‘The voice of the stomach’: the mind,hypochondriasis and theories of dyspepsia in the nineteenth century

Systematizing sympathy: the case of dyspepsia

Physicians were interested in a condition they thought of as dyspepsia, which is simply ‘indigestion’ in many medical glossaries. Dyspepsia, much like fevers in the nineteenth century, had many forms and conditions (Hamlin, 2014), and fever itself was a disease. My case study involves a British physician, Samuel Osborne Habershon, who embraced mercurial cures but was also sceptical of these interventions, especially for the stomach. He believed, as we do now, that the mind has a role in stomach disorders, and he was trying to build a taxonomy of stomach illnesses that was interesting to the philosopher but useful to the physician. In 1866, he wrote a manual for physicians entitled On Diseases of the Stomach: The Varieties of Dyspepsia, Their Diagnosis and Treatment.

Habershon was born in Yorkshire to a working-class family, but was taken as a student by a local physician and then, by the age of 17, was sent to Guy’s Hospital (Anon., 1889; Bettany, 2020; Munk’s Roll, 1950; Stephen and Lee, 1890). Habershon did well in school, according to Munk’s Roll, and was a high achiever at the Bachelor and doctoral levels; he even began teaching anatomy prior to receiving his medical doctorate (Anon., 1889). Ultimately, he became a lecturer at Guy’s Hospital, where he was involved in promoting and demonstrating the microscope. Eventually, he also became the curator of the hospital museum. However, he resigned from Guy’s amid controversy, mostly about mistreating the nursing staff (Anon., 1889; Bettany, 2020; Waddington, 1995).

In addition to being a physician, Habershon was also a member of the Royal College of Surgeons and Apothecaries. He took a job at the City Dispensary, worked at the Star Life Assurance Society and volunteered at the London City Mission (Anon., 1889). In 1860 he published a book, On the Injurious Effects of Mercury in the Treatment of Disease. When he turned his attention to the disorders of the abdomen, Habershon published two books on the subject: On Diseases of the Stomach (1866) and On the Pathology of the Pneumogastric Nerve (1877). He had a good reputation of working with surgeons (Anon., 1889); for instance, he worked with Mr Cooper Forster to perform what was thought to be the first ‘gastrostomy for stricture of the aesophagus’ (Stephen and Lee, 1890: 414). Ultimately, stomach illness would cause Habershon’s death.

His book On Diseases of the Stomach (1866) was intended to be useful for the practitioner. In writing it, Habershon drew on his many years of practice at Guy’s Hospital and also his experiences in private practice, concluding that clinical learning originates from a study of cases:

The careful analysis of individual cases leads us spontaneously to follow the mode of grouping, which is both truthful in its character, and useful for diagnosis and treatment; and the experience of the author has led him thus to classify those forms of diseases, which are naturally associated together. (p. iv)

In his view, the physician needed to cure the patient, not merely treat the diseases.

In this book, he analyses the stomach according to its various functions and diseases, focusing on the constitution and sympathy. The constitutional analysis considers the diet, weather, emotional conditions, and internal wind that the patient experienced. The idea of sympathy was important in the nineteenth century, when physicians thought that bodily systems affected each other. Often the hard parts of the body (bones, muscles, tendons, etc.) and the soft parts and liquids convey and respond to irritations (pp. 1–2, 39–40).

Habershon discusses the role of the stomach across a patient’s life, then he tries to make a nosology of dyspepsia. The book reads more like a treatise on the theory of the diseases of the stomach than a manual for the practising physician. (Manuals for medical practice did exist at that time, and were also available to the lay practitioner. ² ) Habershon points out that, although there was a lot of literature on the diseases of the stomach, the number of maladies from which people suffered continue to expand. He wanted to keep away from the larger scientific debates regarding ‘gastric disease’ (pp. 83–4), and to remain practical in his approach. This book was designed especially for the day-to-day work of the physician.

