A PRELIMINARY report of 100 cases of gastro-duodenal ulcers treated during the past three years.
We term this medical treatment “gastric collapse” to distinguish it from the Sippy and Alvarez treatments and their modifications wherein bland fluids an semisolids often with alkalies re given frequently, i.e.m every hour or two hours.
More than half of our ambulatory cases are relieved of their symptoms by a bland diet.
Up to the present the profession has generally accepted the theory that heavy foods induce hyperacidity that finally cause ulcer and that frequent bland liquid feeding coupled with rest in bed for six to eight weeks neutralize that acidity, thereby inducing healing of the ulcer.
We put the ulcer patient in bed after an x-ray of the lesion has been made;wish the stomach through a Levine tube and then given four ounces of mineral oil and one ounce of castor oil through the tube and remove the ounce of castor oil through the tube and remove the tube. We then insert a gold Hendon canula into the saphenous vein at the inner malleolus or cephalic vein three inches above the elbow and give thirty to forty drops per minute or five to eight pints of 5 per cent dextrose-saline daily for give days. The sixty day another x-ray is taken with exactly the same angle of exposure; if; if the ulcer is healed the patient is given a bland diet and discharged. If hot healed and a crater is still present the treatment is continued for for five days more.
We have abundant evidence now to confirm our belief that corporic, Prepyloric, postpyloric and jejunal ulcers will heal thus rapidly.
Surgery-There are only cases of calloused ulcer that heal all right but leave the stomach distorted or obstructed at the pylorus and that need surgery-and simple gastrojejunostomy is the most satisfactory procedure in our hands. We have been disappointed in all forms of pyloroplasties. In badly distorted stomachs we have excellent results with the Devine exclusion operation.
Colonic Fecoliths-Upon opening the abdomen for gastric operations we have long since noted the frequency of obstruction of he colon by fecal noted the frequency of obstruction of the colon by fecal masses that were often so hard in consistency as to warrant the term fecolith. Moreover, the colon was often so contracted and dehydrated that we could not strip the hard fecal masses downward toward the rectum without damage to the mucosa.
This colonic impaction obviously produces various degrees of intestinal obstruction with reverse peristalsis that retards the emptying time of the stomach regardless of the amount of organic ulcer-scar obstruction at the pylorus-facts that must interest the radiologist as well as the physician and the surgeon. Furthermore, we noted that there was often postoperative regurgitation of bile and feces into the stomach for many days that would have meant fecal vomiting had we not kept the Levine tube in place constantly.
It occurs to us as possible if not probable that the much feared”vicious circle”-supposedly due to a long jejunal loop of certain gastrojejunostomies- may be caused by a score of unrecognized fecoliths in the colon.
We wish also to report that ten or twelve days sometimes elapse before these fecal mass are recovered and the lumen of the colon is clear throughout, and duodenal and jejunal regurgitation ceases, and the stomach empties.
This experience taught us the wisdom of the preliminary oil treatment outlined above in all cases and especially before any operative treatment.
Gastric neuroses, protracted vomiting of hysteria etc-The treatment described above has a place in the management and cure of these unfortunates for such patients in our hands have been relieved of the gastric phase of their hysteria.
Our chief remedies are hydrastis canadensis, arsenicum album, pulsatilla, ignatia and nux moschata.
Summary:description of a method of healing gastric ulcers in fasting stomachs.