The controlled trial SIR RICHARD DOLL

In 1945 I was looking for a job, after having spent a short post-war convalescence as a junior assistant in the Medical Unit at St. Thomas's Hospital, when I had the good fortune to be introduced to Dr Avery Jones. He had just then had the idea that clues to the causes of gastric and duodenal ulcers might be obtained if differences could be found in the frequency with which they occurred in men and women in different occupations, particularly if the ulcers proved to be unusually common in transport workers, who, it was commonly believed, tended to be afflicted because of the irregularity of their meals. His clinical responsibilities, however, prevented him from conducting a survey himself and he obtained a grant from the Medical Research Council to employ a medical assistant to conduct one under his supervision. I was offered an appointment to work on the project and secured as a result, a life long friend and teacher with whom I collaborated actively in research for 24 years. Our work on the occupational distribution of gastric and duodenal ulcers did not produce any major surprises, but it did establish the prevalence of each type of ulcer by sex and age and showed that factors of importance in the aetiology of the two types of ulcer were different. Duodenal ulcers were found to occur more or less evenly throughout the population, with some excess in men holding responsible positions at work, while gastric ulcers were found to occur most often in the poorest socioeconomic groups (Doll, Avery Jones and Buckatzsh, 1951). Two years later, when the collection of data was complete, I obtained a post in the Medical Research Council's Statistical Research Unit, but continued to work with Avery Jones at the Central Middlesex Hospital in an honorary capacity. At that time new methods of treatment for gastric and duodenal ulcers were being proposed with monotonous regularity and it was not difficult to compile a list of recommended treatments commencing with every letter of the alphabet. What was difficult was to assess whether any of them had any effect at all. So much so that some sceptical physicians even began to enquire whether the standard dietary treatment with milk and eggs had any advantage over normal food, and one carried his doubts so far as to treat 20 chronic gastric ulcer patients with daily injections of distilled water (Gill, 1947). The results showed that the patients' pain disappeared and their ulcers healed as quickly on this treatment as in a control series treated previously on orthodox lines.