Beer should never be taken by one who has suffered from gastric ulcer. In fact it is well for all who have stomach trouble to avoid the use of beer, especially such as have had ulcer. Such patients have to be on their guard in matters of diet through the remainder of their lives, and must avoid excesses both in eating and drinking. You will occasionally come across persons who can not stand a milk diet in any form whatever. They frequently do not bear eggs well. In such cases I proceed at once, but with great care, to the use of meat in very small quantities, finally chopped and roasted, and have it taken several times a day. You will frequently have to try one article of food and then another, and experiment for awhile before you reach that form of diet which suits the case best.
There are a number of substitutes, some of which are really good, while others are worthless. Of them all I prefer the fresh meat juice ext. carnis recent. pressum, and have it prepared in the following manner: The meat (beef should be used) is cut into thin slices, placed between pieces of tissue paper, and pressed in a hydraulic press. The juice thus obtained is given in teaspoon doses every half hour or so, just as though it were medicine. In the majority of cases I have the meat juice made by the druggist, so that a large number of the patients think it is medicine. It has a rather pleasant taste and is well borne by the stomach. There are a great many peptones in the market, a large number of which ought not to be used, as they are not fresh and more likely to do harm than good. Of them all the English make is the best, as it is usually well preserved, being packed dry.
Patients who can only take a small quantity of nourishment by the stomach can be materially aided by the use of nutritious enemata given luke warm once or twice a day. When the rectum is very irritable a suppository containing one-half to one grain of ext. opii given a half hour before the enema is very serviceable. There are a great many other remedies recommended in the text books, but I would advise you not to rely too much on them. Lay your main stress on the dietetic part of the treatment, and use remedies only where they are absolutely necessary to support this. Among the remedies used the alkalies are the most valuable. Bicarbonate of soda alone, or in combination with ext. belladonna when the stomach is very irritable.
℞ Sod. Bicarb., ʒiss.
Ext. Belladon., gr ii. Misce et div. in pulv. XVI.
Sig. One in the morning and one in the evening.
Or I sometimes substitute atropia sulph. (1/120 gr. pro dosi) for the belladonna. At any rate the use of alkalies is the most plausible treatment. But the permanent alkalization of the contents of the stomach by the frequent use of large doses of alkalies, as has been recommended in Paris by Debove is not plausible, as by this the process of digestion would be checked entirely.
It is also good to give a dose of Carlsbad salts in the morning every two or three days, in order to correct the constipation usually attendant upon such a course of diet. These salts also aid in rendering the contents of the stomach more alkaline, and in this way aid the plan spoken of before.
I do not think it advisable to send patients with gastric ulcers to health resorts or watering places. They can only regain their health by a strict enforcement of dietetic measures, and these can be carried out just as well at the patient's home as at the health resort. For the treatment of such cases after the ulcer has healed, these health resorts can be of great benefit, but the patient must be cautioned not to commit excesses in eating or drinking, especially to the latter must their attention be called, as it is customary in most resorts adapted to such cases, to drink large quantities of the medicated waters in the morning. It is also well to caution the patients with regard to their diet before sending them away. This should be unirritating, bland and easily digestible. Among the European health resorts, Carlsbad is the most suitable for such cases.
There are unfortunately some patients who are not benefited by any method of treatment hitherto thought of, but luckily they are few, and if you will follow the rules I have laid down you will in a great many cases meet with splendid results.
One important question still remains to be answered, namely: "What should be done in case of hemorrhage of the stomach?" Here the patient must be left quiet just where he happens to be—placed in a horizontal position on his back if possible. Ice bags should be applied to the region of the stomach, small pieces of ice swallowed, and hypodermic injections of ergotin given. This is all that can be done with benefit in such cases. The patient should not be transported for several hours. Monsel's solution can be of no service, as it cannot be introduced into the stomach in a sufficient concentration to be of benefit.