Treatment. The pain is the most important criterion as a guide during the treatment. It is the signal by which I judge of the present condition of the ulcer. According to the variation of its character and intensity, I can judge whether the ulcer is healing, is remaining stationary, or is spreading and increasing in size or depth in spite of the treatment. If the pain has been removed permanently the ulcer has been healed. From the relation of this symptom to different kinds of food you can also judge of a progress or improvement of the ulcer.
Theoretically considered, that form of treatment would seem the best which gives the stomach absolute rest, entire abstinence from food, a fast of several weeks. But this can not be carried out in practice. The patient could be nourished per rectum, you might say, by means of nutrient enemata. In my opinion this method of nourishment does not amount to much. I believe that very little water is absorbed by the rectum, the patient would suffer from thirst and you would then be compelled to allow him to drink water at least.
Luckily we do not need to resort to such extreme measures in the majority of cases. With the exclusive use of the proper bland, liquid food, we usually attain the same results. In the treatment of gastric ulcer I lay the main stress on the restriction and regulation of the diet, and put the patient on an exclusive milk diet. Milk contains all the constituents necessary for the nourishment of the human body.
I begin by giving every half hour to one hour a small quantity of skimmed, boiled milk, which has been cooled on ice. The patient must rest in bed or on a lounge, as he is weakened by the treatment, and can not follow his usual avocation. I forbid all other articles of food. With this diet a patient with ulcer should have no pain and usually has none. Should there be pain it is necessary to find out whether the feeling described as such be not simple oppression, or a feeling of weight in the stomach. Some patients do not seem to digest milk well. It ferments, forms gases and then they have this feeling of oppression. Some drink the milk too fast and take too much at a time, swallowing a lot of air with the milk, thus distending their stomachs unnecessarily. The patient must be instructed to drink the milk slowly, and only take a small quantity at a time (about one or two ounces). Some patients can not stand iced milk but bear luke warm milk much better. Others seem to prefer milk which has slightly soured.
The patients should adhere to this strict diet as long as possible, regulating the length of time according to the duration and intensity of the disease. They have to observe the above rules one or two weeks at least, several weeks if possible.
Often you will meet with the reply: "I have already tried this diet, I was put on milk diet once before by Dr. —— and it did not help me any, I even felt worse afterwards." If you inquire more closely, however, you will find that they drank milk several times a day, but ate bread with it, soaking this in the milk. This is what is understood to be a milk cure. Gentlemen! I am sorry to say that this misunderstanding is not confined to the general public, but that some physicians even do not know better, and consider such a course of diet a milk diet. I cannot impress it upon your minds any too strongly not to allow yourselves to be diverted from your purpose by any such assertions, but to order another course of milk diet, wherever you find it indicated, and see to it that it is carried out properly this time. You will thereby occasionally meet with excellent success where a previous wrong attempt in the same direction failed.
After the patient has been free from pain from eight to ten days, I then add to his diet soft boiled eggs with a slight addition of salt, beginning on the first day with one half of an egg. If this is well borne I gradually allow more day by day, until he is able to digest four or five a day without difficulty. Eggs do not agree with some patients. In such cases I pass on the use of meat. I have beefsteak chopped fine, roasted in little meat cakes of the size of a silver half dollar. One of these is given to begin with, and if well borne repeated every two or three hours as long as there is no pain. When eggs agree I prefer to give them for a few days before beginning with the meat, waiting until such patients can digest four or five eggs a day. After the meat has been borne well in small quantities for a while, I gradually increase the quantity taken per day until it reach a pound or two.
You cannot be too careful and should instruct the patient to return to the strict milk diet as soon as any pain is felt, no matter how nicely he may have been getting along up to the time. Not until the patient has been entirely free from pain for several weeks is it advisable to allow the use of cereals boiled in milk, such as rice or tapioca. Then he can also be allowed to take a quarter of a biscuit (well baked) at each meal. A full meal, however, in the sense in which it is ordinarily understood, a large quantity of food taken at one time, is still to be avoided. It is better to give small quantities of food oftener, in order not to distend the stomach, and thus run the danger of too great a strain upon the newly healed ulcer.
These meat cakes made of beef can be taken for a week or so, and then if well borne other kinds of meat may be occasionally substituted.
Wine and alcoholic liquors in general are to be avoided for several months.