Publications on peptic ulcer in Britain, France, Germany and the US

There are no reasonable explanations for the increases first of gastric, and then of duodenal, ulcers in the second half of the nineteenth century. Previous studies have analysed hospital admissions, necropsies and mortality data. This paper uses a novel method, a study of the rates of increases in publications on these peptic ulcers over the centuries in four countries, the US and three in Europe.

Between 1700 and 1919 the Surgeon General's Catalogues listed 2958 publications on gastric ulcer in Britain, France, Germany and the US, and between 1700 and 1929 1132 publications on duodenal ulcer. The published US cases of proven peptic ulcer in the nineteenth century were further analysed; details of sex, year of proven diagnosis and year of birth were available for 184 (90 male) cases of gastric ulcer and 77 (63 male) cases of duodenal ulcer.

There were exponential increases in the number of monographs and articles on both types of peptic ulcer in the nineteenth century, and the curves for the four countries are remarkably similar. The increases in publications on gastric ulcer began about 1800 and for duodenal ulcer decades later. The number of cases of gastric ulcer diagnosed definitively in the US rose slowly in the first half of the nineteenth century and then increased markedly, with the increases in proven duodenal ulcer 10-20 years later. The birth years of patients with gastric ulcer peaked for those born in the 1850s, and about 10-20 years later for patients with duodenal ulcer.

Such exponential increases are compatible with current models of infection with Helicobacter pylori but do not explain either the difference in timing between gastric and duodenal ulcer or the simultaneity between the four countries.