¹ For shell shock, see Allan Young, The harmony of illusions: inventing post-traumatic stress disorder, Princeton University Press, 1995, pp. 50–85; Anthony Babington, Shell-shock: a history of the changing attitudes to war neurosis, Barnsley, Cooper, 1997; Ben Shephard, A war of nerves: soldiers and psychiatrists in the twentieth century, Cambridge, MA, Harvard University Press, 2001; Peter Leese, Shell shock: traumatic neurosis and the British soldiers of the First World War, New York, Palgrave, 2002. For Gulf War syndrome, see Jeff Wheelwright, The irritable heart: the medical mystery of the Gulf War, New York and London, Norton, 2001, and Martin L Pall, Explaining “unexplained illness”, New York, Harrington Park Press, 2007.

² Analysis of the medical complaints of this conflict has been limited so far. Academic attention has mainly concentrated on conflicts such as the First World War. On this gap in the historical literature, Mark Harrison comments that no “other aspect of military life … has been so poorly served” as that of medicine in the British armed forces during the Second World War. See Mark Harrison, Medicine and victory: British military medicine in the Second World War, Oxford University Press, 2004, p. 1.

³ G H Brieger, ‘Dyspepsia: the American disease? Needs and opportunities for research’, in Charles E Rosenberg (ed.), Healing and history: essays for George Rosen, New York, Science History Publications, 1979, pp. 179–90, on pp. 188–9.

⁴ W F Bynum, ‘Introduction’, in W F Bynum (ed.), Gastroenterology in Britain: historical essays, London, Wellcome Institute for the History of Medicine, 1997, pp. 5–6, on p. 5.

⁵ For more on the history of gastric illnesses, see D A Christie and E M Tansey (eds), Peptic ulcer: rise and fall, London, Wellcome Trust Centre for the History of Medicine at UCL, 2002; Gerald N Grob, ‘The rise of peptic ulcer, 1900–1950’, Perspect. Biol. Med., 2003, 46 (4): 550–66; Christopher E Forth and Ana Carden-Coyne (eds), Cultures of the abdomen, New York, Palgrave Macmillan, 2005; E A Williams, ‘Neuroses of the stomach: eating, gender, and psychopathology in French medicine 1800–1870’, Isis, 2007, 98 (1): 54–79; Ian Miller, ‘Necessary torture? Digestive physiology, vivisection, the Suffragette movement and responses to new forms of clinical practice in Britian c.1870–1920’, J. Hist. Med, Allied Sci., Jul. 2009, 64 (3): 333–72.

⁶ See Kenneth C Hyams, F Stephen Wignall and Robert Roswell, ‘War syndromes and their evaluation: from the U.S. Civil War to the Persian Gulf War’, Ann. Intern. Med., 1996, 125 (5): 398–405; W J Coker, B M Bhatt, N J Blatchley and J T Graham, ‘The clinical findings of the first 1000 Gulf War veterans in the Ministry of Defence’s medical assessment programme’, Br. Med. J., 30 Jan. 1999, 318 (7179): 290–4.

⁷ Edgar Jones and Simon Wessely, ‘War syndromes: the impact of culture on medically unexplained symptoms’, Med. Hist., 2005, 49 (1): 55–78.

⁸ The most extensive work on the problem is Charles F Wooley, The irritable heart of soldiers and the origins of Anglo-American cardiology, Aldershot, Ashgate, 2002. See also Joel D Howell, ‘“Soldier’s heart”: the redefinition of heart disease and speciality formation in early twentieth-century Great Britain’, in W F Bynum, C Lawrence and V Nutton (eds), The emergence of modern cardiology, London, Wellcome Institute for the History of Medicine, 1985, Med. Hist. Suppl. No. 5, pp. 34–52; Christopher Lawrence, ‘Moderns and ancients: the “new cardiology” in Britain 1880–1930’, in ibid., pp. 1–33. For a discussion of pensions in the First World War, see Peter Barham, Forgotten lunatics of the Great War, New Haven and London, Yale University Press, 2004.

