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PARTIAL GASTRECTOMY BRITSHrMEDICAL JOURNAL the way of effective treatment, and, indeed, the value of the medical treatment of peptic ulcer has recently been sharply questioned. Martin and Lewis (1949), in a study of 185 patients undergoing medical treatment for peptic ulcer, found that only 20% remained free from dyspeptic symptoms, that 40% endured recurrent ulcer symptoms, and that the remaining 40% required operative treatment. Evans (1954) has reported a failure rate greater than 50% in the medical treatment of peptic ulcer in a series of 111 patients. It is in the light of such studies that we can best appreciate the results of surgical treatment. A complacent satisfaction with surgical results cannot, however, be accepted, and the lessons to be learned from a study such as this are clear. Any operation which leaves the antrum of the stomach intact is a dangerous measure. This has long been appreciated. A limited gastric resection with gastro-duodenal re-anastomosis is apt to lead to recurrent ulcer. A more extensive gastric resection in the Billroth I manner would avoid this trouble, but the technical problem of the anastomosis becomes difficult with penetrating duodenal ulcer. If vagotomy is combined with such an operation, recurrent ulcer may be avoided, and we believe this is probably the best form of treatment for peptic ulcer, and it is the principle we now follow and recommend in all cases. The Billroth I operation appears less likely to cause anaemia over the course of years, and, because there is no afferent loop, true bilious regurgitation and the prodromal symptoms associated with it are avoided. The vomiting of food mixed with bile does, however, occur, but it is not common.The Polya type of gastrectomy is still that favoured by most surgeons. As might be expected, it seems from our study that the higher the resection the greater the freedom from recurrent ulcer but the more probable the development of serious post-gastrectomy syndromes. The very high subtotal resection is a grave offender in this respect, and is not the surgical answer to the problem of peptic ulcer treatment. A more limited resection accompanied by vagotomy may achieve the same freedom from ulcer, and lead to less serious post-gastrectomy syndromes. We have been impressed with a small series of 25 cases treated by us in this way three years ago, but it is yet too early to talk of their end-results.Whatever the surgical method of treatment for peptic ulcer employed, a careful examination of the results must be undertaken at regular intervals. Only in this way is it possible to achieve effective treatment and satisfaction for the patient.Finally, we may fairly claim to be gaining some understanding of the causes of disability after surgery for simple peptic ulcer. On the basis of this understanding we can see more promising initial operations developing, and, so far as concerns those who have had their operations and are still not well, we can predict with some accuracy the likelihood of response to drugs and diet, and we can re...

The case is made for basing analysis of longitudinal measurement data on each individual's array or curve of scores, and employing methods of analysis which take account of shape of each individual's curve. DQs at 6 months and 18 months, and IQs at 3, 5, 8, 11, 14, and 17 years were available on 84 subjects from 6 months to 17 years, and 109 subjects from 6 months to 14 years, from a London longitudinal project. Scores at each age were converted to SD scores with M = 0, SD = 1. Polynomial equations were fitted to each subject's curve over periods: 6 months − 17 years; 3 years − 17 years; 3 years − 11 years. For whole sample fitted curves yielded highly significant error reduction across all periods, thus rendering untenable doctrine of IQ constancy. Over 6 months to 14 years, 54 per cent of subjects’ curves had a significant fit. Curves differ not only in linear slopes, but in degrees and forms of curvilinearity, particularly over longer periods. A visual method of classification of curves is also presented, which proved effective. Implications of findings are discussed, including that changes in IQ scores cannot be regarded as random variation, but as following systematic trends which differ between subjects; need to regard isolated IQ measures on a subject as derived from a curve of unknown shape and slope; and dangers of treating as equivalent IQs of subjects at different ages. It is concluded that present methods of analysis are applicable to a variety of longitudinal measurement data.