Since methantheline (banthine\s=r\) bromide was first used in the treatment of patients with peptic ulcer, many enthusiastic reports of its therapeutic value have appeared in the literature. Most studies reported were short-term evaluations of not more than a few weeks or months.1 Others were done for longer periods, some as follow-ups on preliminary reports.2 The authors of many of these reports have stressed the prompt symptomatic response to the drug. Healing of ulcer craters has also been frequently observed. Little has been mentioned, however, regarding the development in patients of tolerance to a maintenance dose of the drug or of their relapse while taking the drug. While most investigators have recommended that a standard dose of the drug should be employed, there has been some disagreement as to the amounts that should be used in therapy and in maintenance.3 Conflicting reports concerning the effect of methantheline bromide on gastric secretion and acidity have also appeared in the literature.4In the past year and a half a number of patients ad¬ mitted to our wards have stated that they had taken methantheline bromide at the advice of their private phy¬ sicians, with disappointing initial results or a recurrence of symptoms after continuing therapy for some time. It was accordingly considered that it would be worth while to select a group of patients refractory to the usual medi¬ cal treatment of peptic ulcer and to follow up their re¬ sponse to treatment with methantheline bromide over a period of months. It was also felt that the effect of vary¬ ing doses of the drug on gastric secretion and motility warranted further study.Mittel zur Behandlung der Ulcuskrankheit, Praxis 40:626 (July 26) 1951. (k) Segal, H. L., in discussion of Grimson.1e 15 male ulcer patients who failed to respond to at least three to four weeks of intensive medical therapy on the gastrointestinal service. Of these patients 10 had duo¬ denal ulcers, 5 had gastric ulcers, and 1 of the patients with a gastric ulcer also had a duodenal ulcer. Four of the patients with duodenal ulcers had craters demonstrable by roentgenogram (cases 2,4,10, and 13) ; the remainder had tender and deformed bulbs. In all five patients with gastric ulcer, the crater was visualized by roentgenogram (cases 2, 7, 9, 12, and 14).The intensive standard medical regimen given prior to methantheline bromide therapy consisted of a milk and cream diet, antacids, and the largest tolerated dose of tincture of belladonna or atropine. Some patients were also given intragastric drips of milk, cream, and antacids. Once the study was begun, the patients received no medi¬ cation other than methantheline bromide or placebo tab¬ lets. The latter consisted of lactose powder with a trace of quinine and were identical with the drug in taste, size, and appearance. In order to be certain that any remissions that might occur while the patient was taking methanthe¬ line bromide were not coincidental with or due to hospitalization, diet, or psychotherapy, the placebo was given prior ...