Partial A‐V Block and Duodenal Ulcer

Abstract

The question of the origin of peptic ulcer has been under discussion for over 100 years and is still not settled. Many theories have been brought forward and have to some extent been a mirror image of the, from time to time, predominant theories of pathology in general. Recent surveys have been given by Laurel1 (151, Ask-Upmark (3), Brun (5) and others in the Scandinavian literature. More and more have neurological and hormonal points of view been stressed, and by some investigators peptic ulcer has been regarded as almost a psychiatric disease. The authors do not want to enter the discussion but they think it correct, to emphasize that the neurogenic point of view has been proved both in experimental and in clinical work during recent years, although it cannot be said that this pathogenesis is the only one. Rokitansky seems to have been the first to put forward the theory of the neurogenic origin of the peptic ulcer, and the observations b y Harvey Gushing on patients operated on for brain tumours gave certain evidence to this theory. It was thought by Gushing that the peptic ulcer might be due to some disorder of parasympathetic centers in the hypothalamus and that the impulses were transmitted through the vagus nerve to the gastric mucosa. The theory was to a certain degree confirmed by others, who were able to produce gastric ulcerations by injection of pilocarpine into the third ventricle or by continuous stimulation of the vagus nerve. The classical experiments of