The rise of peptic ulcer, 1900-1950

The seeming increase in the incidence of peptic ulcer after 1900 quickly occupied the attention of physicians. Their understanding and treatment of peptic ulcer was shaped not only by new diagnostic tools, but by differences between contesting medical specialties, broad concepts or paradigms current in the larger medical and scientific community, and prevailing social and ideological beliefs. Surgeons and internists, for example, were often at odds over appropriate therapies; each maintained that personal experiences demonstrated the efficacy of their therapies. Nor were etiological theories derived from empirical data. The claim that peptic ulcer resulted from focal infections was simply a reflection of the popularity of germ theory. Other explanations included the role of stress, race, constitutional makeup, psychosomatic factors, and the pressures of modern industrial society. Virtually all were derivative and reflected social and intellectual currents that were common in the larger society of which medicine was but a part. Thus, the history of peptic ulcer during the first half of the 20th century provides an instructive and in many ways a typical case study in the complexities posed by the emergence of modern medicine.