Peptic ulcer

The probable explanation of the development of a chronic peptic ulcer is that there is a lowering of local vitality. Important amongst numerous predisposing causes for this are faulty diet and nervous strain. Described types of organisms either attack the stomach and duodenum before such a devitilisation or more likely after it. The acid of the stomach tends to keep the ulcer open and to counteract a tendency for spontaneous cure. As Judd has truly remarked, "The final word concerning (the pathogenesis of) gastric and duodenal ulcer has not been spoken". Diagnosis rests particularly on two considerations. The first consideration is that following a careful clinical examination where especial note is made of the history. The second is a consideration of an X-ray examination. When operation has been advised or a post-mortem has been made, the excellence of modern radiology is proved, I have no regrets for basing my diagnosis so essentially on this ancillary science. Claims that a proper etiological basis had been found, led to the administration of histidine. Its use has been very doubtful, if not useless. A recent successful treatment of haematemesls has been described. The mortality rate is not high. The future health and working capacity of the individual is frequently impaired. Gastric acidity must be neutralised or buffered. Thus diet, alkalies and buffering agents are necessary. A reasonable proportion of cases does well. Relapses are likely in the present state of our knowledge. Routine treatments are useful. Physicians and Surgeons are co-operating to obtain a higher proportion of cures. There must, however, be a decided change from general treatment of the disease, to the individual study of the patient, and his circumstances