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The following factors as determinants of chronicity of ulcer of the stomach and upper intestines have been discussed: (1) infection, (2) mechanical effect of food and motility, (3) blood flow and fibroblastic reaction, (4) allergy, (5) nutrition or digestive disturbance, (6) corrosive or irritating action of gastric contents, and (7) mucosal susceptibility. Experimental evidence is cited which shows that the roughage in or consistency of the diet in the presence of a factor conducive to connective tissue proliferation is conducive to the formation of a chronic gastric ulcer in rabbits. Experiments have been devised in an attempt to evaluate the mechanical, nutritional, chemical and mucosal susceptibility factors in the etiology of intestinal ulcers following gastroenterostomy. The evidence shows that all these factors operate and that the mechanical, chemical and mucosal susceptibility factors are the most important. On keeping the mechanical factor constant and varying the chemical factor (the change in the chemical factor leads to some change in nutrition, which could not be avoided in all animals), it is shown that the chemical factor is the most important. On keeping the nutritional factor constant and by analyzing the chemical, mechanical and mucosal susceptibility factors, it is shown that the jeJunaI mucosa is more sensitive to the irritating action of gastric contents than duodenal mucosa.

Resection of at least 66 per cent of the stomach in 10 out of 12 dogs resulted in varying degrees of compensatory hypertrophy of the gastric remnant. It is believed that the hypertrophy was due to rapid eating of large quantities of food due to the polyphagia incident to inadequate digestion. The jejunum at the stoma was also hypertrophied. The emptying time of the stomach was permanently decreased in spite of the hypertrophy. The acidity of the gastric contents returned practically to normal in from three to five months. Jejunal ulcers developed in 3 of the 12 dogs.