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