Habershon was very interested in ‘healthy digestion’:

Healthy digestion is performed unconsciously; and the physical movements, the chemical solution, and the subsequent absorption produce no sensory phenomena. The replenishment of the natural wants of the system excites a consciousness of healthy vigour, and of capacity for new exertion; and, as exercise produces waste, the demand for fresh material, by which the deficiency may be resorted, is expressed by a health hunger, and by a thirst which is soon satisfied. (p. 2)

If something goes wrong in this automatic function, then the physician must respond. But to find the cause of dyspepsia, Habershon thought we should look at the history of the patient holistically:

To enumerate all the causes of dyspepsia we must trace the daily life of an individual from earliest years to advanced age; and not only must we note the external and physical conditions, but the subtle workings of the mind amidst its joys and arrows, its gratifications and disappointments, its corroding cares and its seasons of buoyant happiness, its thirst for sensual enjoyment, as well as its highly intellectual pursuits. (pp. 2–3, original italics)

Habershon wants to explain all the types of dyspepsia, which is simply defined as the ‘corresponding defect of the stomach’ (p. 3). It can be caused by problems with the mucus of the membrane of the stomach and what it is thought to secrete; the stomach as a muscle not being able to move properly; not enough blood flowing into the system; problems caused by the nervous system, or by either the diet or some problems related to ‘chemical decomposition’ (p. 4). In this book, Habershon also wants to add causes of dyspepsia resulting from imperfect nutrition, diseased vessels, weakness or nerve failure. He also thinks that dyspepsia can originate from congestion occurring in the lungs, heart, bronchi or liver. Bloody dyspepsia (hepatic), also described as ‘bilious indigestions’, refers to the vomiting up of blood.

Gout and rheumatism can also be connected to dyspepsia, as well as diseases of the kidneys. Habershon also thinks of the stomach as working to digest through a fermentation process or some type of chemical changes that cause the food to be digested. He says that he also examined some stomachs with ulceration when he taught anatomy at Guy’s Hospital. ³

Throughout the book, Habershon continues to refer to the idea of the sympathy, which he defines as follows:

By the word sympathy we mean that an organ of the body may become functionally distrusted by irritation of a structure external to itself: in this way severe pain and abnormal sensation may be induced in parts far removed from the original seat of disturbance. (pp. 26–7)

Irritations can be conveyed by the nerves, or by organs close to each other, or they can be spread through the blood or vascular system. For instance, Habershon writes about the sympathetic diseases that emerge as ‘cerebro-spinal’ problems: seeing, taste, smell and feeling can be altered; and muscle movements in the body can cause pain as the stomach is not moving naturally. Pain can spread to the head or produce feelings of numbness in other places. Habershon focuses on the idea of the mind–stomach connection, and reminds the reader that:

. . . it has long been acknowledged that the stomach easily affects thought and judgement, reason and memory. Whilst digestion is going on the mind is less active whether the effect be due to a larger quantity of blood being sent to the stomach, or to the blood being altered by the influx of new material . . .’ (p. 28)

The cerebral nerves can affect and be affected by the mind, especially when the mind is ‘disturbed’. The mind–stomach connection is an important point, which Habershon continues to highlight in his book: the mind can become ‘perverted’ by stomach pain (p. 28).

Hypochondriasis was another disease studied in the nineteenth century, and there was also a mind–stomach connection with this condition. Habershon warns that ‘The hypochondriac sees everything under an erroneous aspect, and forms his judgement accordingly’ (p. 28). The senses are also affected by the juices produced in the stomach: the patient’s vision can suffer; all the senses in general, all connected to the stomach, can be affected by dyspepsia. Anxiety and other nerve problems may also appear during periods of dyspepsia.

The symptoms of dyspepsia, beyond those of the sympathetic organs mentioned above, include pain and the rejection of food. However, it is important to note that pain can be distracting and may not be a good indicator of where the true problem is located, according to Habershon (p. 41). Pain in the kidneys and bladder can also emerge, and abscesses can develop without the patient knowing (p. 40). Dyspepsia may present with or without pain. Gastritis, or gastro-enteritis, can result from poisons, problems with the muscular membrane, or poor muscular action that produces vomiting (p. 41). Some cancers can also be present without providing much pain, and gastric ulcers may be painless. Most of the pain that patients experience is not from the stomach, but from the sympathetic organs, such as the spine.

Vomiting was the principal condition that needed to be investigated. Habershon states that this presents in many conditions, but close investigation of the vomit can provide more information than that obtained by simply investigating the patient’s pain. Vomit is thought to have two origins: the stomach and the intestines. However, vomit appears by sympathy as well. Patients can vomit because of inflation, gastritis or gastro-enteritis, undigested food, irritation from medicine, mucous problems, ulceration, obstruction of the pylorus, cancer, pressure from tumours, hernia, liver or gall bladder problems, diseases of the ovaries, and many other blood and nerve diseases (pp. 49–50).

