; burning as from hot needles. We use the 6th potency.

In many ulcer patients we find feeling of pressure and heaviness in stomach, and here the true homoeopathist also tries to differentiate in order to find the really indicated remedy distinct from many others.

Bryonia has a feeling of a heavy load in the stomach, usually immediately after meals; intolerance of fat and motion. Though this remedy has thirst for large quantities of water, yet there is aversion to warm food and drinks. The tongue is coated white; bitter taste. Irritation and peevishness is often found in the Bryonia patient; his stomach cannot stand pressure, even a careful examination is not tolerated; mucous membranes are dry; stools are hard, dry, black as if burned.

For the full feeling and pressure in stomach consult also Abies nigra 3, Pulsatilla 4 and Memordica 1.

In ulcer haemorrhage absolute rest in bed must be enforced,ice bag over stomach, and rectal feeding, to which may be added 20 drops of Geranium tincture.

We wish to give the indication for surgical intervention thus: If Roentgenograms and careful clinical examination suggest a threatening perforation, and strictly soft diet and medical treatment do not improve, then an operation must be considered in order to avoid perforation. If old ulcers have caused pyloric stenosis, then operative procedures cannot be avoided.

During 1934-5-6 at the Stuttgart Homoeopathic Hospital in 109 cases the X-rays showed the presence of gastric or duodenal ulcer and were so treated. It is interesting to see how the cases were constituted. 87 had duodenal ulcers, 19 gastric, 2 resp. parapyloric ulcers, 1 patient had gastric and pyloric ulcers.

In two cases the seat of ulcers could not be located with the X-rays with any degree of certainty because a recurrent haemorrhage was feared. The male sex exceeded the women by 78. The most cases occurred between 20 and 40. In 36 patients there was a great increase of acidity, subacidity in two, and in one case no free acid. Six cases were brought in with haemorrhage. In 29 patients the Benzidine-Guaiac rest was positive.

The Stuttgart Homoeopathic Hospital has many patients suffering from stomach troubles because, when they have been unsuccessfully treated for a long time in other hospitals, they are willing to try homoeopathy. Hence we have a long list of severe stomach cases with extensive anamnesis. When the X-ray and clinical examination is ended, the patients are put to bed. The treatment is ushered in by putting patient on a diet as prescribed by von Bergmann with the Calcium modification, or the Bircher-Brenner regimen. Local warmth is furnished by linseed poultices.

We have aimed to prove the efficacy of our homoeopathic treatment at the bedside in different diseases. If the ulcer patient, in spite of strict bed rest, diet and poultices is not free from complaints after several days, then we begin the medical treatment. The benefit derived from our remedies is then clear when they relieve, and the preliminary and previous treatments do not. Here at the Stuttgart Homoeopathic Hospital we are fortunate that we can observe our cured and now ambulant patients, so we know whether the cures are lasting or not.

The 109 ulcus cases required an average of four to five weeks hospitalization for a cure, when they are free from all complaints. I do not dare [and why not ! S.W.S.] to credit our good results to our homoeopathic remedies. It is very difficult in the clinic for internal diseases to prove that the results are unquestionably due to the remedies used, and in the treatment of ulcer cases it is almost impossible. [I disagree. If 109 cases received the preliminary treatment without relief, but improved and recovered under homoeopathic medication, is not that proof enough ? How else can we prove anything in medical science ? S.W.S].

Permit me to bring a few examples of our treatment. A patient complained of pain in the gastric region for a year and a half, which occurred two hours after eating and often at night, and was aggravated from smoking. The X-ray examination showed an ulcer on the anterior wall of the bulbous duodeni with gastritis. The benzidine test was twice positive, the guaiac test showed always negative. After six days of absolute bed rest, diet and warmth, the pain remained the same. Ignatia 4 three times daily was prescribed.

