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Since January of 1943 bilateral section of the vagus nerves to the stomach has been performed in this clinic on 160 patients with benign duodenal, jejunal, and gastric ulcers. The technic employed to obtain complete bilateral vagus section and the clinical results have been described elsewhere (1 to 4). During the course of this work there arose the opportunity to study the effect of vagotomy on the continuous night secretion of gastric juice in the empty stomach, on the gastric secretory response to histamine, caffeine, insulin, and sham feeding, and on gastric motility in ulcer patients. A report dealing with a portion of these studies has appeared recently (5). The present paper presents the results of night secretion tests on 37 patients with diseases other than benign ulcers and on 42 patients who underwent vagotomy for benign ulcer. It describes the gastric secretory response to insulin hypoglycemia and sham feeding before and after vagotomy in 23 ulcer patients and the effect of vagotomy on motility in 13 such patients. In general, the patients who underwent vagotomy and are presented here had ulcer symptoms of many years' duration. With only a few exceptions they had all experienced typical ulcer pain and in most a crater had been demonstrated by gastroduodenal x-ray examination. A majority had suffered pyloric obstruction, hemorrhage, or perforation. They were either refractory to medical management or had been proved unable to follow such a regime. Thus, in every case, the ulcer represented a serious affliction. The patients were led to accept vagus section because of refractory pain, recurrent hemorrhage, pyloric obstruction, or the prospect of cure of their ulcer disease without the necessity for long-term medical management. Bilateral section of the vagus nerves to the stomach was performed at or just above the level

THE EFFECTS OF VAGOTOMY ON THE PHYSIOLOGY OF THE STOMACH IN PATIENTS WITH PEPTIC ULCER 1