Habershon discusses the distention of the stomach and eructation, which included flatulence. Gaseous formations, which he describes and identifies in an orderly list, were linked to abdominal diseases. They were thought to have many different causes, including swallowing gas, food decomposition, blood, mucus, abscess in the colon, or some type of growth in the stomach. Normal atmospheric air is blended into the food and pushed out into the saliva. Carbonic acid and other ‘effervescent drinks’ help to clear the distended stomach. Finally, gaseous formation can come from the decomposition of food (p. 74).

Physicians discussed the conception of digestion with fermentation, which caused diseases such as cancer (pp. 102, 120, 255). The transformation of gaseous and liquid matter in the body can create diseases. Also, the circulation of gases in the body causes distension and other diseases. The levels of mucus and gases need to be balanced in the body in order to maintain proper health. Abscesses in the stomach can also lead to poor gas exchanges in the body. Habershon writes that gases can be communicated throughout the body:

So also in instances we have known where an abscess communicated with the stomach, and the presence of offensive gas was explained by decomposing pus. And lastly, we may mention that when sloughing takes place in the stomach gaseous evolution necessarily follows. (p. 76)

Bad breath also represents an indicator of diseases. It points to disorder in the stomach, and Habershon comments that ‘an offensive state of the breath’ can be indicative of gas going to the wrong parts of the stomach and being released from the body (p. 77). The practitioner must be ‘on his guard’ (p. 78), and check the state of the teeth, diseases of nose and ears, tonsil problems, ulceration of the throat, diseases located in the lungs and bronchi, and pulmonic diseases. Bad breath can identify pneumonia and other chronic problems.

The bowels are also subject to and indicative of disease. Habershon notes that the proper label for this is ‘disordered condition of bowels’, and that patients are instructed that their bowels need regular ‘evacuations’ (p. 82). However, people may suffer from constipation, which is caused by problems with the liver and pancreas; these also cause loose and odd-looking evacuations. Their colour is different and indicates disease; sometimes their character is ‘light or frothy, mixed with decomposing mucus, with changed epithelial products, or even blood’ (pp. 82–3).

A change in urine colour can also indicate disease. Habershon points out to the physician that ‘Disorders of the stomach at once react upon the kidney and bladder, especially if there be any undue sensibility of these parts’ (p. 83). Gouty dyspepsia is a clear example of this:

In gouty dyspepsia the urine contains an abnormal quantity of uric acid, and equally expressive are its indications in rheumatism, and in the imperfect digestion connected with hepatic and renal disease, with cardiac and pulmonary affections, with functional and organic diseases of the brain, and diabetes. (p. 83)

Habershon then turns to the ways in which conditions of the stomach can be treated with medication and other therapies. He comments that the ‘state of the mind’ must be attended to, as it is the most important consideration. Anxiety can kill any appetite, but intense stimulation and being overly social could also have a negative effect. In his discussion of the importance of emotions on the digestion process, he writes:

In the treatment of these gastric maladies, perhaps more than in any other, the confidence of the patient in the skill and diagnosis of the practitioner is an essential element of success. Without that confidence, every suggestion will probably result in an aggravation of the symptoms, and with it the simplest placebo will sometimes suffice to relieve functional diseases. (p. 87)

Habershon also examines the role of climate in digestive diseases. Perhaps very damp areas may cause digestive afflictions and, much like Hippocrates, he advocates a dry and ‘bracing’ air to invigorate the system (p. 87; see also Chaplin, 1993, 2001; Pappas et al., 2008).

Habershon (1866) writes that the labour in which one participates also makes a difference. Sedentary positions and jobs lead to ‘gastric complaints’; heat also makes a difference: ‘. . . several hours spent in a hot and oppressive atmosphere, containing an excess of carbonic acid, produces a sense of exhaustion and oppression, and the organic functions become less energetic’ (p. 88). Another cause may be not eating regularly. The gastric organs of some people can also be harmed by their working conditions and the air they breathe, for example the shoemaker, the tailor, the hand-loom weaver, and those working in dusty air. Habershon also mentions harmful chemicals in the air, such as mercury (pp. 88, 108); he had previously written a critical book on the use of mercury in medical practice (Habershon, 1860).

However, those who are tasked with testing the quality of food, such as those who taste sugar, butter or cheese, are at risk for dyspepsia (pp. 88–9). But working outdoors and exercising are the best methods of preventing diseases (p. 89). Habershon also advocates simply moving outside or travelling away from the scene of emotional turmoil, and consideration of how the home and its air flow can improve health.

