The topical nature of the treatment of Zollinger-Ellison syndrome arises from the alternatives to total gastrectomy, namely medical management with cimetidine, and tumorectomy. The various stages in the history of the syndrome are described with reference to a personal series of 16 cases, and various observations are made with regard to the clinical aspects of its diagnosis, treatment, and emergency surgical management. A detailed account is given of several illustrative cases. Detailed assessment of the various factors on which the current indications for surgery are based suggests that a certain degree of eclecticism should be adopted, though the results offered by total gastrectomy must be regarded as sound in the long term.