⁹ Edgar Jones, Robert Hodgins-Vermaas, Helen McCartney, Brian Everitt, et al., ‘Post-combat syndromes from the Boer War to the Gulf War: a cluster analysis of their nature and attribution’, Br. Med. J., 9 Feb. 2002, 324 (7333): 321–4.

¹⁰ A Giacosa, S G Sukkar and L Giogoso, ‘Dyspepsia among young conscripts: correlations with psychoemotional state and eating habits’, J. R. Army Med. Corps, 1987, 133 (1): 59–62.

¹¹ Arthur Hurst, Medical diseases of war, London, Edward Arnold, 1944, p. 194.

¹² A wider discussion of this as an international problem is available in T L Cleave, The saccharine disease, Bristol, John Wright, 1974. Detailed statistics of the British experience can be found in J N Morris and Richard M Titmuss, ‘Epidemiology of peptic ulcer vital statistics’, Lancet, 30 Dec. 1944, 244: 841–5. For more on Titmuss, see A Oakley, ‘Making medicine social: the case of the two dogs with bent legs’, in Dorothy Porter (ed.), Social medicine and medical sociology in the twentieth century, Amsterdam, Rodopi, 1997, pp. 81–96.

¹³ Rolf Valentin, Die Krankenbataillone Sonderformationen der deutschen Wehrmacht im Zweiten Weltkrieg, Düsseldorf, Droste Verlag, 1981. The extent to which this problem was an international one is beyond the scope of this article.

¹⁴ For more on British medicine and the military, see Harrison, op. cit., note 2 above.

¹⁵ G G Taylor, ‘The abdominal surgery of total war’, Glasgow Med. J., 1942, 19 (6): 123–42, pp. 133–4.

¹⁶ For modern epidemiological literature, see Mervyn Susser and Zena Stein, ‘Civilisation and peptic ulcer’, Lancet, 20 Jan. 1962, 279: 115–19; J H Baron, ‘Peptic ulcer’, Mt. Sinai J. Med., Jan. 2000, 67 (1): 58–62; J H Baron and A Sonnenberg, ‘Period- and cohort-age contours of death from gastric and duodenal ulcer in New York 1804–1998’, Am. J. Gastroenterol., 2001, 96 (10): 2887–91; A Sonnenberg, ‘Causes underlying the birth-cohort phenomenon of peptic ulcer: analysis of mortality data 1911–2000, England and Wales’, Int. J. Epidemiol., 2006, 35 (4): 1090–7.

¹⁷ Bertel Bager, ‘Beitrag zur Kenntnis über Vorkommen, Klinik und Behandlung von perforierten Magen- und Duodenalgeschwüren nebst einer Untersuchung über die Spätresultate nach verschiedenen Operationsmethoden’, Acta. Chir. Scand., 1929, 64, supp. 11.

¹⁸ Denys Jennings, ‘Perforated peptic ulcer: changes in age-incidence and sex-distribution in the last 150 years’, Lancet, 2 Mar. 1940, 235: 395–8, 9 Mar.: 444–7. It is worth noting that autopsy studies and GP consultations failed to observe the existence of an ulcer in the early period before technologies such as X-ray were used.

¹⁹ Jones and Wessely, op. cit. note 7 above, p. 55.

²⁰ Reginald T Payne and Charles Newman, ‘Interim report on dyspepsia in the army’, Br. Med. J., 14 Dec. 1940, ii: 819–21.

²¹ Philip H Wilcox, ‘Gastric disorders in the services’, Br. Med. J., 22 June 1940, i: 1008–12.

²² J Gibson Graham and J D Olav Kerr, ‘Digestive disorders in the forces’, Br. Med. J., 29 Mar. 1941, i: 473–6.