Actual medicines for digestive disorders could fall into four general categories. First, those that work to improve the performance of the stomach, and Habershon recommends attention to diet and exercise. One remedy can be the way food is consumed: it must be the right amount and sufficiently varied, properly cooked, and then chewed and eaten without too much mental stimulation (p. 93).

Second, Habershon mentions medicines that improve digestive power. The organs involved in digestion include the stomach, the pancreas, the liver and the bile. Therefore, the medications that work well include pepsin, hydrochloric acid, lactic acid/lactates, inspissated bile and pancreatine (p. 97). The effect of each of these medications is to make the digestive juices more normal, much like humoral medicine; they make the juices more viscous or they dilute it.

Third, Habershon discusses methods that work to remove digestive problems. Secretions are the most important part of the digestive process, so problems are best helped by exercise which produces secretions. Opium and opium derivatives often relax the patient, and mercury often stimulates the organs for better digestives processes. However, Habershon advises against the use of mercury, writing: ‘With all the vaunted improvements of modern science in therapeutics, mercurial medicines are given in a very indiscriminate manner, and most injurious results often follow their use’ (p. 108). This fits with his criticism of mercury, mentioned above.

Finally, Habershon mentions medicines that work on secondary diseases or sympathetic organs that affect the stomach. Inhalation is the best method of sending medications directly to the stomach; air is the best remedy for the stomach, so therefore inhalation works in a similar manner. Medications that relax the skin and are breathed in, such as oils, are the best, or the patient can be exposed to them in a bath. Palliative measures are good for restoring proper digestive balance, for example taking soda in the case of heartburn (p. 105). Purgatives, much like the humoral method, also relieve dyspepsia. Alcohol relieves flatulence, and shortens the length of stomach diseases, although it is thought to irritate the body, especially the stomach membrane (p. 109). The rest of the book describes the other forms of dyspepsia.

In 1877, Habershon published many of his lectures on the pneumogastric nerve. He opened his first lecture by emphasizing that this nerve is important to understanding digestion and the disease processes of the body:

One of the most deeply interesting questions in physiological science is, in what manner the harmony of the different animal functions is maintained. The most delicately-adjusted machinery is at work; actions of an entirely different character are performed without interfering the one with the other, and the result is expressed by the term health. The body is a microcosm; and, as in the external world there is harmony in the working of natural forces, so in man’s organism there is an adjustment of forces, an even balancing of the living power in its functional integrity, so that, with diversity of operation in the several parts, there is unity in the complex whole. (Habershon, 1877: 9–10, original italics)

The harmony that allows the body to thrive is important; lack of harmony explains the diseases of the body. Respiration, circulation and digestion each works as its own entity, but they also work together (pp. 10–11). However, a problem with one can cause cascading problems in the other two. Habershon, as an experienced physiologist, explains the idea that diseases are seldom caused in one area, but are the symptoms of cascading problems. He cautions that ‘Few diseases can be regarded as strictly local in their character, and the morbid processes in one part are inseparably connected with those which take place in another’ (p. 10–11). He goes on to say that the pneumogastric nerve is one of the most important parts of the body as it maintains the facilitation of three processes: respiration, digestion and circulation.

In a section on the stomach, Habershon writes about the effect of the mind on the pneumogastric nerve and cautions that problems related to this nerve come from ‘over-anxiety of mind and distress’ (p. 70, original italics). He relates the case of an anxious partner in a ‘commercial house’ (p. 70), who vomited in the morning every day; Habershon could not see any obvious cause: the man had no pain or tongue disorders, his pulse was not high, and he had regular bowels. The irritation did not result from the stomach, but from distressing events of his life: he had fallen from his horse prior to his illness and his mind was now only thinking of certain calamities, so disease in the stomach had originated in the brain:

It was evident that the irritability of the stomach was not due to disease of that organ; and, on making inquiry, it was found that the patient had had a fall from his horse some time previously, and the fear was entertained that organic disease of the brain had commenced. Mercantile collapse came at length, the heavy clouds of disaster broke, and when a more healthy state of money affairs was obtained, then the cerebral disquietude also ceased. (p. 70)

Habershon also links epilepsy and insanity to stomach-related issues, complicated by problems with the pneumogastric nerve. Any mental trouble does not necessarily produce physical symptoms directly, but causes potential problems for the nerves, which can later cause physical problems. Cerebral problems can cause trouble with the hearing, sight, etc., resulting from cascading problems from the pneumogastric nerve.

