The Gurgling, Growling History Of The Gut

In her new book, medical historian Dr. Elsa Richardson discusses the changing cultural and scientific understandings of the gut.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Speaker 00

  Despite our medical advances, the gut continues to be a source of both fascination and mystery.

• 0:09Speaker 01

  It is an organ of the body which has resisted medical authority in interesting ways.

• 0:18Speaker 00

  It's Monday, November 18, and you're listening to Science Friday. I'm Sci-Fri producer, Shoshana Buckstow. You're likely familiar with the gut's microbiome, that constellation of trillions of microbes thriving inside of our bodies, and that our stomachs have some of the same neuroreceptors as our brains, a second brain, so to speak. And that gut feeling, it's, well, impossible to ignore. A new book explores not only how the scientific understanding of the gut has changed over time, but also its cultural significance. Here's Ira with more.

• 0:56Ira Flatow?

  Dr. Elsa Richardson is author of Rumbles: The Curious History of the Gut. She's the co-director of the Centre for the Social History of Health and Healthcare at Strathclyde University, based in Glasgow, Scotland. Welcome to Science Friday.

• 1:11Speaker 01

  Thanks so much for having me on, Ira.

• 1:13Ira Flatow?

  In the book, you write about not just the medical history of the gut, also its cultural history. How have the metaphors we use to describe the gut shaped our understanding of it?

• 1:25Speaker 01

  Well, I think that's what really got me interested in the gut as a topic. So I'm a medical historian by training, but my interest tends to lie in where medicine and ideas about health sit in culture. And what I noticed when I was looking into the history of digestion and looking into the history of diet was how dramatically the metaphors we have used to describe, think about our stomachs have changed over time. So my area of specialism is the 19th century, 19th century British history. And one thing that I found really odd, in a way, was the way that the metaphors then that attached themselves to the stomach were overwhelmingly negative.

• 2:08Speaker 01

  So I think today, we tend to talk about our stomachs as, you know, these kind of beautiful blooming gardens that have to be, you know, tended and carefully managed, you know, ecosystems within, maybe. Whereas in the nineteenth century, the metaphors and the language associated with the gut was much more confrontational. So you know, you have physicians in the middle of the century describing the gut as an enemy within, as a foe that had to be conquered, or this kind of irascible creature that lived within you, which you know, you fed and you tried to placate and yet it still acted against you. You still gave you stomach

• 2:47Speaker 01

  aches and terrible pains. Many of the sources I was looking at and citing were, you know, from the medical community, were physicians who were talking about and describing the stomach using really florid language, kind of quite unusual imagery.

• 3:04Ira Flatow?

  You know, possibly some of the mystery of the gut revolves around historically, it was harder to study as compared to other body systems, right?

• 3:16Speaker 01

  Yeah, I think that's part of why the metaphors around the gut are so rich and so diverse. One of the reasons is that for so long, the stomach really remained something of kind of medical mystery. When dissection became part of medical education, these dissection manuals would often describe the need to examine the stomach first, because it's the organ which will decay quickest, right? So there's this sense in which like outside of the body, the stomach doesn't really make sense, or it doesn't make sense for very long. Added to that, there is throughout medical history, especially before kind of

• 3:56Speaker 01

  modern medicine, the gut is also so important to treating the body, to diagnosing disease, and to managing health generally. So, you know, before we have antiseptics, before we have ways to anesthetize patients, opening up the body is a really dangerous procedure. That leads to the question of, you know, what other interventions can you make into the body? And one of the major ones is through diet, right? It's through the gut. So the gut is both a way that the body's health can be treated and maintained, but it's also kind of diagnostic space. So many doctors would examine the feces for clues as to what

• 4:40Speaker 01

  was going on in the interior of the body.

• 4:43Ira Flatow?

  Yeah, and it's still talked about having a microbiome that's healthy, right? And your diet might be able to impact that.

• 4:53Speaker 01

  Yeah, absolutely. So part of what is so interesting for me as a historian of medicine about stomach and about diet is that it is an organ of the body which has resisted medical authority in interesting ways. So on the one hand, where there are other parts of the body where medical expertise is paramount, right? So you think about perhaps going to, let's say, a cardiologist and the cardiologist tells you, listen, you know, you have to take these particular, you know, pills in order to stop yourself from having a heart attack. You would be relying on the expertise of that physician, right? And you would probably likely do what they say.

• 5:36Speaker 01

  However, the stomach is this space in which there is a lot of kind of competing different forms of knowledge and competing forms of expertise. So you think about the way that perhaps, you know, you may see a nutritionist if you had particular gastric problems, but you might also look to forms of household wisdom, right? You might also look to, I don't know, the advice of your grandmother about what to, you know, what's good to eat and what's not.

• 6:02Ira Flatow?

  But we've had big advances in understanding the gut. And I'm talking about the discovery of the enteric nervous system, right? That there are all these nerves down there. How, how was it discovered that, that we have this sort of mini-brain there?

• 6:17Speaker 01

  Part of what is so interesting about the enteric nervous system and so, I think must have been mind-blowing to discover at the time, it's not only that there are nerves down there, but it is also that it is kind of truly, in a way, a second brain in that.

