Comments on the Early Development of Gastroenterology in the United States of America

COMMENTS ON THE EARLY DEVELOPMENT OF GASTROENTEROLOGY IN THE UNITED STATES OF AMERICA* H. L. BOCKUSÌ It has been suggested that I comment upon the early development of gastroenterology in the United States of America. I shall confine my remarks to an account of events occurring prior to or during the first thirty years oflife ofthe American Gastroenterological Association, that is, 1897-1927. Actually, gastroenterology as an acknowledged subspecialty of internal medicine was born in the United States as a result of the activities ofthe American Gastroenterological Association. Following the War between the States (1861-1865), specialization in medicine proceeded at an ever-increasing tempo. This was a natural consequence ofthe rapid advances that were occurring in the science ofmedicine . When S. J. Meltzer was president of the American Gastroenterological Association in 1903, he had this to say concerning specialization: "While there may be some doubt about the desirability of too great a division oflabor in the practice ofmedicine, there can be no doubt about the desirability ofthe division oflabor in the study ofthe science ofmedicine . Ifwe build up this Association on a high, ideal, scientific basis and develop it along these lines we shall dispel distrust and attract the best workers inthis field." This thesis has been amply proved by the subsequent contributions ofthe members ofthis pioneer society. The era ofspecialization beginning soon after the mid-nineteenth century was manifested by the formation of national medical societies of a specialized nature. The first ofthese was the American Ophthalmological Society founded in 1864. Our medicos ofthe eye had great vision. * The first Walter L. Palmer Lecture, University ofChicago, November 1969. t Department of Medicine, University of Pennsylvania, 250 South 18th Street, Philadelphia, Pennsylvania 19103. 228 H. L. Bockus ' Gastroenterology Perspectives in Biology and Medicine · Winter 1971 The first medical society inthe United States dealing with a subspecialty of clinical medicine was that of gastroenterologists, the American Gastroenterological Association, founded in Philadelphia, June 3, 1897. The society was organized by a small group ofseventeen men. A number of these were of German extraction: Julius Friedenwald, Willy Meyer, May Einhorn, S. J. Meltzer, H. W. Bettman, J. Kaufman, J. C. Hemmeter , and Ludwig Kast. The founders ofthe society wisely included in its membership not only internists, but other scientists and clinicians who were interested in and contributed to the advancement ofknowledge of affections ofthe digestive tract, for example, surgeons, radiologists, pathologists , physiologists, andbiochemists. Laterpsychiatrists were included in the membership. The value ofa gastroenterological forum, participated in by all scientists and clinicians interested in the alimentary tract and nutrition, rather than by clinicians only, cannot be overemphasized. Many other national societies of gastroenterology throughout the world have wisely followed this principle. Among the earliest contributors to the science of gastroenterology in the world were the physiologists. Reaumur [1] and Spallanzani [2] are credited with the initial experiments dealing with the study ofthe gastric juices. John R. Young of the University of Pennsylvania (1803) was probably the first investigator to prove that this secretion contained an acid [3, p. 40]. Its identity as hydrochloric acid was announced before the Royal Society in London by William Prout in 1823 [4]. Incidentally, the gentlemanwe arehonoring (Walter L. Palmer) has been more responsible than anyone in stressing the role ofhydrochloric acid in peptic ulcer. Ten years after Prout's discovery, there followed the classical studies on gastric physiology by the American army surgeon, William Beaumont [5]. (As is well known, his experimental subject was Alexis St. Martin with a gastric fistula produced by a gunshot wound.) Contributions in gastrointestinal physiology lagged during the succeeding decades until the appearance of the publications of the "Altmeister " ofthe physiology ofthe digestive apparatus, Professor Pavlov, and his associates, following a lecture series in 1897. Physiological surgical experimentation actually was first developed in Pavlov's laboratory [6]. His contributions soon received worldwide acclaim. It was Pavlov who stated at that time, "I am convinced that it is by frequent interchange of opinionbetween thephysiologists andthe physician that the common goal 229 of physiological science and of medical art will be most quickly and safely reached. It was Pavlov and Claude Bernard who believed that food in the duodenum aroused pancreatic secretions through the...