Medicine: Nerve Cut for Ulcers

At Chicago’s Billings Hospital, 97 men & women suffering from severe stomach and intestinal ulcers have submitted during the past three years to a revolutionary operation for their disorder. Its discoverer: Dr. Lester Reynold Dragstedt, gentle, stooped professor of surgery at the University of Chicago Medical School. His operation: opening the patient’s chest above the diaphragm, cutting the two vagus nerves where they lead to the stomach and intestines.

Of the 97 Billings patients, all but two were cured of their ulcers. One of the failures died of bronchial pneumonia after the operation; the other, a neurotic, thought it did not help.

By last week Dr. Dragstedt’s operation, now tested by many another surgeon, had stirred plenty of interest among ulcer specialists. Because peptic ulcers may recur in five-year cycles, Dr. Dragstedt and other investigators were not yet ready to pronounce the three-year-old operation a permanent cure. But so far, there had been no relapse after a vagus operation.

Overstimulated Stomachs. Dr. Dragstedt made his discovery while studying the secretion of gastric juices in the digestive system. Ulcers result from the secretion of abnormally large amounts of gastric acid. The normal stimulus for gastric secretions is eating. What puzzled Dr. Dragstedt was the fact that ulcer patients secrete large amounts between meals, especially at night, without any obvious stimulus.

Doctors have long suspected that stomach ulcers, popularly considered an occupational disorder of business executives, doctors, taxi drivers, newsmen and others who work under stress, have their root in the nervous system. If so, Dr. Dragstedt reasoned, overstimulation of the nerves must somehow be responsible for the abnormal secretions of gastric acid. When he tested his theory, he discovered that the operation did indeed greatly reduce the amount of gastric juice in the digestive system. Cutting the vagus nerves just above the stomach slows digestion, but seems to have no serious effect on other organs.

Men with a History. About 80% of all ulcers respond to medical treatment—e.g., a mild, unstimulating diet—and a change to a less exacting job. The remaining 20% may be relieved by removal of ulcerated sections of the stomach or intestines, but often new ulcers break out after the operation. All the vagotomy cases were in this stubborn group.

After a vagus operation, ulcers heal rapidly, the stomach quiets down and the patient leaves the hospital within twelve days. At Massachusetts General Hospital, Surgeon Francis D. Moore reported that vagotomy is especially effective for young or middle-aged men with a long history of peptic ulcers. Nonetheless, Drs. Dragstedt, Moore, et al., advise the operation only after diet and other treatments have failed. For nervous stomachs and the “tensions and strains of modern life,” says Dr. Dragstedt, preventive psychoanalysis may be better than nerve-cutting.