Improvement set in soon. After a few days it developed that patient did not tolerate sweets, hence Argentum nitricum 5 was given. The symptoms disappeared entirely during the 31 days of hospitalization, and even resumption of work did not cause any further trouble. Four weeks after the patient was dismissed the X-rays did not show any ulcer manifestation, and the gastritis was much diminished. A lady of 62 came to us on account of a bleeding duodenal ulcer. An a cute intestinal haemorrhage had occurred four years previous, which was then diagnosed as duodenal ulcer. Now there was nausea and retching.

Ipecacuanha 6 three times daily was given, and the diet was mucilaginous; bed rest and epigastric ice packs were ordered. A secondary anaemia was present with 58 per cent. haemoglobin and 3,380,000 erythrocytes. After three days there were no tarry stools, and the general condition improved. After two weeks the guaiac test was negative, and only the benzidine test showed faintly positive.

After four weeks, when recurrence of haemorrhage was not expected an X-ray examination was made, which showed a large penetrating ulcer on the posterior wall of the bulbous duodeni, and a small nick on the anterior wall. Since there was still pressure in the gastric region, and occasional pyrosis, Carbo animals 6 was given three times daily instead of Ipecacuanha. After fifty days hospitalization the patient was dismissed cured.

Frequently severe constipation accompanies ulcer, which makes it especially unpleasant when strict bed rest and soft diet must be insisted upon.

A women of 24 showed in the X-ray examination an ulcer situated high up on the lesser gastric curvature, as also an ulcer on the bulbous duodeni. The fractional gastric siphoning after alcohol ingestion showed increased acidity, plus 65 free HCL and plus 80 total acidity. Occult blood was absent from the faces. The blood picture was normal, the sedimentation speed of the erythrocytes was accelerated to medium values. The symptoms vanished after seven days of bed rest and soft diet, but a severe constipation remained. The patient has the feeling that “nothing stirred” within. Opium 6 three times daily was given.

After a few days patient felt frequent, but ineffectual urging to stool. We changed from Opium to Nux vomica, of course, which was given in the 4th potency twice daily. After that the bowel movements were normal and remained so during the further 20 days of hospitalization. When patient was dismissed, the skiagraph failed to show any duodenal irregularity, and only a slight gastritis remained. When the patient called three weeks later, she was well, and the constipation was also cured.

In a man of 49 the skiagraph showed a duodenal ulcer and gall stones. There was a hyperacidity of plus 80 free HCL and plus 98 total acidity, and the stools reacted positive to benzidine and guaiac tests. After six days of total rest and soft food, there still were severe symptoms indicating Anacardium; crampy pains in stomach when empty and nights, but relieved by drinking a little milk. Besides, patient had a stubborn constipation. After taking Anacardium 6 for four days the constipation was relieved, and the other symptoms gradually subsided during the four weeks hospitalization, and he gained 18 pounds in weight.

The X-ray showed in a 31 year old lady an ulcer on the posterior duodenal wall with gastritis. Bed rest and ulcer diet relieved the pain in a few days, but when mashed potatoes were added to the diet, all symptoms promptly returned. Patient stated that s weeks always increased her troubles and caused pyrosis. She also complained of pressure in the gastric region, even the clothes were not tolerated. The gastric symptoms were worse form excitement and exertion. After taking Argentum nitricum 5 for a few days, the symptoms were relieved, and did not return when her diet was added to. A few weeks after her dismissal she came back to report that she was well. The X-ray showed that the ulcer had completely disappeared, and the gastritis was much improved.

A patient of 68 complained of severe burning pains in the stomach which were not improved by large doses of Atropinum in ambulant treatment. The fluoroscopic examination showed an ulcus niche of sharply circumscribed walls a centimetre deep. The mucous membrane picture was large with a three-finger-high ridge. A previous examination showed plus 56 free HCL and plus 76 total acidity.

Occult blood proved by the benzidine-guaiac test. Aside from ulcer diet and bed rest Capsicum 3 was given on account of the ulcer and the burning pain. Soon the pain abated, the general condition improved and patient gained 6 pounds. The control X-ray examination showed only a minute remnant of the large ulcer, and there was no occult blood present.

E. Hanke