PROBABLY no disease ha?; resulted in sncli ti number of articles and papers during the last three decades a s peptic ulceration, and i t is apparent that a decided increase in the incidence and mortality of the disease is occurring. Thus even ten years ago Wilkie pointed out that peptic ulcer admissions to the wards of the Edinburgh Royal Infii*mary had increased 100% during the preceding twenty years, and Jennings has recently demonstrated a great increase in perforated ulcers in young men both in England and on the Continent. I n a recent paper, Tidy has shown that the mortality rate for males over forty years of age sufl'ering from peptic i&er has increased strikingly in England. From a consideration of numerous statistics it appears that peptic ulcers now occur in approximately 2% of the population a s a whole and with about the same frequency in persons admitted to general hospitals. They are also encountered in about 9% of all post-morteni examinations (Present). disease has waxed and waned ever since Wijlfler initiated the latter by performing the first gastro-enterostomy in 1881 in Billroth's cliuic for an obstructing pyloric neoplasm, and as internists ancl surgeons tencl to see each other's failures, viewpoints tend to become biased. This is well exemplified by Tidy, who (in 1936) after reviewing the results in large numbem of cases of peptic ulcer treated either medically or surgically in England and America, concluded that both methods gave approximately the same late results, when they were judged by the frequency of failure to relieve completely symptoms, relapses, and impairment of the patient's wage-earning capacity. He also pointed out that in addition surgical treatment carried an operative mortality higher than generally believed, especially in cases of gastric ulcer, in which it might rise to between 10% and 20%. Nielsen, however, has shown that when a peptic ulcer has been present for more than five years, cure by medical means will not be obtained in more than 10% of cases, and Conybeare has pointed out that the longer the period of observation after medical treatment, the smaller will be the proportion of cures. From numerous recent military reports it appears that the development of ulcer symptoms constitutes one of the common causes of invalidism in the services, and that in the majority of such cases a long history of dyspeptic troubles in civilian life is present. In other words, any patient suffering from a chronic peptic ulcer, even if well controlled medically, is liable to a relapse the moment his regime and diet are changed.Nerertheless, probably some 80% of peptic ulcer patients receiving efficient medical treatment are symptom free on discharge from hospital (Cutler), and provided they avoid contributory causes such as alcohol and tobacco and are not subjected t o mental worry or anxiety, can live a useful economic life.Controversy on the results of medical versus surgical treatment in this .
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