Speaking of Ulcers

Last week the American Journal of Digestive Diseases brought into the open a bitter dispute of long standing between physicians and surgeons. Ulcers of the stomach, most doctors believe, are caused by too much acid in the digestive juices. Too much acid corrodes the stomach lining at sensitive points, leaving a raw wound. But why some people have a constant gush of acid, instead of a gentle trickle at mealtime, is a mystery to doctors. Certain it is that tobacco and alcohol do a delicate stomach no good. Many authorities hold that ulcers are the fruits of temperament, for only worrying, sensitive, high-strung people are affected. Chief choice that confronts an ulcer victim is medical v. surgical treatment.

Last summer members of the American Gastro-Enterological Society held a meeting in Atlantic City. As usual, they talked mostly about ulcers. The doctors could speak from bitter experience, for as a professional group they have a high percentage of ulcers. Last week the American Journal of Digestive Diseases printed the full debate. Since physicians have no sure cure, and surgeons can only cut out pieces of flesh, the doctors had plenty to argue about. The patient as usual was left holding his stomach. Drift of the argument:

Keynote speaker was a noted surgeon, Dr. Irvin Abell of Louisville. The division of labor, he said, is clear. Any ulcers which do not heal with rest and special diets must be dealt with by surgeons. As for surgery, he went on, most experts believe it does little good merely to snip out the ulcer and patch up the stomach or intestine. For the incorrigible stomach keeps on brewing its corrosive acid. Most authorities hold that the best procedure is to cut out "three-fourths to four-fifths of the stomach." Since the stomach is primarily a churn and a reservoir for big meals, it is possible to get along without it. Of course, said Dr. Abell, mortality rates for removal of most or all of the stomach are about 10%, but even so, the operation is worth trying.

Famed Surgeon Albert Ashton Berg then told of 173 patients on whom he had operated; 29 were desperate cases, and of these, all but five survived. These cases, said Dr. Berg, all came to him because they were "medical failures."

Up jumped Physician Albert Frederick Ruger Andresen of Brooklyn. Since there is really no medical treatment for ulcers, said he with brilliant logic, there are no medical failures. Some ulcers heal of themselves. Both physicians and surgeons worry too much about stomach acids, he continued, instead of considering a patient's temperament and general condition. And operation on desperate cases which have not been doctored up "is little short of murder."

To this Dr. Berg made candid answer: "The surgeon can only be accused of accessory murder. The premeditated murder lies at the doorstep of those internists who permit their patients to get into such a deplorable state in which only the 'Hand of the Almighty' could save them. Would Dr. Andresen let them all die? . . . I am sorry that my remarks offended [him] . . . I simply asked for a closer cooperation."

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