Alimentary diseases in the poor and middle class in London 1773–1815, and in New York poor 1797–1818

Summary Background : Although dyspepsia has been described for thousands of years, few studies have analysed its incidence before the 19th century when peptic ulcer first became a major dyspepsia‐producing disease. Methods : The incidence of alimentary disease around 1800 was examined in three private practices for the fee‐paying middle class and in five public dispensaries for the poor in London, as well as in one dispensary in New York. Results : The proportions of attendances for alimentary disorders were identical, 16%, in each of the three groups. Diarrhoea and dysentery were twice as common in the London dispensary than in private practice, presumably because of poor sanitation. Dyspepsia showed a similar incidence in the London dispensary and private practice, but was only half as common in New York. Worms were three times more common in dispensary patients in New York than in London. The incidence of diarrhoea and dyspepsia indicated no significant time trends over 43 years. None of the alimentary causes of death showed peptic ulcer at necropsy, and both haematemesis and intestinal haemorrhage were rare. Conclusions : Around 1800, the infrequent deaths from alimentary conditions suggested that the ulcer epidemic had not yet started. Instead, it is probable that the dyspepsia was similar to the non‐ulcer dyspepsia of today.