Well, diseases have patterns, peaks and troughs through time. Stress today can't be less prevalent but often has very different aetiologies. Patients now wouldn't tolerate symptoms very long as compared with times of yore - they would then chew antacids and drink far too much milk. Finally, longevity of symptoms or a perforation or bleed, would push them towards surgery.Physicians would often (in the '30s and 40s') be reluctant to refer patients for operation, since, in all honesty, complications were not uncommon after gastric surgery. Now, the knowledge of Helicobacter Pylori infection, access to the internet and different symptom tolerance levels, push the patient to the doctor sooner! Surgery for ulcers and their complications is now rare. Modern stresses provokes other challenges in medicine - as you know - Irritable bowel, hypertension or a variety of psychological issues. I often wonder if Bonaparte suffered with IBS. Michael.