The empiric surgical approach to the ulcer problem has come to an end. Out of fifty years of accumulated experience has come a mass of conflicting data with reference to the accomplishment of operation in the management of ulcer without a clearcut definition of the criteria of an acceptable operation. The cause of this confusion is not difficult to detect. There being no general agreement among clinicians or investigators concerning the cause of ulcer, the surgeon knew only that the objective of his craftsmanship was to prevent recurrence of ulcer; in determining how to attain that end, he had little or no help to guide him. Little wonder that the surgeon groped about aimlessly for procedures which he hoped might accomplish his objective of obviating recurrence of ulcer since he did not know how ulcer came about, what was demanded of a satisfactory operation or how his handicraft mediated its