Habershon’s works show that nineteenth-century physicians thought of stomach illnesses as involving the brain; they thought that the two organs were linked together and that curing diseases centred on understanding that sympathy. This idea would continue to flourish in the work of other physicians in the nineteenth century.

Medical dissertations and mechanistic theory

Physicians training in medical schools became interested in diseases that involved both the mind and the stomach.

Hypochondriasis and its physical mechanism

Hypochondriasis was another form of dyspepsia that could manifest itself as a disease of the intestines or the stomach. In 1805, William Gibbons of Pennsylvania wrote An Inaugural Essay on Hypochondriasis, and he received his doctorate of medicine from the University of Pennsylvania in the same year. In his introduction, Gibbons sets out the importance of hypochondriasis, which was both a difficult and interesting subject to him: difficult because it was principally about the mind, but interesting ‘. . . as it leads to an investigation of one of the most affecting and troublesome diseases incident to man’ (Gibbons, 1805: 5).

Gibbons also points out that hypochondriasis was located in ‘low-spirits, spleen &c.’, much as it was in the eighteenth century. Noyes (2011) writes that hypochondria during this time changed from an illness centrally located in the mind to that of localized disease. Gibbons describes the disease as having physical symptoms and being located in the alimentary canal. The disease also had bodily secretion indicators: in the ‘. . . urine, discharge, and vomiting’ (Gibbons, 1805: 6). Also large amounts of gas are passed, and there is a lot of pain in the bowels. He describes the problems in the intestines:

In general, the first observable symptoms indicate an affection of the stomach, and alimentary canal. – This is evidenced by nausea and vomiting; obstinate costiveness, sometimes a diarrhea; a want of appetite, but now and then an increase or perversion of it; flatulence; acid eructations; cardialgia; pain in the stomach and bowels; an acid or bitter taste in the mouth, &cc: to these may be added a copious flow of pale urine, the discharge of which is frequently attended with pain; difficult respiration; palpitation of the heart, &c. The pulse is variable but generally slow and weak; sometimes hard. (p. 6, original italics)

Gibbons also mentions that patients were obsessed with his help; their intense vigilance about their health was most distressing to him. These symptoms also had a mental component: ‘He is sad, timid, and distrustful, languid dull, and inactive: he is fond of solitude, but when in company, his disease is always his favorite topic’ (p. 7). The patient is convinced that he is going to die, but yet desires it. Further mental symptoms of hypochondriasis are: patients believe that they are turning into animals, have pains everywhere, face impending death, and they often plan their own funerals. These symptoms are often accompanied by bad dreams (p. 7).

Gibbons frames the disease as a disease of the bowels, abdomen and spleen. He says that some physicians thought that there was a humoral problem in the ‘. . . spleen, stomach, and neighbouring viscera’ (p. 8). Others thought that it was due to poor stomach movement, stomach problems, or irregularity, blockage of blood, or trouble with the veins in the abdomen.

But Gibbons was frustrated by the work of other physicians, especially those of the past. He complains: ‘. . . hence it appears that the notions of the ancients, with respect to the nature of the disease, have been vague and imperfect’ (p. 9). He then proceeds to argue that there are two main causes of hypochondriasis: first, factors like the weather that work ‘directly’ on the stomach, and second, lifestyle problems (such as a sedentary life) that ‘indirectly’ affect the mind (pp. 9–14).

It is ironic that Gibbons criticizes the ancients, while maintaining one of Hippocrates’ main ideas about diseases. He believed that experiencing different airs from different regions or temperatures caused disease, and Gibbons refers to this explanation as a good one. In a section entitled ‘Exposure to cold, moist air’ (p. 9), Gibbons re-affirms the mind–stomach connection: ‘The connection of the stomach with every part of the body, has long been observed by medical philosophers. – It has been called the centre of association, and the index of the nervous system.’ He goes on to talk about the sympathy between the parts of the body, and its importance to both curing and preventing disease.

