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OBJECTIVES: Mortality data of peptic ulcer are mostly national and limited to the 20th century. The New York City data from IS04 have therefore been examined by both year of death and year of birth (cohort analysis), to consider whether the increases and subsequent decreases in deaths from gastric, followed by duodenal ulcer, can be attributed to Helicobacter pylori. METHODS: The annual mortality reports of New York City described gastric ulcer from 1838 and duodenal ulcer from 1931. The age-specific death rates per 100,000 population were calculated in 10-yr periods both by year of death and by year of birth for each disease according to age and sex. RESULTS: For gastric ulcer the period-of-death-age contours from the 1850s to the 1990s showed an increase to a mid-19th century plateau, but the cohort-age contours revealed a peak mortality for those born in the 1870s. Women born between about 1770 and 1880 showed a faster increase in mortality. For duodenal ulcer the period of birth contours showed a decline from a peak tor those born in the 1850s and 1890s, with no sex difference. CONCLUSIONS: This urban study with data regarding deaths from gastric ulcer registered from 1838 and in those born from the 1770s, revealed by cohort analysis a peak in the 1870s. and for duodenal ulcer in the 1880s, comparable to national data worldwide. These time changes in fatalities are compatible with a change in the environment of children born in these decades, as, for example infection by a pathogenic strain of H. pylori. [ABSTRACT FROM AUTHOR]

The characteristics of adult patients admitted for self-poisoning to an inner London district general hospital were examined during 1971/72 and 1983/84. The incidence of self-poisoning halved over the 12 years, from 326 to 178 per 100 000. Although no West Indians were admitted in the first period, they comprised 7% of such admissions 12 years later. The West Indian population in the catchment area remained constant at around 6%. Amongst all patients admitted for self-poisoning, there was a fall in the number of patients diagnosed as depressed, having a personality disorder or admitting to prior psychiatric care, but an increase in alcoholism. Paracetamol became more common as a drug used in self-poisoning and barbiturates were taken less often. Only one patient died in the series. These results should stimulate more soundly based epidemiological studies on ethnic variation in self-poisoning, and on self-injury in inner-city areas. [ABSTRACT FROM AUTHOR]

In a general medical unit 27% of 104 admissions and 17% of bed occupancy were attributed to alcohol consumption, although only 10 of these 28 patients had classical alcohol-related conditions. Questioning on the amount of alcohol consumed was the most accurate method of screening for these patients. The brief MAST questionnaire, mean red cell volume, γ-glutamyl transferase, aspartate transaminase and urate were all inadequate as screening tests. Only 13% of the admissions were defined as ‘problem drinkers’ on the brief MAST questionnaire, suggesting that harmful effects of alcohol are not confined to ‘alcoholics’. Clinical suspicion and questions on the level of alcohol consumption are more efficient than questionnaire, biochemical or haematological screening tests in detecting alcohol-related medical problems. [ABSTRACT FROM AUTHOR]

Basal gastric secretion and the maximum response to pentagastrin and basal secretion into the duodenum and its near-maximum response to secretin were measured in 20 control subjects and ten patients with duodenal ulcer disease. In control subjects the volumes of stimulated gastric and duodenal secretions were significantly correlated. In patients with duodenal ulcer, there were no significant correlations between basal gastric and duodenal secretion but after stimulation both volumes and outputs (but not concentrations) of gastric and duodenal secretions were significantly correlated. The bicarbonate secretory capacity in patients with duodenal ulcer was not only normal but was also comparable to the gastric acid secretory capacity. The basal bicarbonate content of the duodenal aspirate, however, in patients with duodenal ulcer was only half that in control subjects, perhaps another example of inadequate entry of bicarbonate into the duodenum in patients with duodenal ulcer in spite of the normal bicarbonate secretory capacity. [ABSTRACT FROM AUTHOR]

Objective and Design: The effects of sex, sex hormones and gonads were studied in dogs because men secrete more acid than woman and duodenal ulcer is commoner in men and remits in pregnancy and after stilboestrol.¶ Material: Four male and 4 female greyhounds with chronic gastric fistulas were tested.¶ Methods: Histamine was infused i.v. 1–16 μg/min and plateau acid output measured in the last 30 min of each 60 min infusion.¶ Treatment: The gonads were then removed and secretion retested. The orchidectomised dogs were then given stilboestrol 2 mg daily (±progesterone 25 mg i.m. three times a week) and the oophorectomised bitches given testosterone propionate 25 mg twice weekly i.m. and secretion again retested.¶ Results: Submaximal and maximal acid outputs (and serum pepsinogen) of dogs and bitches were similar and correlated with body weight. Gonadectomy did not alter these functions nor did hormones of the opposite sex given for 1–12 months.¶ Conclusions: In the dog, as in the rat, and probably in man, histamine-stimulated gastric acid output is a function of body size and not of sex. [ABSTRACT FROM AUTHOR]