62 Berlin. klin. Wochenschrift, 1883, No. 51.
63 Shattuck, Boston Med. and Surg. Journ., June, 1880, vol. ciii.
Other complications, such as pulmonary tuberculosis, valvular disease of the heart, general atheroma of the arteries, cirrhosis of the liver, syphilis, chronic Bright's disease, waxy degenerations, and malaria, have been considered under the Etiology, and some of them will be referred to again in connection with the Pathology, of gastric ulcer. In most instances when ulcer is associated with these diseases the ulcer is secondary.
SEQUELÆ.—The most important sequelæ of gastric ulcer are changes in the form of the stomach in consequence of adhesions and in consequence of the formation and contraction of cicatrices. These lesions are most conveniently described under the Morbid Anatomy. The symptoms of the most important of these sequels—namely, stenosis of the pylorus with dilatation of the stomach—will be described in another article.
MORBID ANATOMY.—As regards number, simple ulcer of the stomach is usually single, but occasionally two or more ulcers are present. It is not uncommon to meet in the same stomach open ulcers and the scars of healed ulcers. According to Brinton, multiple ulcers are found in about one-fifth of the cases. In one case O'Rorke found six ulcers on the anterior wall of the stomach.64 Berthold mentions a case in which thirty-four ulcers were found in the same stomach.65
64 Trans. of the New York Path. Soc., vol. i. p. 241. Wollmann mentions the occurrence of over eight simple ulcers in the same stomach (Virchow und Hirsch's Jahresb., 1868, Bd. ii. p. 126).
65 Op. cit., p. 21. It is expressly stated that these were not hemorrhagic erosions, but deep corrosive ulcers.
The usual position of simple gastric ulcer is the posterior wall of the pyloric portion of the stomach on or near the lesser curvature. Ulcers of the anterior wall are rare, but they carry a special danger from their liability to perforate without protective adhesions. The least frequent seats of ulcer are the greater curvature and the fundus.
The table on page 504 gives the situation of 793 ulcers recorded in hospital statistics:66
| Lesser curvature | 288 | (36.3 per cent.) |
| Posterior wall | 235 | (29.6 per cent.) |
| Pylorus | 95 | (12 per cent.) |
| Anterior wall | 69 | (8.7 per cent.) |
| Cardia | 50 | (6.3 per cent.) |
| Fundus | 29 | (3.7 per cent.) |
| Greater curvature | 27 | (3.4 per cent.) |