The prevalence of peptic ulcer in India shows striking variations, the disease being common in some parts of the country and rare in others (Somervell and Orr, 1936; Dogra, 1940). The ulcer is uncommon in the Punjab but the disease as so far reported from the Punjab is rare in the arid plains though by no means uncommon in the humid hill districts of Kangra, being 12 times more common than in the plains (Wig, 1959; Chuttani and Saigal, 1958). Hadley (1959) had noted similar variations in the incidence of the disease in various parts of the country: Ludhiana (Punjab) 0-2y%, Srinagar (Kashmir) 2-5y%, and Vellore (south India) 1-6y%.

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DIET Ulcers have been ascribed in various parts of the world to hot foods, spices, fasting, overeating, excessive starch, alcohol, coffee and tea, and to smoking. Somervell and Orr (1936) and Hadley (1959) believed that hot foods, tapioca, chillies, and condiments contributed to the high incidence in the south of India. This belief cannot be correct as in this study we have found that a lot of chillies and condiments are eaten also in the Punjab and the plains of Rajasthan where the incidence of ulcer is low. Konstam (1954) ascribed the high incidence in his Nigerian study to vitamin B deficiency. Pulvertaft (1959) has observed that ulcer in his series was more common in populations which consumed more sweets and sugar. In Africa, China, and south-east Asia, a suspicion seems to have been established that the carbohydrate diets taken there may be contributory, a view supported by higher mortality rates from ulcer in Japan, Chile, and India where similar starchy diets are taken. Against this is the high ulcer prevalence in England, Scotland, Norway, and Australia where the diets are well-balanced and rich in protein. Although May (1958), analysing the limited data at his disposal, was unable to relate diets to regional ulcer prevalence, it appears from the present study that it is not only what is eaten but how it is eaten that is important.

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