War Surgery and Medicine
Pain was the chief symptom, although in the nervous group complaint of vomiting was just as frequent. Assessment of pain was page 625 difficult as it depends on the subjective sensibility, and the neurotic always tended to exaggerate his symptoms. In the ulcer and the ‘ulcer-like’ groups, pain was described as burning, aching, or gnawing. In the nervous group it was variously described as burning, aching, dragging, stabbing, pressing, sinking, cramping, and knot-like. Some actually likened it to a ‘lump of ice’, others to ‘turning rollers’ or ‘rattling nails’. In the ulcer cases, both duodenal and pyloric, pain tended to come on two hours after a meal and to disappear immediately afterwards. In the ‘ulcer-like’ group the time interval after meals was often less than two hours, while in 51 per cent of the neurotics pain and meals had no constant relationship. In the nervous group the situation of pain was variable, e.g., near the umbilicus, over the whole abdomen, in the iliac fossae, or if it happened to be epigastric, right across the epigastrium. In most of the ‘ulcer-like’ cases and in all the ulcers pain was felt in one small area of the epigastrium. Periodicity was less common in the nervous group, many of whom complained of ‘constant pain’ or ‘pain every day’. Alkalies relieved only 37 per cent of the nervous cases, while some even complained that it aggravated their pain. Appetite tended to diminish as one passed from the ulcer to the neurotic group.
Although many patients, especially the neurotics, complained of loss of weight, undernourishment was evident in only a few.