The ancient physician, who recognized and recorded the disease, was known as Aretaeus of Cappadocia and was a contemporary of the great Roman physician of that time, Galen. In 1856, Francis Adams translated Aretaeus' writings for the Sydenham Society of Great Britain. The ancient Greek text used the world KOILIAKOS, from which the word coeliac is derived. It means, literally, 'suffering in the bowels'. Aretaeus appears to have understood a great deal about the illness. In his essay on the 'Cure of Coeliacs', he said, 'If the stomach be irretentive of the food and if it passes through undigested and crude, and nothing ascends into the body, we call such persons coeliacs.' He indicated that food made from grains was particularly suspect'... for bread is rarely suitable for giving



[coeliac children] strength'.

In 1888, Dr Samuel Gee wrote a paper on the coeliac condition in which he said: 'To regulate the food is the main part of the treatment ... the allowance of farinaceous foods must be small .., but if the patient can be cured at all it must be by means of diet.

A book was written by Dr Herter in 1908 which investigated the problem of coeliac disease in children. Dr Herter said that, in coeliacs, fats were better tolerated than carbohydrates. It was this contention that coeliacs were sensitive to carbohydrates in general, but grains in particular, that was supported by Sir Frederick Still in his memorial lecture to the Royal College of Physicians in 1918, when he said: 'Unfortunately, one form of starch, which seems particularly liable to aggravate the symptoms, is bread. I know of no adequate substitute.'

Dr Howland, in a far-sighted address to the American Paediatric Society, in 1921, on 'Prolonged Intolerance to Carbohydrates' spoke about the health risks of carbohydrates.

From clinical experience it has been found that of all the elements of food, carbohydrate is the one which must be excluded rigorously; that with this greatly reduced, the other elements are almost always well-adjusted even though the absorption of fat may not be so satisfactory as in health.

He advocated a three-stage diet 'with the most careful observation of the digestive capacity... Bread, cereals and potatoes are the last articles which can be allowed'. He went on to say: 'The treatment is time-consuming but these patients will repay the effort expended on them.' I fear that his entreaty to spend more time on observing the patient, would fall on very deaf medical ears today.

Dr Haas, in 1938, noted that fatty diarrhoea was experienced by coeliacs with even minute amounts of carbohydrate in the diet and hardly any fatty foods. He found however, that bananas were an excellent form of carbohydrate for coeliacs and caused no diarrhoea or other symptoms.

Since 1950, Professor Dicke, Professor Anderson and others have shown that the exclusion of wheat, rye, oats and barley from the diet of coeliac children, and the substitution of gluten-free products, has reduced inflammation in the small intestine and, in most cases, allowed a return to good health. However, if the gluten-containing cereals were incorporated back into the diet, serious health problems followed in a very short time, due to the lining of the small intestine becoming rapidly abnormal.