Rush University, Chicago, Illinois, United States (Spring 2014)
Jeremy Hugh Baron, a well-lettered physician, scientist, and scholar takes us through a comprehensive tour of the “The Stomach” in recorded history. It is immediately apparent that Dr. Baron is not limiting himself to the anatomical organ, but to what the patient suffering from abdominal distress perceives to be the “stomach.” The author has set before us a banquet of information digesting a corpus spanning the eras of early Mesopotamia, the Greco-Roman centuries, the Far East, and writings from the Middle Ages. He draws on ancient medical texts, the writings of philosophers, Islamic physicians, the Talmud, and similar sources from Ancient China and Tibet. It is a formidable task complicated by language obstacles and the difficulty translating symptomatology from “dead” languages into terminology comparable to that used in medicine today. He provides a very useful appendix, “The Vocabulary of Indigestion,” relating modern symptomatology to the terminology from a broad spectrum of languages used in the sources he has studied. In each of his chapters, he tries to derive some statistical notion of the frequency of gastrointestinal complaints in the sources he has explored. Each chapter also neatly provides excellent references.
Beginning with a chapter devoted to the Renaissance and continuing with the 16th and 17th centuries, advances in anatomy and pathology herald a body of literature and concepts that begin to be more recognizable to the modern reader. The author shows us how it is possible to mine a variety of sources in assembling a picture of gastric distress as seen in Europe during these centuries. Examples include medical texts, parish registers yielding the causes of death, physician case books, and a fascinating body of letters and diaries. Notable individuals include Erasmus, Robert Hooke, and Samuel Pepys. Physician case books are an important source in gleaning a picture of the frequency with which physicians confronted gastrointestinal complaints. As an example, Shakespeare’s son-in-law Dr. John Hall left case notes on 177 patients, one tenth of whom presented with gastrointestinal distress. Necropsies first allowed in Europe in the fourteenth century yielded early descriptions of gastric ulcer. Records from the 1700s offer insights into the activities of hospitals and dispensaries. The increase in hospital admissions and medical publications dealing with dyspepsia suggests a true epidemiological phenomenon.
The 1800s witness the growing recognition of peptic ulcer disease as well as an understanding that the stomach had the ability to secrete hydrochloric acid. Clinical symptoms such as heartburn, water brash, and dyspepsia make their way into the literature in a form recognizable today. Baron explores the digestive lamentations of notable 19th-century authors recorded in their diaries and letters. Examples include: William Blake, Samuel Taylor Coleridge, Thomas de Quincy, Thomas Carlyle, Honoré de Balzac, and Charles Darwin. The heart of the chapter deals with the epidemiology of peptic ulcer disease, and the author notes the dramatic increase in the number of publication on both gastric and duodenal ulcers during the 19th century. The sudden appearance of acute perforating gastric ulcers in young women during that century is of particular interest. The author puts forth the hypothesis that for most of human history the stomach was infected with micro-organisms that lowered gastric acid output. Improvements in sanitation allowed Helicobacter pylori to “flourish and cross-infect from childhood, and modest [increases in] gastric secretion ulcerated the stomach only.”
The last four chapters of the book are devoted to a review of developments after 1900. This includes a review the epidemiology of esophageal acid reflux, dyspepsia, the irritable bowel syndrome, peptic ulcer disease and the integration of H. Pylori into our understanding of these entities.
The Stomach: A Biography is a well-referenced text and will serve as a useful source to the clinical and epidemiological literature of gastrointestinal symptomatology and upper gastrointestinal disease. The review of ancient literature and the insights into terminology are a notable resource. An afterword or projection as to avenues for research and study might have served as an attractive conclusion.
The stomach: a biography
Copyright @ 2013 Jeremy Hugh Baron
JAMES L. FRANKLIN, MD is a gastroenterologist and associate professor emeritus at Rush University Medical Center. He also serves on the editorial board of Hektoen International and as the president of Hektoen’s Society of Medical History & Humanities.