²³ C A Hinds-Howell, ‘A review of dyspepsia in the army’, Br. Med. J., 4 Oct. 1941, ii: 473–4.

²⁴ Payne and Newman, op. cit. note 20 above.

²⁵ Henry Tidy, ‘Peptic ulcer and dyspepsia in the army’, Br. Med. J., 16 Oct. 1943, ii: 473–7, p. 473.

²⁶ For more on the strong stomach, willpower and military manhood, see Ana Carden-Coyne, ‘American guts and military manhood’, in Forth and Carden-Coyne (eds), op. cit., note 5 above, pp. 71–85. See also O A Trowell, ‘The relation of tobacco smoking to the incidence of chronic duodenal ulcer’, Lancet, 14 Apr. 1934, 223: 808–9; V S Hodson, ‘Duodenal ulcers and cigarette smoking’, Lancet, 21 Nov. 1936, 228: 1235–6.

²⁷ Wilcox, op. cit., note 21 above.

²⁸ D N Stewart and D M de R Winser, ‘Incidence of perforated peptic ulcer: effect of heavy air-raids’, Lancet, 28 Feb.1942, 239: 259–61; C C Spicer, D N Stewart and D M de R Winser, ‘Perforated peptic ulcer during the period of heavy air-raids’, Lancet, 1 Jan. 1944, 243: 14; C F W Illingworth, L D W Scott and R A Jamieson, ‘Acute perforated peptic ulcer: frequency and incidence in the West of Scotland’, Br. Med. J., 11 Nov. 1944, ii: 617–20.

²⁹ See, for instance, ‘Total war and the individual’, Lancet, 1941, 237: 791–2. A contemporary text which dealt with these themes is Martin E Rehfuss, Indigestion: its diagnosis and management, Philadelphia and London, W B Saunders, 1943, p. 346. For more on total war, see Arthur Marwick (ed.), Total war and social change, Basingstoke, Macmillan, 1988, and Raymond Aron, The century of total war, Lanham, University Press of America, 1985, among others.

³⁰ It had been a dominant theme in literature on digestion for centuries, and was reasserted in Britain from the 1920s in several texts, including Arthur F Hurst and Matthew J Stewart, Gastric and duodenal ulcer, London and New York, Humphrey Milford, Oxford University Press, 1929.

³¹ W B Cannon, ‘The influence of emotional states on the functions of the alimentary canal’, Am. J. Med. Sci., 1909, 137 (4): 480–6; B A McSwiney, ‘Innervation of the stomach’, Physio. Rev., 1931, 11 (4): 478–514.

³² J Beattie, ‘The relation of the tuber cinereum to gastric and cardiac functions: a preliminary note’, Can. Med. Assoc. J., 1932, 26 (3): 278; H Cushing, ‘Peptic ulcer and the interbrain,’ Surg. Gynecol. Obstet., July 1932, 55 (1): 1–34; Millais Culpin, ‘Temperament and digestive disorders’, Br. Med. J., 20 July1935, ii: 102–6.

³³ Franz Alexander, ‘The influence of psychologic factors upon gastro-intestinal disturbances’, Psychoanal. Q., 1934, 3: 501–88. For more, see idem, Psychosomatic medicine, New York, Norton, 1950.

³⁴ Daniel T Davies and A T Macbeth Wilson, ‘Observations on the life-history of chronic peptic ulcer’, Lancet, 11 Dec. 1937, 230: 1353–60, p. 1353.

³⁵ G W B James, ‘Anxiety neurosis’, Lancet, 2 Nov. 1940, 236: 561–4.

³⁶ For a contemporary statistical evidence of ulcer as a male disease, see Jennings, op. cit., note 18 above.

³⁷ Alexander, ‘The influence of psychologic factors’, op. cit., note 33 above.

³⁸ Davies and Wilson, op. cit., note 34 above, p. 1360.

