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.