Another 20th century epidemic.
Sir,

I greatly enjoyed Dr David Grimes’ review ‘An epidemic of coronary heart disease’.1 An epidemic of a completely different disease, duodenal ulcer, occurred during almost exactly the same time, which seems rather unlikely to have been a coincidence. David Grimes describes the fact that coronary heart disease was rare before the first world war, then became increasingly common in the 1920s and then, after peaking in the late 1960s, has declined in incidence steadily ever since. Duodenal ulcer disease shows a very similar time scale.

Duodenal ulcers were rare before the early 1900s. Although this was partly due to the lack of radiological diagnosis, dramatic events such as perforation or fatal haemorrhage were obvious to doctors, and such events provide the most reliable data for estimating ulcer incidence around a 100 years ago. The work of surgeons such as Moynihan2 made it possible to recognize the typical symptoms. William Osler, then working in Johns Hopkins Hospital, Baltimore, wrote in the third edition of his textbook of medicine, published …