The end and purpose of iedicine is to alleviate pain, prolong life, restore to health, and promote good health in the individual and the community. The science of medicine is being rapidly advanced by those who work in the laboratories of physiology and patho gy, and its art yearly becomes more intricate, as the advance of knowledge adds to the burden of physicians who practise it. Medical research, the instrument of progressive medicine has made great advances in the present century. But whilst realising that the practice of medicine is changing, we must also take into account the change which the human race is under- going. In the evolution of species, especially in human beings, the reactions to environment undergo constant modifications, and certain diseases disappear in whole or in part, and other new diseases just as certainly make their appearance. No other facts in the history of medicine are more soundly established than the results of the laws of evolution of the diseases which inflict mankind. This has been accepted with respect to the plagues of the human race, and the cyclic character of epidemics, but the same study has not been given to the systemic diseases of the body. We rather fail to realise that any particular organ and its environment is constantly and permanently changing, and the disease which today follows a definite course may in the passage of future generations become hardly comparable with the disease which takes its place. A pathologist, reincarnated a hundred years from now would probably find many pathological conditions which he had never seen before, and the microscopic appearances of the various organs under varying pathological reactions would be largely new ground for his once experienced eyes. It is not only new knowledge attained by new methods which changes our conceptions of disease processes; the diseases themselves are changing, and in the course of time it becomes necessary to correlate the facts concerning them in order to establish and to be able to appreciate the extent of this change. There can be little doubt but that the incidence of peptic ulcer of the stomach and duodenum, in the present harassed state of the world and mankind shows a distinct rise in the last quarter of a century and the factors which tend to this and the treatment of the disease as advocated by various authorities I shall endeavour to bring forward clearly in this Thesis.
Since graduating, and for the purpose of this Thesis, I have endeavoured to specially interest myself in this disease - chronic peptic ulcer.
As Resident Medical Officer, for a year, at St. Andrew's Hospital, Dollis Hill, London, - a general Hospital of fifty -five beds, specially for the professional and middle classes who could not afford high Nursing Home fees, I had ample opportunity to observe a number of these cases, and at the Marylebone Infirmary, London, where I was House Physician, I had similar opportunities. Thereafter, in my own practice and in the Outpatient Department of the Royal Sussex County Hospital, Brighton, I have tried to further my knowledge. In one section, to follow, will be found an analysis of 293 cases of peptic ulcer admitted to the wards of the Royal Sussex County Hospital during the years 1930 and 1931. I have no solution to put forward for this great medical problem of Peptic ulcer, but have endeavoured to express my ideas, especially as regards treatment, from the point of view of the general practitioner.
The aetiology of this disease is a subject of mystery and immense interest, for, in the light of our present knowledge, we can really point to no specific factor and can only surmise. But great strides are being made of late years by physicians, though it is rather sad to relate, as Hurst states, that
-4- that we owe the enormous progress in our knowledge of gastric and duodenal ulcer during the first twenty years of the present century almost entirely to surgeons; during the last ten years the bio- chemist and radiologist have added their quota. If the general practitioner and physician are prepared to seize the opportunity, the prevention, early recogni- tion and successful treatment of peptic ulcer should in the future be in their hands. Hurst, rather cynically states, when considering operations in general, in this disease, and gastro-enterostomy in particular, that in his experience gastro -enterostomy is the commonest gastric disorder to -day, and undoing open ,,t i oN gastro -enterostomy is the gastricAwe now frequently recommend. Medicine, however, cannot be an exact science because of the ever present and variable factor in our problems, of the human or temperamental element.
No amount of chemical, X -ray, or other investi- gations can compensate for the absence of a clinical insight, which is at first innate in varying degree, and later developed by careful observation, clear thinking, and the use of experience.