Early history of dyspepsia and peptic ulcer in the United States.

In Scotland, dyspepsia was first recorded in the mid-eighteenth century; its marked increase preceded the rise in the occurrence of gastric and duodenal ulcer. The aim of the present study was to analyze the earliest available statistics of dyspepsia and peptic ulcer in the United States and compare their trends with those previously reported for Scotland. We analyzed the annual in- and outpatient records of hospitals and dispensaries in Philadelphia, New York, and Boston for 1750-1920. The cumulative number of cases in each diagnostic category from 5 consecutive years was divided by the resident population of the same period and expressed as average annual rate per million population.We found that dyspepsia was first recorded in hospital statistics at the end of the eighteenth century and increased markedly thereafter. It remained a common diagnosis throughout the nineteenth and twentieth centuries. Hospital admissions for gastric ulcer started to rise only in the last quarter of the nineteenth century, followed, with a 20-year delay, by a similar rise in the occurrence of duodenal ulcer. Proportional admission rates for dyspepsia were similar among men and women. Gastric ulcer was more common in women; duodenal ulcer was more common in men. Similar trends were observed in the three cities. Our analysis supports the contention that non-ulcer dyspepsia has long been distinct from peptic ulcer.

Sailors' scurvy before and after James Lind--a reassessment.

Scurvy is a thousand-year-old stereotypical disease characterized by apathy, weakness, easy bruising with tiny or large skin hemorrhages, friable bleeding gums, and swollen legs. Untreated patients may die. In the last five centuries sailors and some ships' doctors used oranges and lemons to cure and prevent scurvy, yet university-trained European physicians with no experience of either the disease or its cure by citrus fruits persisted in reviews of the extensive but conflicting literature. In the 20(th) century scurvy was shown to be due to a deficiency of the essential food factor ascorbic acid. This vitamin C was synthesized, and in adequate quantities it completely prevents and completely cures the disease, which is now rare. The protagonist of this medical history was James Lind. His report of a prospective controlled therapeutic trial in 1747 preceded by a half-century the British Navy's prevention and cure of scurvy by citrus fruits. After lime-juice was unwittingly substituted for lemon juice in about 1860, the disease returned, especially among sailors on polar explorations. In recent decades revisionist historians have challenged normative accounts, including that of scurvy, and the historicity of Lind's trial. It is therefore timely to reassess systematically the strengths and weaknesses of the canonical saga.

Hospital admissions and primary care attendances for nonulcer dyspepsia, reflux oesophagitis and peptic ulcer in Scotland 1981-2004.

AIM: The aim of this study was to assess the recent time trends of oesophageal disorders, nonulcer dyspepsia, gastric and duodenal ulcer in the light of such risk factors as age, sex, deprivation and urban versus rural residence. METHODS: The Scottish National Health Service provided diagnostic data on all admissions to all Scottish hospitals from 1981 to 2004 and patient visits to general practitioners (GP) from 1998 to 2004. RESULTS: In the last quarter of a century in Scotland, there were sevenfold increases in annual hospitalizations for dyspepsia (from 900 to 6000 per million population) and for oesophageal disorders (from 500 to 3700). Annual hospitalisations for gastric and duodenal ulcer changed from 590 to 1100 and from 1400 to 1130 per million population, respectively. The variation of hospital admissions for dyspepsia among various Scottish regions closely matched the variation of deprivation among them. GP contacts for dyspepsia (27 600 per million population) and oesophageal disorders (10,000) were common compared with relatively infrequent contacts for gastric ulcer (500) and duodenal ulcer (1200). Dyspepsia showed a rise of GP contacts with increasing scores of deprivation. This rise occurred similarly among urban and rural residents and applied to data for each individual year between 1998 until 2004. None of the other diagnoses showed any clear-cut correlation with grade of deprivation. CONCLUSION: Gastric and duodenal ulcer are relatively rare causes for hospital admission as well as outpatient physician visits. Their former predominant role in upper gastrointestinal disease has been replaced by gastro-oesophageal reflux disease and nonulcer dyspepsia, both increasing sevenfold in the last quarter of a century.

Medical police and the nanny state: public health versus private autonomy.

