Essays On Surgical Subjects

f, based upon an experience the length of which I dread to contemplate, that no small part of what is written requires ruthless revision in the light of the modern methods of inquiry conducted by the radiographer and the surgeon. The wealth of teaching in the text-books is too often impersonal, and represents rather a legacy flowing from one's ancestors than a fortune newly won by hard endeavour. The heritage in respect of gastric ulcer is heavy enough, but not all of the securities are worth their face value. A gastric ulcer is, of course, an ulcer occurring in the stomach. During development the stomach is differen- tained as one part of the foregut from that other part which forms the duodenum as far down as the ampulla of Vater. The foregut terminates at the point of entrance of the ducts of the liver and pancreas; at the end of the second month of fetal life the pylorus marks off the stomach from the duodenum. When development is complete it is, as a rule, easily possible in all periods of life to distinguish the stomach from the duodenum. On palpation the pyloric muscle and valve are felt at once. Exactly in the lineof the pylorus a thin white line is to be seen on careful examination; the line becomes clearer if in the living subject the pylorus is held forward by a finger and thumb placed one on the stomach, the other on the duodenum, and closed to meet in the pylorus. In close proximity to the "pyloric white line" is a vein, the "pyloric vein," which beg...