An Address on RADIUM AND ITS SURGICAL APPLICATIONS
Authors: H. S. Souttar
Journal: BMJ (1929)

MEDICAL JOUENAS thlo coniception that, the neutralizationi of the acid gastric juice by the regurgitailt fluid thlrotuglh a gastro-eiitero- stomy is due mainily, if not entirely, to the bile conitaiined in that fluidl.Whilst good results have, beeni r eported in cases of gastric ulcer so highly situated in the lesser curvature as to preclude excision, anid in a nuimnber of cases of doubtful pathology with hyper;acidity as thleir doniinaiit symlptomi, the basis of the meth1od is insecure, as bile in itself is not alkalinie, an-d after a gastro-intestinial aitastomosis it is the duodenal and panicr-eatic secretionis rather thani the bile wlichl give the reguirgitant fluid its neutralizinig properties.I hlave carried ouit this oper-atioIn in only two ulcer cases, onie of very high lesser curi-vattur e ulcer anti one of gastro-jejuLal ulcer.In bothieases solle imnmediato imuprovemnent resulted, but the sympItoins of acidity and paiin returned.ULCER AS ONE OF MANiY SEPTIC Foci.No treatment of ulcer can bear the promise of lasting cure if it does not take cognizance of thle other foci of infectioni which accompany it.The pre-valence of (lental infection is to my mind the most important single factor in determining the frequency of peptic ulICer.It is indeed surprising to find in the vast majority of the patients sent for surgical operation after ineffective medical tr eatmenit that gross dental infection lhas beeii left-untreated.In many of these cases we recover fromii the pyorrhoeal pockets the3 same streptococcus as we find in the uleer.Efficienit dental treatment must, tlherefore, be a first consideration, no muatter what other lines of tbei'apy we may follow.It is withliin the abdoiuen, however, that we, so frequiently finid otlher infective foci which must be dealt wi-ithi at the samle tiie as the ulcer'.The combinationi of an -uilcer in the stomiach or (himodenumii or both with infectioni in both gall-bladder anid al)l)euidix is quLite commiiiioni.All tllhree lesionls mlutist be diealt with if complete aned lasting relief is to be, obtained.The following brief note of a case will illustrate thle significance of a thorough eradication of foci.Mr. A. B., aged 57, had tlhirteen years previouisly had a gastro- eiiterostomtiy performed for duodenal ulcer.He obtained som-e tem- porary relief, but his old pain soon returned; lie suffered from niauisea, flatulence, anid constant abdominal discomfort, and led the life of a chronic dyspeptic.On examination we found him emaciated, witth a dilated stomach and tenderness over, three poinits in the abdomen-just to tlle left of the umbilicus, just below tlhe right costal margin, and in the right iliac fossa.X-ray examlination showedI his stomach to be dilated, the stoma stenosed anld irregular, evidently from a jejunal ulcer.At operation a jejunal iulcer was founjid aimd excised anid his stoma enlarged.His gall-bladder was thicEkenie(d anid inflamed, as was his appendix; both were renioved.Regional lvnplm glands were taken from all three sites and from all the St(cptococeus ciridasis was grown in pure cullture.On injectioni into rabbits both cholecystitis and duodenal ulcer were pr oduced.since the second operation the patient hias enijoyed perfect health and lost all his dyspeptic symptoms.It may be that we shall eventually succeed by suitable inoculationi in inmmiiunizing patients against these miiultiple strel)tococcal abdominial lesions, oi., still better, by tiniiely dleltal treatmienit amid better dietary and hygienic tr.eat- memmt, in preventiing them.Till then, however, surgery nimust conitiitue to play a part in dealing with the full-blowvi lesions, anid surgery, whilst coniserviimg healthy tissue, miiust deal tholoughly and radically with the differenit foci. Aft