Rome tried to increase both the numbers of its people and their well-being, and hence their wealth, but it was not until the 16th century that European rulers were urged to achieve these aims by the power of the state to enforce public health. By the 17th century, absolutist states such as France, Austria and especially Germany had created an administrative profession of enlightened despotism, with medical police to encourage healthy and thus wealth-producing citizens. Johann Peter Frank (1745-1821) was the profession's exemplar with his 6,262 page System einer vollstländigen medischiner Polizey, leading to comprehensive public health legislation in German-speaking states, followed by more libertarian countries such as Britain and the United States. However, controversy continues on the role of government in trying to save its citizens, and especially their children, from harming themselves and/or others by their actions and omissions.

American medical students in 19th-century Europe.

Many Americans studied medicine in Britain in the 18th century, but the major influx to Europe began after 1815, when the French Revolution's reforms of health care and medical teaching had reached their zenith. Americans were well trained in France (and later in Germany) in medicine, surgery, pathology and clinical science, and brought these skills back to the US. Their training had been in countries with government-run, relatively egalitarian health care systems. On their return, they did not seek to transplant such a system to the US, but they did introduce European medical science and medical techniques, and something of the European medical education system.

Corporal punishment of children in England and the United States: current issues.

Proverbs has eight sets of instructions on beating children, but that book does not contain the often cited proverbial "spare the rod and spoil the child." This form of discipline, which is thousands of years old, has only recently been abandoned and forbidden in many states in the US, and in much of Europe. It is still legal in Britain and some US states, and remains a controversial issue.

"Thou shalt not kill": some legal and linguistic problems.

Large plaques of the religious precepts generally known as the Ten Commandments were recently placed in official public spaces in several states. This practice has been successfully challenged in federal courts of appeals, and the challenge was upheld by the Supreme Court in April 2003. Yet there is another problem with such plaques, if older translations are used. "Thou shalt not kill" is actually a mistranslation of the Hebrew, "You shall not murder. The two statements are not synonymous, yet many people in the world still use archaic biblical translations, with unfortunate bioethical consequences. There is also widespread usage of a non-commandment, "Thou shalt not kill; but needst not strive officiously to keep alive." This is not a biblical injunction; it is a line from A.H. Clough's satirical poem, "The Latest Decalogue."

If I were Dean: a challenge to new medical students.

If I were Dean I would welcome new students by explaining that they will be trained to become humane, compassionate scientists, and that our medical sciences are based on classical Greek science and medicine, with its first aphorism "Life is short, but art and skill are long." Science involves the conception and construction of refutable hypotheses, and their testing by repeatable experiments, followed by publication of the results. Thus, science is uncertain, tentative, probabilistic and universal. Our students will learn compassion both from our bioethicists and from faculty role models. I would warn the students that, unfortunately, much of the general public has little understanding of science, does not accept our medical model, and is increasingly seeking alternative, pre-scientific, non-scientific and even pseudo-scientific models of care, not necessarily from lack of intelligence, but perhaps more from scientific illiteracy and innumeracy. And the public fruitlessly demands safe and effective drugs, free from side effects, for all ailments, but they often fail to take drugs when prescribed, and/or take alternative medicines instead.

Campylobacter pyloridis in the upper gastrointestinal tract: a brazilian study

O recente isolamento do C. pyloridis em biopsias gástricas humanas tem despertado enorme interesse no papel deste organismo como agente etiológico da gastrite crônica antral, bem como da possível correlaçäo entre esta e a úlcera péptica. Com o propósito de avaliar sua incidência entre nós, foram estudados 51 pacientes encaminhados a esofagogastroduodenoscopia por diversos transtornos gastrointestinais. Todos os pacientes foram submetidos a 3 biopsias endoscópicas do antro gástrico; biopsias adicionais eram realizadas na presença de úlcera péptica ou neoplasia. O material obtido foi avaliado por métodos bacteriológicos e histopatológicos. Foi detectada a presença da bactéria em 40/51 (78%) dos pacientes, tendo sido evidenciada ótima correlaçäo entre a cultura (100%), Gram (90%) e coloraçäo pelo Gimenez (80%) na identificaçäo do organismo. Em todos os casos positivos para C. pyloridis foram observadas alteraçöes histológicas de gastrite crônica antral, ativa ou quiescente, mesmo quando a aparência endoscópica era normal. Todos os portadores de úlcera péptica (n=17) albergavam C. pyloridis no antro. No duodeno os organismos foram encontrados principalmente em áreas de mucosa gástrica extópica propriamente dita. Nossos achados reforçam a hipótese que C. pyloridis está fortemente relacionado com a gastrite crônica e possivelmente com a úlcera péptica