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

How does one define a “modern history”? Does it cover a “modern” time period, or refer to the author’s choice of historical method? In the case of Ian Miller’s modern history of the British stomach, it could be interpreted either way, since he suggests that the organ came to occupy a central position in British “medico-social” thinking as a result of social changes provoked by the nineteenth-century Industrial Revolution, and that it functioned as a rhetorical site of professional identity (7). In other words, this is a social constructionist approach to the subject which excludes not only the patient’s perspective but also most of the contextual social history which might have broadened the book’s appeal. At its best, the history of medicine is a vibrant interdisciplinary field, but there are corners which prefer theoretical methodologies with the narrower focus and potential for reductionism which they engender. By contrast with Fay Bound Alberti’s Matters of the Heart (2010), for example, Miller’s exploration of the history of the stomach is limited indeed. Based in his Ph.D. thesis, it is short, with just over one hundred thirty pages of text, and for the most part preoccupied with stomach ulcers. Disentangling a specific Victorian element to the story is not easy, since chapter chronologies cover the nineteenth century: from 1800 to 1860; from 1870 to 1920; from 1880 to 1920; and from 1920 to 1945.

Miller avows that there is a longstanding tradition emphasising the importance of the stomach to medical, social, and cultural history, so his adoption of a narrowly medical approach to his topic is a disappointment. The stomach richly deserves a fuller, more interdisciplinary approach, and it is possible to envisage a chronology which would encompass the Georgian, Victorian, Edwardian, and other stomachs as distinct cultural entities. It might have been helpful to the more generally interested reader if Miller had discussed the perceived medical landscape of the internal body, the ways in which it changed across his period, and the reasons why the stomach was privileged as a rhetorical site of professional identity in preference to more medically problematic organs. A systematic trawl of the run of the Lancet or the British Medical Journal might have helped to put the Victorian and later history of the stomach in broader medical and social perspective, but Miller’s concentration on literature relating to stomach problems did not encourage such comparison. In terms of cause of death, stomach problems, always allowing for diarrhoea and the enteric fevers (which fall outside Miller’s remit), did not feature prominently among the major killers of the nineteenth century. Considered in relation to the heart and the lungs, to a rising tide of angina pectoris, to the ravages of pulmonary tuberculosis, and to the accelerating incidence of bronchitis in damp and smoky cities, stomach problems, largely of dyspepsia, were of a minor order. And while dyspepsia undoubtedly ravaged lives, as the torments of Charles Darwin, T. H. Huxley, and others make clear, its treatment did not add significantly to the laurels of the medical profession. Darwin at one stage famously gave up on doctors and took to hydrotherapy; others developed their own remedies. The barrister and London police magistrate Thomas Walker devised his own programme for a healthy stomach after years of biliousness and inflammatory attacks, and his book of reflections, called The Original (1835) and beginning with an elaboration of “The Art of Attaining High Health,” ran to six editions, the last two being edited by the eminent physician William Guy.

While the prevalence of dyspepsia in the lives of the Victorian good and great undoubtedly reflected psychological stresses for which they had no other culturally permissible expression, the existence of indigestion as a problem in all social classes almost certainly grew exponentially with urbanisation, and with what contemporaries saw as...