³⁹ For more on social medicine, see Porter (ed.), op. cit., note 12 above.

⁴⁰ Morris and Titmuss, op. cit., note 12 above.

⁴¹ Payne and Newman, op. cit., note 20 above.

⁴² Ibid.

⁴³ An example of investigators pronouncing these points can be found in Illingworth, Scott and Jamieson, op. cit., note 28 above.

⁴⁴ Rehfuss, op. cit., note 29 above, p. 346.

⁴⁵ R Coope, ‘Recent trends in gastro-enterological treatment’, Practitioner, 1942, 149 (5): 277–83, p. 277.

⁴⁶ R A Murray Scott, ‘Incidence of peptic ulcer’, Br. Med. J., 31 Mar. 1945, i: 457.

⁴⁷ Tidy, op. cit., note 25 above, p. 473. The reference to drivers probably stems from links made between gastric illness and the medical problems commonly suffered by London bus drivers. See A Bradford Hill, An investigation into the sickness experience of London transport workers, with special reference to digestive disturbances, London, His Majesty’s Stationary Office, 1937.

⁴⁸ A H Douthwaite, ‘Gastro-enterology’, Practitioner, 1941, 147 (10): 622–9, p. 624.

⁴⁹ For more on Hurst, see Arthur F Hurst, A twentieth century physician: being the reminiscences of Sir Arthur Hurst, London, Edward Arnold, 1949.

⁵⁰ See Harrison, op. cit., note 2 above, p. 1.

⁵¹ See David French, Raising Churchill’s army: the British army and the war against Germany 1919–1945, Oxford University Press, 2000, pp. 242–6. For productivity, see John Pickstone, ‘Production, community and consumption: the political economy of twentieth-century medicine’, in Roger Cooter and John Pickstone (eds), Companion to medicine in the twentieth century, London and New York, Routledge, 2003, pp. 1–20.

⁵² Harrison, op. cit., note 2 above, pp. 1–3.

⁵³ J B Wrathall Rowe, ‘Wartime diet for peptic ulcer patients’, Br. Med. J., 9 Oct. 1943, ii: 464.

⁵⁴ J J Horwich, ‘Incidence of peptic ulcer’, Br. Med. J., 30 Dec. 1944, ii: 866.

⁵⁵ For the development of gastroenterology, see Bynum (ed.), op. cit., note 4 above.

⁵⁶ This is a highly complex subject outside the boundaries of this paper, see Grob, op. cit., note 5 above.

⁵⁷ See Nikolas S Rose, The psychological complex: psychology, politics and society in England 1869–1939, London, Routledge and Kegan Paul, 1985; Mathew Thomson, Psychological subjects: identity, culture, and health in twentieth-century Britain, Oxford University Press, 2006.

⁵⁸ Psychologists, for instance, created instruments intended to screen out men most likely to succumb to battle exhaustion, thus keeping so-called “psychoneurotics” out of combat roles. See J T Copp and B McAndrew, Battle exhaustion: soldiers and psychiatrists in the Canadian army, 1939–1945, Montreal, McGill-Queen's University Press, 1990; Nafsika Thalassis, ‘The use of intelligence testing in the recruitment of “other ranks” in the armed forces during the Second World War’, Hist. Philos. Psychol., 2003, 5 (1): 17–29. For more on psychiatry and war, see Richard A Gabriel, No more heroes: madness and psychiatry in war, New York, Hill and Wang, 1987; Hans Binneveld, From shell shock to combat stress: a comparative history of military psychiatry, Amsterdam University Press, 1997; Joanna Bourke, ‘Disciplining the emotions: fear, psychiatry and the Second World War’, in Roger Cooter, Mark Harrison and Steve Sturdy (eds), War, medicine and modernity, Stroud, Sutton, 1998; Ben Shephard, ‘Pitiless psychology: the role of prevention in British military psychiatry in the Second World War’, Hist. Psychiatry, 1999, 10 (4): 491–524; Edgar Jones, ‘War and the practice of psychotherapy: the UK experience 1939–1960,’ Med. Hist., 2004, 48 (4): 493–510; Nafsika Thalassis, Treating and preventing trauma: British military psychiatry during the Second World War, University of Salford, 2004; eadem, ‘Soldiers in psychiatric therapy: the case of Northfield Military Hospital 1942–46’, Soc. Hist. Med., 2007, 20 (2): 351–68.

