ULCER OF THE DUODENUM, WITH REPORT OF TWO HUNDRED AND SEVENTY-TWO OPERATIONS.

The surgical invasion of the upper abdominal region has gradually enabled us to replace theory with facts, and fallacious clinical observations have given way before actual demonstration of diseased conditions. One of the most striking illustrations of this newer knowledge is the discovery that three-fifths of all gastric and duodenal ulcers are situated in the duodenum. Until within recent years gastric ulcer has been considered the chief lesion, while reference to a duodenal location has been infrequent. In a paper read before the American Surgical Association, May, 1904, I was able to report 58 operations for duodenal ulcer, which at that time was 27 per cent. of all the ulcers of the stomach and duodenum on which we had operated. Two years later, in a paper read before the Surgical Section of the British Medical Association, August, 1906, on "Duodenal Ulcers," our statistics showed about 40 per cent. of ulcers