Christopher Booth

Robert Willan and his kinsmen.

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A history of gastric secretion and digestion: experimental studies to 1975

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Clinical research in gastroenterology: History and future prospects

The emergence of specialities within the general field of medicine is a particular feature of the past century of medical history. The development of a specialized discipline has usually followed a predictable pattern. In many areas of medical activity-and ear, nose and throat surgery provides an excellent example--technology has been the driving force. For other specialities, scientific developments have been of prime importance in providing a background of understanding that has given a spur to specialization. The traditions of our own speciality, gastroenterology, are rooted in both technology and science. In most countries, a number of interested individuals, often stimulated by a particular charismatic figure, have first gathered together to establish a specialty group. Their motives have ranged from the highest scientific ideals to the more mundane desire for status among practitioners seeing themselves as Cinderellas among the grandees of medicine who were their contemporaries. These individuals have then established an association or society, created a journal where they are able to publish papers reviewed within their own peer group, and have invariably gone on to set up training requirements, recognized nationally, which ensure that the specialists themselves control entry into their chosen field of clinical work. Gastroenterologists have followed this general pattern in many countries and now form an important part of the generality of medicine and surgery, to say nothing of other disciplines such as radiology, pathology and paediatrics. Within this framework, gastroenterologists have established their position as controllers of clinical standards and practice, of education at both undergraduate and postgraduate level and of the calibre and numbers of those to whom they permit entry to their privileged and secret garden, Research in gastroenterology, however, is not the prerogative of the gastroenterologist, who does not control its development. The alimentary tract and its appendages attract research workers from a wide variety of scientific disciplines, particularly the basic sciences where the organorientation of the clinician does not rule. It is for this reason that so many of the most important advances that have influenced our specialty have come from other specialities or from basic scientists who have only a remote connection with gastroenterology. Research consists of three main activities-observation, scientific experiment and the development of new technology. It has, sadly, to be admitted that technology is often derided, particularly by scientists; there have been those who have dismissed the award of the Nobel Prize to Godfrey Hounsfield for the development of computerized tomography scanning as having been given for ‘mere technology’.z Yet, as gastroenterologists, we have good reason to appreciate the importance of technology, since it has had so deep an influence on the practice of our specialty. Let us recall too that technology has a far older history than science. As Benjamin Franklin so aptly remarked, humans have always been tool-making animals and it was their capacity to make tools that led to the development of crafts such as carpentry, building, metal smelting, weaponry, leather tanning, weaving and so on. Biotechnology-associated so often in the modern mind with unicellular models-has an equally ancient lineage. Our clothing has always been the product of biotechnology -the organism concerned often being the sheep-to the great advantage of countries such as Australia. It was from crafts that there emerged through the centuries the technology that has been one of the four environments within which humankind exists-the three others being the cosmic, the natural and the social. And since the practice of medicine is neither an art nor a science, but a craft, it is not surprising that technology forms so dominating a part of our clinical lives. The experimental method of science is a more recent development in human history than technology. Although it belonged originally to mathematics and astronomy and to the aristocratic philosophy of the ancient Greeks, it only became the experimental science that we know today after the Renaissance. So far as medicine is concerned, the modern era began with the dissection of the human body by the great Italian anatomists and led, in the 17th century, to William Harvey’s demonstration of the circulation of the blood. The modern scientific philosophy of Francis Bacon, John Locke and Isaac Newton was soon to be established in Europe, particularly in Holland, despite a rearguard action in France from the adherents of Rene Descartes. At the same time, the University system, within which science has advanced so remarkably during the modern era, became established. Padua, not owing allegiance to Rome but enjoying the religious freedom bestowed upon it by a secular Venetian State, provided an unparalleled environment for scientific achievement during the 16th and 17th centuries. Here Fabricius and Vesalius dissected and taught, Galileo offended against holy writ by affirming that the earth circled the sun and Harvey received the stimulus to his own work on a different circulation. I t was