The discovery that an apparently benign gastric ulcer is in reality malignant is made often enough to justify the most strenuous efforts to avert such a tragedy. That this feeling is widespread at present is indicated by the abundant literature on the subject. Most of the papers, however, assert or imply that carelessness on the part of the physician is largely responsible and that something useful could be done if he did not stand idly by and allow the patient to drift into the late and hopeless stages of cancer; the thesis is sustained that careful study of people with ulcers which appear to be benign should make it possible to detect early malignant change and to effect a cure by prompt radical operation. It is my purpose in this paper to analyze this position and to see whether in fact it is a sound one.
I will consider first