Antacids in the Medical Management of Peptic Ulcer

Abstract

the median number of rubs. This, however, is easily explained. It means merely that the more susceptible patients develop mercurialism, not only after a smaller number of rubs, but of a type that progresses in sever¬ ity much more rapidly than with the less susceptible patients.The* results of all the series show that the average susceptibility is strikingly uniform in different series, if a sufficient number of patients is observed. They show also, however, that the susceptibility of a consid¬ erable number of individual patients differs widely from this average. If we give to the average a latitude as wide as from eleven to nineteen rubs, we find, in 112 observations (combining all the series), that fifty-five patients, or 49.1 per cent., are within this range; twenty-five patients, or 22.3 per cent., require less than eleven rubs (from five to ten) ; thirty-two patients, or 28.6 per cent., require more than nineteen rubs (from twenty to thirty-eight) ; i. e., about half of the patients require from eleven to nineteen rubs ; about a fourth require less and another fourth more than this number. Among the factors that might be concerned in these variations of susceptibility may be named:A. Locally: (1) Condition of the teeth.(2) Oral hygiene during administration. B. Systemically : (3) Idiosyncrasy and resistance. C. Excretion : (4) Renal efficiency. D. Absorption: (5) Efficiency of inunction.(6) Condition of the skin. Differences in the energy of inunction and in the oral hygiene, which play a large rôle ordinarily, prob¬ ably play a relatively small part in this series, since precautions were taken to secure uniformity in these respects. No systematic attempt was made to distin¬ guish between the other causes, but we were rather impressed with the importance of the condition of the skin as a factor in absorption. Thus, in the present series, there were five patients who had extensive, gen¬ eralized, miliary, papular syphilids : all were salivated by few rubs (7, 7, 9, 10 and 11 ; the 9 rub patient "old style," the others with improved technic). Another congenitally syphilitic patient had an ichtbyosis ; mer¬ curial effects started early, and severe salivation resulted after fifteen rubs ("improved technic"). When the skin is diseased, it may be supposed that the oint¬ ment may obtain direct access to the stratum mucosum through fissures. We have also gained the impression (but have not sufficient data for a decisive judgment) that patients whose skin is abnormally dry tend to be hypersusceptible, perhaps because such skins are more easily fissured, or perhaps because the ointment can be rubbed more easily into the ducts when the glands are not actively secreting. This would be somewhat analogous to the observation of McConnell a that indi¬ viduals with a very dry skin were more prone to indus¬ trial dermatoses. His observations were made in studying dermatoses due to cutting oils, and the erup¬ tions seen in printers. He explains this phenomenon as due to the fact that the epidermal cells of patients with a dry...

Experimentally Produced Peptic Ulcers

“…These findings were confirmed by Shattuck, Rohdenburg and Booher. 3 Gatewood and his co-workers,4 however, in a series of forty-six patients with peptic ulcer treated by the Sippy method, found that there was no definite evidence that the alkalemia observed was productive of any renal change. Definite nephritis was not recognized in any patients in whom alkalosis later developed.…”

“…In about 50 per cent of the animals thus operated on, peptic ulcer developed in the duodenal mucosa at the usual site for the development of duodenal ulcer in man. 3 Finally, the entire normal mechanism for receiving the acid gastric contents was eliminated by the func¬ tional resection of the duodenum together with the secretion poured into it. This was accomplished in the following manner : The pylorus was sectioned and the distal end inverted; the jejunum was transected a few centimeters distal to the ligament of Treitz ; the distal end was anastomosed to the pylorus, and the proximal end was anastomosed to the ileum from 30 to 60 cm.…”

“…The fact that subacute or chronic ulcers developed so readily under such experimentally produced conditions, in spite of the fact that it has been difficult to produce the lesion experimentally by other methods, indicates that so far as the ulcers we are studying are concerned 3 acidity is an important factor in causation. It was thus desirable to know definitely the changes in the pH of the gastro-intestinal tract with particular refer¬ ence to the variations occurring at the pylorus or at the ulcer-bearing area.…”

Chloride Metabolism and Alkalosis in Alkali Treatment of Peptic Ulcer

“…40 Citrates have been used in very small doses in the treatment for peptic ulcer.41 Both acid and basic chlorides are lost in aspirations and vomiting. 40 Citrates have been used in very small doses in the treatment for peptic ulcer.41 Both acid and basic chlorides are lost in aspirations and vomiting.…”