• 6:36Speaker 01

  What was discovered about the enteric nervous system when it was mapped in by physiologists in the latter part of the 19th century was that it's also able to think for itself. The enteric nervous system can act outside of the central nervous system. So I think part of what the enteric nervous system might force us to question is exactly, you know, what kind of thinking different parts of the body are capable of doing? Because obviously the enteric nervous system and the gut don't think in the same way as the brain thinks.

• 7:10Ira Flatow?

  Right.

• 7:10Speaker 01

  But part of what this suggests is that there is a kind of cognition going on.

• 7:15Ira Flatow?

  Yeah, because most of us are keenly aware of the connection, I think, between the gut and the brain. You get butterflies in your stomach, you have anxiety, stomach aches, right? That relationship between mind and gut has changed over time, hasn't it? I mean, we sort of realize it, but now we know more medically or scientifically how that happens.

• 7:37Speaker 01

  I think it's absolutely changed over time. But what I find consistent through the history of the gut is that basically as long as we have been interested in the brain, or as long as we've been interested in the stomach, we have been convinced of a link between the two of them. So I think that, you know, modern science is doing wonderful work in terms of mapping that connection. So through the enteric nervous system, through, you know, the kind of neurons in the microbiome that you mentioned in the opening, also through the vagus nerve, that kind of direct highway between the gut and the mind. So there's a great deal of work being done just now in terms of trying to understand

• 8:21Speaker 01

  exactly what the kind of mechanisms are which facilitate that connectivity.

• 8:30Speaker 00

  After the break, a Victorian era surgeon's monomaniacal obsession with constipation, and why throughout history, women have been seen as being predisposed to gut issues.

• 8:45Speaker 03

  I'm Kevin Roos. And I'm Casey Newton. And together, we've been tech journalists for decades. Now, we're your hosts of Machine Gods, a new podcast from NPR that makes sense of what AI means for your work, your life, and all of our futures. Twice a week, we'll be exploring the biggest moves in tech and give you unmatched access to the real titans of industry. Listen to Machine Gods from NPR on the NPR app or wherever you get your podcasts.

• 9:13Ira Flatow?

  I know you're an historian of science, and I want to get into some history because it's fascinating. You write about a Victorian-era physician, Dr. William R. Bothnot Lane, who is obsessed with constipation and curing it. Tell me a bit about his work and his theory of the gut, and I hope I got his name right.

• 9:33Speaker 01

  So William Bothnot Lane is a fascinating figure. So he was an extremely well-respected surgeon, working in London around the end of the 19th century and the beginning of the 20th century. He was at one point surgeon to the king. So he is Sir William R. Bothnot Lane, actually.

• 9:50Ira Flatow?

  Excuse me, I didn't mean to leave that out.

• 9:52Speaker 01

  Excuse you. He becomes obsessed, in the latter part of the 19th century, with the problem of constipation. And one of the reasons that he becomes so interested in this problem is because of a theory, it's not his theory, but which was very kind of present in this period, called the theory of auto-intoxication. And so the idea of auto-intoxication basically posits that material, waste material, sitting in the bowel for too long, will begin to fester, grow putrid, and begin leaking all kinds of nasty bacteria and toxins back into the rest of the system.

• 10:32Speaker 01

  So this is, as you can probably tell, partly a product of the rise of bacteriology as a field, right? So this is the language of good bacteria and bad bacteria. It's also a product of a generalized anxiety in the latter part of the nineteenth century about, you know, the problem of kind of causativeness, right? The problem of, yeah, not being able to go. And William Arbuthnot Lane suggested or perceived that this was, in fact, a much bigger problem than, you know, than physicians had previously acknowledged. And what he suggested was that all of these kind of toxins that he thought were leaking back into the body from the guts were causing all kinds of problems.

• 11:14Speaker 01

  So he attributed things like infertility to autointoxication, fatigue, muscle wastage, neurosthenia, but also, you know, quite dramatically, things like cancer. You know, the failure to empty your bowels at least once a day was something which he viewed as absolutely imperiling your health. He would advise his patients to modify their diet, to perhaps, you know, take up different forms of exercise. But in the most severe cases, he began removing clinical large sections of their colons. So either like chunks of colon, but also sometimes like full colonectomies in the most

• 11:59Speaker 01

  severe cases.

• 12:00Ira Flatow?

  Wow.

• 12:00Speaker 01

  And he performed hundreds of these surgeries, mainly on women. It's got, must should be noted, towards the end of the nineteenth century and the beginning of the twentieth century, until finally he was pulled up in front of the British Medical Board and was eventually struck off British Medical Register. So he had this kind of quite dramatic kind of fall from grace, really, all because of this quite monomaniacal obsession with constipation.

• 12:27Ira Flatow?

  Well, I want to get into that part you said about women. I mean, you're right about how throughout history, women have been seen as being predisposed to gut issues, right?

• 12:36Speaker 01

  Yes.

• 12:37Ira Flatow?

  Why is that?

• 12:38Speaker 01

  I think it's a really complicated question. So, I mean, think about the way that even, I don't know what it's like over in the States, but in Britain, medication, laxatives, but also things like yogurts with probiotics, which are meant to improve gut health, are really predominantly marketed at women.

