Book Review

The History of Gastroenterology: Essays on its development and accomplishments

N Engl J Med 1996; 334:804-805March 21, 1996

Article

The History of Gastroenterology: Essays on its development and accomplishments
Edited by T.S. Chen and P.S. Chen. 313 pp., illustrated. Pearl River, N.Y., Parthenon, 1995. $88. ISBN: 1-85070-365-5

This is an odd book. The editors, a professor of pathology and a professor of radiology, have not written a history of gastroenterology but have collected 21 already published essays (dating from 1960 to 1988) to take “a backward look” at the emergence of the science and practice of a branch of medicine that has become immensely popular. Yet it is an interesting book. The editors' aim, which is ambitious, is to outline the scientific foundations of gastroenterology, the impact of technology on this specialty, and the evolution of concepts of specific diseases. Lacking any editorial guidance, the meal they present us is a tasting prepared by 21 chefs. The collection ranges from the merely antiquarian (Brown Kelly on esophagology) to the brilliant (Wingate on the migrating motor complex).

In the section on the scientific foundation of gastroenterology, secretion, gastrointestinal hormones, and motility are covered, but absorption (active transport and translocation of dietary elements) is not mentioned. The section on technology contains a vivid personal account by Hirschowitz of the development of fiberoptic endoscopy, but such technical advances as modern vascular radiology, sonography, computed tomography, and magnetic resonance imaging are passed over. Yet Booth's literate discussion of the overall impact of this technology on gastroenterology and Spiro's witty account of the influence of technology on training in this field are rewarding and were new to me.

It is in the section on specific diseases that the lack of commentary by an editor is most telling. The paper on peptic ulcer by Avery Jones needs a word on Marshall's rediscovery of Helicobacter pylori and the consequent revolution. The paper on celiac disease (“From Aretaeus to Crosby”) needs Dicke's own words on his remarkable discovery of the role of gluten in this disorder. The history of Crohn's disease seems to me a just account, but why did it take so long to see that the large bowel, as well as the small one, could be affected? Smith's paper on the evolution of concepts about acute appendicitis is a very detailed account covering the period from the 1860s until Fitz's presentation in June 1886. If the errors of the past can be instructive, then one can understand the inclusion of Wangensteen's report on freezing the stomach for duodenal ulcer.

To the selected essays, the editors have added a 22-page chronology of what they consider the landmarks in gastroenterology, starting with the cave paintings at Lescaux, France, circa 30,000 b.c. and ending with the Sydney classification of gastritis in 1990. I miss esophageal and anal manometry, Dicke's gluten-free diet, and Goldfinger's discovery of the startling effects of colchicine on familial Mediterranean fever. A list of gastroenterology journals and textbooks helps round out this potpourri, but I would have added Kirsner and Shorter's book on inflammatory bowel disease. The reference section is followed by a list of associations, most of which are in the United States or Europe, but I miss the Crohn's and Colitis Foundation of America and its Canadian counterpart.

In the end, I must ask, for whom was this book assembled? It is like a Christmas basket, with something for everyone. Nicely printed, but too heavy for bedside reading, it would be a good present to give fellows and residents in gastroenterology who think their interest in the field began with the fiberoptic endoscope but cannot remember who invented it. They might appreciate the clinical astuteness of Fitz, who described not only acute appendicitis, but also acute pancreatitis, and might take heart from the fact that Elman discovered the elevation in serum amylase in the latter disorder while still a resident.

Henry D. Janowitz, M.D.
Mount Sinai Medical Center, New York, NY 10029-6754