Word: ulcerated
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Wanting in Elegance. Nobody knows the root cause of ulcers in the digestive tract, but what happens after the process gets started is fairly clear. Countless cells in the wall of the stomach secrete chemicals, such as gastrin, and hydrochloric acid. These are designed by nature for the digestion of food. But if for any reason-physical or emotional -the stomach cells churn out digestive juices when there is no food for them to work on, they may start digesting a spot on the wall of the stomach itself. The result is a gastric ulcer. More often, the corrosive juices...
After 1930, these and variant operations were widely used for ulcers. It mattered not that the ulcer might be in the duodenum: the part to cut out, the doctors reasoned, was in the stomach, where the digestive juices were being overproduced. Over the years, doctors concluded that this part was high up in the stomach. Some surgeons went on cutting out not only 50% but 75% to 80% of the stomach. "This," complains Boston's famed Surgeon Francis D. Moore (TIME cover, May 3), "is not only crippling but wanting in elegance of rationale...
Problem of Choice. Not until 1943 was a more elegant and rational attack on ulcers adopted. Since the stomach-wall cells are activated by the vagus nerves (which explains why stress or emotional upsets can trigger the ulcer process), Chicago's Dr. Lester R. Dragstedt figured that cutting the vagus nerves would cut down the acid output. His operation, "vagotomy," is not as simple as it sounds: surgeons often have difficulty finding and cutting all the nerve fibers in the bunch. And by itself, vagotomy is not consistently effective. So vagotomy has been combined with hemigastrectomy (second diagram...
...latest advance in ulcer surgery is still simpler, less mutilating, and therefore "more elegant" by Dr. Moore's definition. This consists of "pyloroplasty," or widening the gate valve between stomach and duodenum by slitting its muscular ring, or "sphincter" (fourth diagram). The tissue is stretched, then the slit is closed at right angles. Such operations (there are several variants) had been around since 1886, but not until 1947 did Dr. Joseph Weinberg of the Long Beach (Calif.) VA Hospital try the promising combination of vagotomy and pyloroplasty. A vagotomy by itself tends to make the stomach flaccid so that...
Something Better. If the surgeons' arguments are not ended, neither are their ingenious efforts to find better ulcer treatments. Dr. Weinberg is still improving his own technique; he now uses only a single row of stitches to close the slit in the pylorus, reducing the risk of a later shutdown. Other surgeons are combining the Weinberg method with the tying-off of blood vessels, especially for bleeding ulcers. Minnesota's Surgeon Owen H. Wangensteen is trying to make fellow surgeons abandon the knife for nearly all ulcer patients and freeze the stomach instead, a procedure that is hotly...