[Reprinted from The Medical News, October 8, 1892.] 
G ASTRIC ULCER IN A CHILD TWO AND A HALF 
YEARS OLD. 
By JAMES F. E. COLGAN, A.M., M.D., 
CLINICAL ASSISTANT, ORTHOPEDIC DEPARTMENT, JEFFERSON MEDICAL 
COLLEGE HOSPITAL. 
On May 26, 1892, at 8 p.m., I was called to attend 
L. H., two and a half years old, who was said to be suffer- 
ing with spasms. The temperature was 106°; the pulse 
about 150, rather full and tense ; the breathing was ster- 
torous ; and all of the voluntary muscles of the body 
were in active contraction. There were also involun- 
tary evacuations from the bladder and rectum. 
The history I obtained from the parents was as fol- 
lows : The child had been perfectly well until 11 o'clock 
that morning, when she came in from the street, saying 
she did not feel well. There was no vomiting, and no 
complaint of pain. The mother had examined the 
stools for worms, but had failed to find any. The first 
dentition had been passed. The child did not eat any- 
thing, and lay on a lounge until I was called. The 
convulsions were readily controlled, and consciousness, 
which had been lost from the beginning of the attack, 
was beginning to return when another convulsion oc- 
curred, apparently limited to the diaphragm, and ter- 
minating fatally at 12 o'clock. 
At the autopsy I was greatly surprised to find a per- 
forating ulcer of the stomach. The high temperature 
had led me to suspect either beginning scarlatina or 
meningitis. Against meningitis was entire absence 2 
of pain of any kind; there was no headache, no fretful- 
ness-in fact, no symptom indicative of intra-cranial dis- 
ease. Against scarlatina was the absence of eruption 
and sore-throat. 
Convulsions in childhood are due to many causes, but 
in this case I could find nothing to account for them 
until the autopsy disclosed the existence of a] gastric 
ulcer. 
In looking over the literature of the subject I find that 
several of the text-books on diseases of children do not 
even refer to gastric ulcer-an indication of its great 
rarity in young children. In Keating's Cyclopedia of 
the Diseases of Children fourteen cases are mentioned, 
of which only five were in children under three years of 
age. The great majority occurred in strumous or anemic 
subjects. 
In the case here reported the child was well nourished 
-in fact, the parents stated that for the last year every- 
thing it ate appeared to be converted into flesh. 
Different observers have located ulcers in different 
parts of the stomach. In this case the ulcer was on the 
posterior wall, at the cardiac extremity, close to the 
greater curvature. In some places there was an entire 
loss of substance, the floor of the ulcer being made 
up only of peritoneum. There was thickening of other 
parts of the stomach, especially on the anterior wall, 
extending to the lesser curvature. 
Various causes have been assigned for ulcer of the 
stomach, such as malnutrition due to altered states of 
the blood; anemia; chronic congestion, as in chronic 
gastritis. Ulceration may also follow diseases of the left 
side of the heart in the course of which the branches of 
the gastric artery become plugged with emboli. 
The cause of the ulcer in the case here reported was 
likely chronic gastric catarrh. The stomach was thick- 
ened in several places ; the mucous membrane appeared 
also to be swollen. The child had, no doubt, been 3 
allowed to eat everything that it wished. A gastric 
catarrh developed, which, becoming chronic, was event- 
ually followed by ulceration and perforation, with re- 
sulting peritonitis, to which must be ascribed the con- 
vulsions and death. 
What surprised me greatly was the entire absence of 
suggestive symptoms ; vomiting might have been pres- 
ent and not have been noticed; but the entire absence of 
pain, the age of the child, and its condition, were not 
calculated to suggest the existence of ulceration of the 
stomach.