⁵⁹ Rehfuss, op. cit., note 29 above, pp. 359–61.

⁶⁰ F Twigg, ‘Perforation of duodenal ulcer when flying’, Br. Med. J., 25 Oct. 1930, ii: 687.

⁶¹ Rehfuss, op. cit., note 29 above, pp. 356–61.

⁶² Hurst, op. cit., note 11 above, pp. 176–8.

⁶³ William Brockbank, ‘The dyspeptic soldier: a record of 931 consecutive cases’, Lancet, 10 Jan.1942, 239: 39–42, p. 41.

⁶⁴ Tidy, op. cit., note 25 above, p. 473.

⁶⁵ Many of those advocating “ulcer battalions” were particularly interested in their potential for research into the gastric system. See F R Brown, ‘“Duodenal ulcer battalions”’, Br. Med. J., 31 Oct. 1942, ii: 530.

⁶⁶ http://www.bbc.co.uk/ww2peopleswar/stories/06/a8790906.shtml.

⁶⁷ Arthur Hurst, ‘Wartime diet for peptic ulcer patients’, Br. Med. J., 23 Oct. 1943, ii: 523.

⁶⁸ D C Smith, ‘Appendicitis, appendectomy and the surgeon’, Bull. Hist. Med., 1996, 70 (3): 414–41.

⁶⁹ T Izod Bennett, ‘Peptic ulcer in the services’, Br. Med. J., 16 Mar. 1940, i: 458.

⁷⁰ H Tidy, ‘Peptic Ulcer’, Practitioner, 1944, 153 (4): 197–203, p. 201.

⁷¹ Bennett, op. cit., note 69 above.

⁷² Coope, op. cit., note 45 above.

⁷³ B Gilsenan, ‘Dyspepsia of peptic ulcer type and its relationship to personality type and anxiety’, Practitioner, 1946, 157 (2): 457–8.

⁷⁴ A Lewis, ‘The psychological aspects of indigestion’, Practitioner, 1944, 153 (4): 257–60, p. 260.

⁷⁵ Hurst, op. cit., note 11 above, p. 193.

⁷⁶ Ibid., pp. 193–5.

⁷⁷ J Robin Warren, ‘Unidentified curved bacilli on gastric epithelium in active chronic gastritis’, Lancet, 4 June 1983, 321: 1273–5.

⁷⁸ G D Smith, ‘The biopsychosocial approach: a note of caution’, in Peter White (ed.), Biopsychosocial medicine: an integrated approach to understanding illness, Oxford University Press, 2005.

⁷⁹ S Levenstein, ‘The very model of a modern etiology: a biopsychosocial view of peptic ulcer’, Psychosom. Med., 2000, 62 (2): 176–85.

⁸⁰ H Spiro, ‘Peptic ulcer is not a disease, only a sign! Stress is a factor in more than a few dyspeptics’, Psychosom. Med., 2000, 62 (2): 186–7.

⁸¹ Cleave, op. cit., note 12 above, pp. 152–3.

⁸² E Shorter, ‘Paralysis: the rise and fall of a “hysterical” symptom’, J. Soc. Hist., 1986, 19 (4): 549–82.

⁸³ Jones and Wessely, op. cit., note 7 above, p. 55.

⁸⁴ For more on this, see C C Booth, ‘Factors influencing the development of gastroenterology in Britain’, in Bynum (ed.), op. cit., note 4 above, pp. 96–107.