• 12:57Ira Flatow?

  I didn't, I didn't know that.

• 12:58Speaker 01

  So we live with that association today. And apparently, you know, according to figures, women are more prone to constipation than men. Now, this may have A physiological cause, it may be that it's associated perhaps with the hormonal changes or menstruation. However, it might also be that women today just report or more willing to admit perhaps to being constipated than men are. But what is interesting is that throughout history, there has been this kind of quite sustained and kind of complicated connection between women and constipation. So when William Arbuthnot-Lane is working in the 19th century, he suggests that part of the problem is a kind of female prudishness

• 13:41Speaker 01

  around matters of the toilet. You know, that what is happening is that women are, have been raised in kind of stuffy Victorian households, that they are too proper, and that this is somehow kind of impeding their, you know, toileting regularity. What he also suggests, and what is consistent also throughout history, is this kind of connection that is made between women's reproductive capacity and her digestive health. So for William Arbuthnot-Lane, one of the ways that he worries his female patients is by saying, look, if you are constipated, this is going to impact, one, your ability to get a husband. Okay, so you will have,

• 14:22Speaker 01

  according to him, sallow skin and be of a kind of, you know, crabby disposition, much less likely to get wed. But also that even if you are able to, you know, somehow bag a man, you will be unable to bear children because this kind of, this constipatedness in your system is going to impact your reproductive health.

• 14:43Ira Flatow?

  I only have a few minutes left, but I don't want to let you go without talking about one of the weirdest pieces of research in your book is about how what's in your stomach relates to what we dream about. Really?

• 14:57Speaker 01

  That came out of a survey which was conducted by the British Cheese Board, boom boom, which suggested that eating certain types of cheese before bed would produce particular kinds of dreams. So, you know, Red Leicester causes weird dreams, Brie invokes

• 15:18Speaker 01

  Kind of celebrities to appear in your dream. This was a survey that was undertaken in Britain. Probably as a piece of kind of, you know, wild marketing material.

• 15:27Ira Flatow?

  Right.

• 15:27Speaker 01

  But it did speak to a quite longstanding association between the belly and the dreaming mind. There were starts that I looked into more closely, looking at the way that medieval dream theorists and dream interpreters talked about digestion. And these dream theorists proposed that a number of things could happen. So one, food digesting in your belly could send up vapors to your brain, which would then produce particular kind of dreams or visions. And based on that, they suggested that, you know, dreams that were had

• 16:07Speaker 01

  in the early part of the morning were more likely to be of a spiritual or kind of divine nature than dreams which were experienced in the early part of the evening, let's say. And the reason for that was that by the early morning, your stomach would have digested all of the food that was in it. There would be nothing sitting there festering anymore. And that therefore, these kind of, your dreams would not be clouded by these like these vapors emitting from the stomach. Now, obviously, we don't tend to think about dreams in exactly those terms anymore. But I think we still sustain some connection between perhaps having, I don't know, overindulged the night before.

• 16:49Ira Flatow?

  Yeah.

• 16:49Speaker 01

  And then suffering kind of weird nightmares or terrors.

• 16:52Ira Flatow?

  Yeah, I remember when I was a kid, my mother would say, don't eat all that, you're gonna have nightmares.

• 16:57Speaker 01

  Yes, yeah, absolutely.

• 16:58Ira Flatow?

  When you go to sleep. I don't think there's any empirical evidence that's connecting any of these dreams to food, is there?

• 17:05Speaker 01

  A folklorist by the name of Caroline Oates has done some research into tracing the cheese dream, but the cheese dream across cultures. So in Britain and North America, we are very likely to report that after eating a strong piece of cheese, we have weird dreams, let's say. Whereas in other countries, namely southern European countries, so thinking France, Italy, places like that, people do not tend to report any association between having eaten, you know, a kind of cheese and having a weird dream. And those countries are not known as kind of cheese avoiding nations, right? You know, without postulating exactly what that tells us, I think that it

• 17:47Speaker 01

  part of what it describes is the way that, yeah, that dreams and the dreaming mind cannot sit outside of culture.

• 17:54Ira Flatow?

  Well, in this case, the cheese stands alone, as we used to say.

• 17:59Ira Flatow?

  Dr. Richardson, thank you for taking to have to be with us today and good luck with your book.

• 18:04Speaker 01

  Thank you so much for having me, I was a real dream.

• 18:08Ira Flatow?

  Dr. Elsa Richardson, author of Rumbles: The Curious History of the Gut. And she is the co-director of the Center for Social History of Health and Healthcare at Strathclyde University, based in Glasgow, Scotland.

• 18:24Speaker 00

  That's all the time we have for today. Lots of folks helped make the show happen, including

• 18:29Speaker 04

  Melissa Mares. Danielle Johnson. Beth Ramey. Jason Rosenberg.

• 18:34Speaker 00

  Tomorrow, ticks are thriving in part due to invasive plant species. Plus, scientists recreate an ancient bird brain. I'm Sci-Fry producer Shoshana Buckstall. Thanks for listening. We'll catch you next time.