This editorial is prompted by my reading of the paper entitled "Peptic Ulcer in Africa" by Clarence A. Snyder and Merton J. Alexander in this issue of the Archives as well as by reflections on reported geographical factors influencing duodenal ulcer in India and in Norway.
While there have been many significant contributions in recent years dealing with the pathogenesis of duodenal ulcer, some factors still remain obscure. One of these is the high incidence of ulcer reported in certain areas, while neighboring regions inhabited by the same race of people remain relatively free from the disease. In my own view a hypersecretion of gastric juice of nervous origin has been established as the sufficient cause of duodenal ulcer in the overwhelming majority of patients in the United States and in Europe. These patients regularly display a hypersecretion of gastric juice in the empty stomach which, if reproduced in the