In the more recent publications dealing with any
branch of the wide subject, comprised under the heading of
"Peptic Ulcer ", the authors have in many cases prefaced
their remarks with an apology for adding to the already
over -burdened literature. If, in offering a thesis on
"Duodenal Ulcer ", the writer feels that he is exempt from
the necessity of making such an apology, it is not because
he can claim to have added anything to our knowledge of
the subject, but rather from the very opposite reason.
In this thesis is to be found little that is new, and
perhaps even less that is original. But in a subject so
controversial as this, where there is already in the
literature a super- abundance of original investigations
and original conclusions, it perhaps serves a more useful
purpose to collect and comment upon the opinions of others,
and by so doing, to attempt a general survey of the more
controversial aspects of this disease, in the light of
In general, this thesis has been confined to the
discussion of Duodenal Ulcer alone. In the sections on
Aetiology and Pathogenesis, however, it has been found
impossible to differentiate between Gastric and Duodenal
Ulcer, and here the two conditions have been considered
It is becoming more generally recognised that the
whole question of ulcer pathogenesis, is closely related to
the existence of abnormal physiological conditions in the
stomach. When a discussion of this "morbid physiology"
was attempted, it became at once apparent that there was no
uniformity of opinion regarding the normal physiology of
gastric digestion, and a further chapter has been included
to discuss the more recent views on this subject.
With regard to the investigation carried out by
the writer into the after histories of duodenal ulcer
patients, a brief word of explanation and apology is due.
A follow up study of i!edical and Surgical results in this
condition is by no means a new venture, but as far as can
be ascertained, it has not been done before in Edinburgh.
It has been pointed out that adjudication between
Medicine and Surgery cannot fairly be made on a direct
comparison of the results of treatment in each case, as
many of the cases operated on have been specially selected
for surgery, and their inclusion in the surgical series
confers an unfair advantage. The writer has attempted to
make the comparison in a series of cases where this criticism cannot be applied. By excluding from the surgical
series cases which may be said to have been specially
selected for operation, the investigation has been confined
to that type of ulcer which presents the greatest problem
in treatment,- the chronic ulcer without stenosis.