on re-examination by Qvigstad and Romcke (1946) became 22% and 10% after a further five years. Ogilvie (1952), in comparing the results of surgical and medical treatment of 660 cases, found 34% satisfactory after medical treatment and 70% satisfactory after surgical treatment after 5-10 years.Figures around 30% seem to be the expected "satisfactory" proportion to be attained after medical treatment. It is essential, however, to be clear what the term " satisfactory" implies. We restricted it to patients who sought no medical advice over two and a half years, but we found that many others could be classed as " satisfactory," as they lost no time from work and had few symptoms. It is significant that in only 25% of cases was surgical treatment necessary. On the whole we feel that medical treatment can keep the patient in a comfortable state in the remaining 75 % of cases.
ConclusionTo conclude, it is felt that the time has come to make more use of the field of general practice as a source of information on the natural history and morbidity of certain ,common diseases such as peptic ulcer, hypertension, rheumatism, and the acute and chronic infections of the chest. These ,conditions are often followed for only short periods in hospital practice; but in general practice they can be surveyed from the time of diagnosis until death, if necessary. It is to general practice that we should turn for further advances in the study of the true natural history of such disorders.The methods that need be used are very simple-based essentially on adequate records over a long period.In presenting these findings from our two practices, even though they cover some 10,000 patients, we fully realize ?their limitations when an attempt is made to apply them to the country as a whole. Nevertheless, accepting these limitations, it is felt that they indicate the probable trend of the natural history of peptic ulcer.
SummaryA report is given on the incidence, morbidity, and course of peptic ulcer in two South-east London practices with a total of some 10,000 patients at risk.On July 1, 1954, there were 177 peptic ulcer cases (G.U. 45 and D.U. 132), 124 of them having a history of five or more years' duration (G.U. 31 and D.U. 93).The latter group has been reviewed for the purposes of a five-year follow-up.For the purposes of assessing morbidity the numbers of medical attendances and the duration of incapacity from work (or its equivalent) were recorded and compared in the various forms of treatment.In the whole series, including both surgical and medical cases, 37 % of patients required no medical attention for digestive symptoms in the two-and-a-halfyear period under study, 77% attended on less than th.e average number of occasions, and 70 % did not lose any time away from work.Surgical treatment with good results was given to 25 % of the patients.Of the remaining medically treated patients (75 %), 30% needed no medical attention, a further 40% attended on less than the average nvmber of occasions, and 66% lost no time from work. These re...