He cautions that a person in good health (or what he calls ‘High Health’) encounters cold air in the form of frost while walking outside, and the stomach reflects this experience. Exposure to cold air increases the movement of the stomach, and digestion increases, causing people to be hungrier in the winter. But in someone in a weak state of health, this same set of experiences will cause indigestion and ill health. Gibbon (p. 10) says that Erasmus Darwin refers to the same idea of sympathy, the stomach and cold air in his book Zoonomia (Darwin, 1809, Vol. 2: 2). The constitution is also important, and this can explain why the wind can affect some patients more than others:

A Cold atmosphere is more especially injurious to delicate constitutions, when loaded with moisture; being in this case a much better conductor of heat, than when dry, the skin is more effectually deprived of its warmth, and becomes cold, and corrugated: hence the reason why the east wind, replete with aqueous vapour, is so much dreaded by dyspeptic and hypochondriac patients. (Gibbon, 1805: 10, original italics)

Cold feet and indigestion usually follow these problems as well. Cold feet are often paired with indigestion: ‘It is of great importance to attend to this connection between the feet and the stomach: gout is often translated from the former to the latter, and frequently with fatal consequences’ (p. 10).

A sedentary life must also be avoided in order to maintain ‘healthy digestion’. Inactivity and the effects of a sedentary life spread through it internally. Gibbons cautions that ‘The heart and arteries sympathise with the inactive state of the stomach, and the whole system is languor and debility’; he thought it was obvious that the mind and the body are connected in regard to diseases: ‘That a connection exists between the action of the heart and arteries, and that of the stomach, cannot be doubted’ (p. 11).

Gibbons also thought that tea and coffee injure the ‘nerves of the stomach’ when taken in strong doses. He also cites tobacco and too much ‘venery’ (sexual intercourse) as bringing on hypochondriasis and also dyspepsia (or ‘local debility of the stomach’) (pp. 12–13). Strong emotions and intellectual work also bring about these same pains: ‘The stomach is the source from which every part receives its support, and when affected by disease general debility follows, the universal predisposing cause of morbid action’ (p. 16).

The cures that Gibbons described were fairly standard for nineteenth-century medical care: purgatives, stimulants, galvanism tonics, baths and opium. Many of these agents work to calm the stomach or excite the stomach into action (pp. 19–20). However, he cautions that any medicines, like opium, should be served with food that do not ferment – fermentation was a root of indigestion at the turn of the nineteenth century. He cautions that ‘The aliment should consist of such food, as does not easily ferment, as oysters, clams, sea biscuit, toasted cheese, &c.’ (p. 21). He even recommends administering the gastric juice of animals when there is a lack of it in patients (p. 21).

Gibbons’ ideas about treating the mind, however, are quite noteworthy. He argues that fear is what motivates this disease, but real healing begins when you are able to convince the patient to become ‘. . . dissevered by an impression stronger than the one you wish to remove’ (p. 22). He reminds the reader that patients often think of themselves as being worse than they are, and often find pleasure in their perceived painful worries. The best cure is to simply enjoy life: ‘Amusements of all kinds; cheerful company; exercise; traveling; rousing the passions, as joy; hope; anger; sailing in a balloon; flagellation, &c.’ (p. 23). Gibbons even suggests that the physician should allow a suicidal patient to slightly hurt themselves to show them the difference between real and perceived pain:

Hypochondriac patients sometimes seek opportunities of committing suicide, to put an end to their miserable existence. In this it is proper to indulge them to a certain degree, if practicable, as in drowning, burning &c by which means the old train of thought will be broken, and to an abhorrence will succeed the desire of life. (pp. 23–4)

Conclusion

The mind and the stomach are historically linked, as many physicians and surgeons during the nineteenth century thought that mental illness had a physical component. Historicizing the link between the mind and the body, especially in stomach-based diseases like dyspepsia, historians are able to contribute to current debates regarding IBS and the importance of treating mental problems that contribute to physical symptoms. It is also relevant that many historical figures also suffered from mental disorders that contributed to real physical problems.

The writings of several physicians and surgeons in the past included an examination of the link between the mind and physical pains. Dyspepsia and intestinal pain were thought to be caused by troubles in the mind, and physicians in the eighteenth and nineteenth centuries thought that digestive problems were also caused by problems in the mind. Finally, hypochondriasis was yet another extension or manifestation between the mind and the body.

Each system was related to the others, through what physicians in the eighteenth and nineteenth centuries thought of as sympathy. Each part of the body responded to the other, in a related system. Some physicians, like Habershon, reduced problems in the body to the prima viae or even the stomach itself. These ideas were further reflected in the dissertations produced in medical schools. In many ways, physicians and scientists were discussing ideas of sympathy in the body and emphasizing the importance of dealing with mental disorders to produce positive effects in the body, and to prevent inflammatory bowel disease.