The relation between age and perforation of gastric ulcer will be discussed in connection with this symptom.
The conclusions concerning the age of occurrence of gastric ulcer may be recapitulated as follows: Simple ulcer of the stomach most frequently develops in the female between twenty and thirty, and in the male between thirty and forty. At the post-mortem table it is found with almost equal frequency in the four decades between twenty and sixty, but clinically it appears with greatly diminished frequency after forty years of age. In infancy and early childhood simple ulcer of the stomach is a curiosity.
We have no positive information as to the influence of climate upon the production of gastric ulcer. The disease seems to be somewhat unequal in its geographical distribution, but the data bearing upon this point are altogether insufficient.
According to the returns of Dahlerup and of Grünfeld, gastric ulcer is unusually common in Copenhagen.22 According to Starcke's report23—which, however, is not based upon a large number of cases—the percentage is also unusually high in Jena. Sperk says that gastric ulcer is very common in Eastern Siberia.24 Palgrave gives a high percentage of its occurrence in Arabia.25 The disease is less common in France than in England or in Germany,26 and in general appears to be more common in northern than in southern countries. The statement of DaCosta27 coincides with my own impression that gastric ulcer is less common in this country than in England or in Germany. I have found 6 cases of open ulcer of the stomach in about 800 autopsies made by me in New York.
22 Dahlerup in Copenhagen (abstract in Canstatt's Jahresbericht, 1842) found 26 cases in 200 autopsies (13 per cent.) made in the course of a year and a half. Grünfeld (loc. cit.) found 124 cicatrices in 1150 autopsies (11 per cent.).
23 Starke (loc. cit.) found 39 cases in 384 autopsies (10 per cent.); cf. also Müller, Jenaische Zeitschr., v. 1870.
24 Deutsche Klinik, 1867.
25 Narrative of a Year's Journey through Central and Eastern Arabia, London, 1865.
26 Laveran and Teissier, Nouveaux Éléments de Path. et de Clin. méd., t. ii. p. 1060, Paris, 1879; and Godin, Essai sur l'Ulcère de l'Estomac, Thèse, Paris, 1877, p. 8.
27 Medical Diagnosis, 5th ed., Philada., 1881. Keating expresses the same opinion in the Proc. of Path. Soc. of Philadelphia, vol. i. p. 142.