A Modern History of the Stomach: Gastric Illness, Medicine and British Society, 1800–1950 by Ian Miller (review)

Though a range of historians and cultural critics have been interested in the stomach, diet, and digestion, tracing its various facets from the ancient to the modern world, Ian Miller’s focus on gastric illness offers a new intervention. Highlighting the specific turning points of medical construction in diagnosis and treatment over a broad period, from the nineteenth century to the Second World War, the book is organized into coherent periods of change. The wide reach across time is ambitious. Miller is quite successful in handling the material and presenting distinct arguments within each period. The first chapter focuses on Victorian ideals of the nation, arguing that the desire to produce a fit society shaped the medical analysis of indigestion. Though the condition was a great concern to French and British societies in the eighteenth century, Miller shows that there were specific inflections through the industrial revolution and as urbanized work practices shaped public health, generating intense political focus on the state of the national body. Since the time of the ancient Greeks, disordered stomachs had reflected moral and religious ideas, however Miller shows that the stomach and its illnesses became “a historical index of social anxiety” (p. 7) underpinned by modern concerns and contexts.

Chapter 2 examines the shift from general symptomatic illnesses such as dyspepsia to the invention of gastric ulcer disease, an organ-focused diagnosis that appeared in the first half of the nineteenth century. It argues that medical knowledge was concentrated and reorganized in this period, especially as pathological science enabled new ways of observing the stomach. This influenced the way in which gastric illness was diagnosed.

Chapter 3 discusses the role of the laboratory and chemistry in shaping the analysis of gastric illness from the late nineteenth century to the immediate post-war period. The rise in physiological understandings of the body influenced new understanding of digestive processes, but this was offset by wider ethical questions about pain. Additionally, Miller offers a truly interesting though brief digression into the suffragette hunger strike of 1909 and their encounter with force feeding.

Chapter 4 concentrates on duodenal ulcer disease, beginning with the story of King George VI and his personal affliction with gastric ill health. The king’s condition is situated in a longer historical trajectory of medical knowledge.

Chapter 5 provides an important account of the elusively described condition, dyspepsia. Importantly, this chapter tackles the aspect of wartime society and the particular impact of the condition on the British soldier and the British military, focusing mainly on the research available from the Second World War. This subject has not sufficiently been tackled or understood by historians of war medicine and should be studied by military historians and cultural historians of war. It would have been interesting to know more about the First World War period, especially as a few historians have already made suggestions about stomach conditions in relation to soldiers’ anxieties, nutritional intake, and the specific problems of a environmental and disease conditions of both trench warfare and dysentery.

For historians of war, the section on the dyspeptic British soldier has particular interest. Soldiers in the Second World War presented with “crippling abdominal complaints” (p. 111) such as dyspepsia and peptic ulcer, which fueled concern about the health and effectiveness of military manpower. To be sure, doctors in the First World War report similar symptoms, which were often associated with psychological dysfunctions such as neurosis. Largely, however, military doctors were focused on either saving lives from radical wound infections, in the pre-antibiotic era, or trying to contain the epidemic of shellshock. Throughout the interwar period, concerns about soldiers’ weak “guts” were channeled into debates about compulsory military service. Thus the psychosomatic thread was lost until it became apparent that there was an epidemic in 1939, almost as...