The Stomach

Frontispiece to “Memoirs of a Stomach“ by The Minister for the Interior - Sydney Whiting, 1853.

   Knowledge of the interconnection of the gut and psyche has a longer history than scientists often admit.

   In recent decades, microbiologists have advanced understandings of how gut bacteria (known as the microbiome) influences emotional well-being. The gut-brain axis is now a topic of major interest. However, understandings of this interconnection between gut and mind have greater historical anteriority than scientists often acknowledge. Indeed, until the 19^th century, most physicians took for granted the relations between gut, mind and emotions until reductionist medicine limited their focus. However, perceptions of the gut as an isolated bodily area, seemingly disconnected from the rest of the body, have usually proven clinically and practically unsatisfactory.

   In the early 19^th century, the most prominent doctors (e.g. John Hunter, James Johnson, John Abernethy) viewed the gut as ‘the second brain’ or ‘the great nervous centre’. They thought of the stomach as the body’s most important organ due to its strong influence on physical and emotional health. Then, it was the stomach’s nerves, not its bacteria, which received medical attention.

   The Victorians produced a wealth of books on the stomach. Perhaps the most intriguing, was published in 1853 by an obscure author named Sydney Whiting. Entitled Memoirs of a Stomach, the book proved immensely popular. Various editions were published and it was even translated into French. All of this was despite the fact that the narrator was a remarkably literate stomach, named Mr Stomach, who described the misery of his long life in great detail.

   Gut health was fundamentally political. Physicians believed that Britain was suffering nationwide from crippling dyspepsia, partly due to the stress and strain of industrialisation. Many feared that if the gut health of communities was comprised by dyspepsia and nervous excitement caused by, say, excessive tea drinking, revolution might ensue. Whereas the heart was associated with love, the gut was associated with menacing, ‘morbid’ emotions. Populations, as well as individuals, needed to be well fed to ensure socio-political harmony.

   Holistic models of the gut-brain axis came under threat from reductionist trends in western medicine. In 1828, Scottish physician John Abercrombie published the first book on the stomach based on anatomical investigation. He developed an intricate knowledge of the stomach not as a cohesive whole but as an organ with different sections, parts and areas, each with their own physical problems such as gastric or duodenal ulcers. In this localism, the organ’s general relationship with the body began to be forgotten. Late-century physiologists approached the stomach in terms of its chemicals and functions. Prominent surgeons such as Berkeley Moynihan developed procedures for excising ulcers and tumours from the abdomen. Both professional groups advocated reductionist approaches that neglected relations between bodies and emotions.

   The development of psychology in the early 20^th century encouraged practitioners (e.g. Walter Cannon, Walter C. Alvarez and Franz Alexander) to revisit ideas about the psychic roots of gastric disorder and, vice versa, the physical origins of psychic disorder. Gradually, physiologists and psychologists came to believe that stomach ulcers were stress-related, revitalising earlier holistic models of the gut-brain axis in light of twentieth-century socio-political circumstances. During the Second World War, seemingly high rates of perforating stomach ulcers on Dunkirk’s beaches and during London’s air raids seemed to offer irrefutable evidence of the correlation between stress, stomachs and minds. The 1980s’ discovery of peptic ulcer’s bacterial causes once again threatened to reduce the management of the stomach to antibiotic treatment. But knowledge of the microbiome has led the pendulum to swing back the other way to a fuller holistic appreciation of the body’s inner connections.

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