Insulin Test for Evaluating Control of Acidity in the Stomach for Control of Peptic Ulcers by Surgical Procedures

peptic ulcers. The first put up by Von Bergmann (1913) regards that chronic peptic ulcers develop because of functional imbalance between vagus and sympathetic nerves, with resulting local or generalized spasm of the musculature and terminal blood vessels of the stomach and duodenum. If this theory be accepted the benefit of vagotomy derives from its motor effect. This might explain the lower percentage of cures by vagotomy (according to Smith, Ruffin and Baylin, 1947; Orr and Johnson, 1947; Boerema, 1948). The second theory is that the primary ^etiological factor in ulcer is a psychosecretory process, operating along the vagi from the higher centres. Complete interruption of the vagus pathways should abolish the neural influences on the gastric secretory mechanism and result invariably in ulcer cure. Complete vagotomy with resultant negative insulin response is not possible in all cases. Camp and Dragstedt (1948) report failure in 10 per cent of their cases. Walters et al. (1947) report failure in 33 per cent of their 39 cases. Stein and Meyer (1948) found 14 per cent failures and 5 per cent equivocal in a series of 22