The stomach: a biography is a new book by Dr Jeremy Hugh Baron, subtitled “Four thousand years of stomach pains: literature, symptoms and epidemiology”. Dr Baron has been using the Wellcome Library and other libraries for many years, during which he has read a huge number of diaries, memoirs, novels, plays, poems, lexica, letters, monographs and other documents from a gastroenterological point of view. In his new book he presents his well-marshalled findings century by century, with extensive documentation. Among other things, his book demonstrates the immense evidence for medical history that exists outside old medical literature. Another is that views on the stomach, whether lay or professional, appear differently when reconsidered in their historical context, and this even applies to recent times, as in the case of the controversy since the 1980s over the role of Helicobacter pylori in peptic ulcer.
He has found great discrepancies in the experience of gastric discomfort: for instance, Ralph Josselin of Essex (1616-1683) recorded in his diary 465 bouts of ill health in himself and his wife, but only one of them a stomach disorder (“a surfett of oysters … lay corrupting in my stomacke”, 27 November 1672 – when there was an r in the month). At the other extreme, Robert Hooke’s diary (1672-1680) recorded 353 health episodes of which 91 were alimentary (26%).
There is also a very large and inconsistent vocabulary for describing stomach disorders: cardiogmos, soda, sour belchings, waterbrash (or, in Devonshire, waterpang), magan woerce, ptyalism, and many others indicate the range of nomenclature in English alone that historians have to get to grips with. A table by Octavia Haure (pp. 333-336) shows different words used in 44 languages for each of four major groupings of symptoms: heartburn, indigestion, stomach-ache, and bloated/wind.
As well as vocabulary, epidemiology, diseases in vogue at different periods, and treatments, the book discusses many examples of pathology. A fascinating comparison which Dr Baron has published in greater detail elsewhere fully deserves the summary of it which is given here: it concerns two cases of perforated stomach ulcer in 1665 and 1670. In 1665 an autopsy in Bologna on the body of the painter Elisabetta Sirani showed a hole in the stomach which two of the four doctors present attributed to an inflammatory ulcer. However, in 1670, a similar finding in the stomach of King Charles I’s youngest daughter Henriette Anne after she died at Saint-Cloud was attributed to the knife of the dissector, apparently because the French and English doctors were unfamiliar with perforated ulcer.
It seems that the unpleasant experience of gastro-oesophageal reflux has been suffered under different names by many of our ancestors. However, the same seems likely to be true of our descendants, for Dr Baron’s conclusion (p. 319) is as follows:
In the last 4000 years dyspepsia and gastro-oesophageal reflux have been ever present. Following the appearance and spread of pathogenic Helicobacter pylori, gastric cancer, gastric ulcer and duodenal ulcers appeared successively in the 1800s, increased rapidly and are now decreasing. It seems probable that the so far unstoppable increase in obesity in the developed world will inevitably increase gastro-oesophageal reflux, just as the decline in H pylori will decrease duodenal ulcer, and the wider use of NSAIDs in an ever aging population will increase gastric ulcer.
Author: William Schupbach