- The Growth of Gastroenterologic Knowledge during the Twentieth Century
The history of gastroenterology almost always brings instantly to mind the oft-cited work of William Beaumont. However, most would be hard pressed to give any further information about the development of gastroenterology. Nonetheless, study and understanding of the digestive tract has grown astronomically over the past century. Diseases of the digestive system that were unknown, unrecognized, and perhaps even nonexistent at the last turn of the century now have their own specialty societies and advocates.
Twentieth-century advances in the knowledge of digestive diseases have been multifaceted, driven by the discovery and improvement of such technologies as the X ray and endoscopy and by developments in surgery, immunology, biochemistry, cell biology, neuroendocrinology, genetics, and most recently molecular biology. Joseph B. Kirsner, a distinguished clinician and researcher at the University of Chicago, has had a long interest in the history of gastroenterology. An earlier work of his traced the development of American gastroenterology from the early colonial seventeenth century through the development of radiology and endoscopy. Now, he has set out to chronicle the explosive growth of scientific and clinical knowledge occurring primarily over the past fifty years. In the preface, he asks: “How did all this come about? Who made the insightful observations, what were the ‘revolutionary’ ideas? Who provided the unifying themes? [End Page 165] What were the critical events . . . [and] contributions of biomedical sciences and . . . technology to the advance of gastroenterology?” (p. xii).
To accomplish his task, Dr. Kirsner sought the input of thirty-one notable clinicians and investigators in the multiple disciplines of gastroenterology; their task was to detail the growth of current knowledge in their individual fields. The result is a multiauthored text that has the overall structure of a traditional anatomic approach: the esophagus, stomach, intestines, colon, liver, gall bladder, and pancreas are the main headings, which are then subdivided into areas of physiology, pathophysiology, and disease. Thus, for example, the chapters under the small intestines include the topics of digestion, absorption, and malabsorption; electrolyte absorption and secretion; gastrointestinal hormones; motility; neurogastroenterology; and enteric flora. The book concludes with a potpourri of general chapters dealing with nutrition; psychosocial and psychologic mechanisms in gastrointestinal illness; defenses against injury and inflammation, as well as another chapter on immunology; circulation; general observations on neoplasia; endoscopy; and finally radiology.
Although each contributor is a recognized authority, and perhaps many have an interest in the history of their discipline, none is a historian—a fact that becomes obvious to anyone trying to read this book. A very few contributions mention ideas, issues, controversies, and personalities: chapters on gastric secretion in the twentieth century, the history of acid-peptic disease, and the development of gastrointestinal endoscopy are written by contributors with a sense of history and historical perspective. The rest of the book, however, is made up of scientific monographs detailing current science and the “state of the art”; all are excellent reviews of the subjects at hand, but each is usually written as if it were an expanded “background” section of a review article for a scientific journal. The authors in this book, virtually all of whom have made major contributions to the discipline about which they are writing, frequently refer to their own work in the third person, as if they were divorced from the history. The presentation is a time line of scientific accomplishment and discovery; however, the overall result is bloodless and lifeless, reading like a textbook of gastroenterology.
In conclusion, as we approach the millennium, this book is a commendable effort to try to define how we have gotten to where we are in the current century. It might be useful to the historian as a starting point, to learn what were the critical manuscripts in specific areas. It well defines the scientific and clinical accomplishments of the past century. I found most of the articles clinically useful as reviews of their subjects. However, the book is not a history.