Abstract
The aim of this book is to provide a historical perspective on the evolution of therapy in gastroenterology but also to couple it with artwork appropriate for the period described. The author accomplishes this purpose in a brilliant fashion. Virtually all of the 343 pages of text contain at least one and usually two appropriate illustrations and/or photographs relevant to the topic being discussed. I found myself intrigued by the unique juxtaposition of text and artwork. The text begins with early concepts of health and disease and reviews Egyptian concepts, Greek medicine (which dealt largely with herbal polypharmacy and the nature of symptoms), Hindu medicine, and Chinese medicine, (where healing was done primarily by priests and sorcerers.) The advent of Christianity led to the consideration of disease as a manifestation of sin, and therapy was considered feasible only if administered under the auspices of religion. Rome and its physicians and medical writers are discussed, and in particular Celsius who recommended cleanliness and that wounds be washed and treated with substances now considered to be somewhat antiseptic such as vinegar. The section on medieval pharmacology is interesting in that the publication of medical information led to widespread dissemination of knowledge and rapid awareness of the properties of drugs. A section on the administration of therapy deals with the art and science of enema administration. The early enema preparations consisted of herbs, honeys, and water. Other preparations consisted of ox brain, warm milk, fresh oil, and honey. Commonly used drugs prior to the 19th century included wine (alcohol), opium (morphine), belladonna (atropine), Ma huang (ephedrine), ergot (ergotamine), cocoa leaves (cocaine), and foxglove (digitoxin). Modlin also traces the early development of gastroenterology as a discipline. He notes that between 1869–1885 Kussmaul, Boas, and Ewald had already decided that gastroenterology and gastrointestinal problems warranted the attention as a discipline. Boas was the first to devote a journal to Gastroenterology as a discipline. It is interesting to note that Rokitansky and Virchow accumulated over 30,000 cases and provided a precise correlation of symptoms with autopsy findings. Modlin then devotes entire sections to the esophagus, stomach and duodenum, pancreas, gut-neuroendocrine system, hepatobiliary tract, small bowel, and colon. To the development of esophageal disorders, Modlin identifies Sir Arthur Hurst, F. Avery Jones, Norman Barrett, Rudolph Nissen, and Charles Code as prime movers. In his discussion of the stomach and duodenum he reminds us of the classic contributions of William Beaumont and his patient Alexis St. Martin, and these observations laid the foundation for the study of human gastric physiology. He also points out the contributions of Rudolph Heidenhaim, Rudolph Schindler, Horace, Davenport, George Sachs, and Sir James Black. It is interesting to note that several investigators in the late 19th century noted bacteria in ulcers and as far back as 1875 Bizzozero, Boas, and Jaworski postulated that bacteria caused ulcers. This antedates by over l00 years the classic description of H. pylori by Marshal and Warren in 1982. Modlin identifies contributors to our knowledge of pancreatic disorders including Reginald Fitz, who first systematically assessed the pathologic alterations in pancreatic disease, Bayless and Starling who provided evidence regarding the mechanism of pancreatic secretion, Comfort, who provided the first comprehensive assessment of the concept of chronic pancreatitis, and Pavlov, who is regarded as the father of gut-neuroendocrine system. With regard to the hepatobiliary tract, he recounts the accomplishments of Vesalius who accurately described cirrhotic livers followed by Laennec and Cruvheilier. With regard to small bowel disease, it is not generally appreciated that Gee in 1888 provided an excellent description of what is now recognized as celiac disease, and Crohn’s classic paper in 1932 describing regional ileitis is cited. Modlin also traces the development of modern gastrointestinal Endoscopy to Basil Hirschowitz and his description of the fiberoptic endoscope in 1957, and to Wolf and Shinya who popularized colonoscopy and effective polypectomy. Basil Morrison’s contributions include the comprehensive pathologic descriptions of ulcerative colitis. Reading all of this in the context of beautiful art amplifies the message in a unique way. The quality and presentation of the figures is excellent. The book’s subject matter clearly does add something new to the already existing body of knowledge but it also reflects Modlin’s surgical orientation. This book can be compared to a book edited by Joseph Kirsner entitled, The Growth of Gastroenterologic Knowledge During the 20th Century. The latter book contains more scientific information, whereas Modlin’s text is, as noted above, coupled with impressive artwork reproductions. I believe this book will be appealing to individuals who are interested in both the history of the evolution of therapy in gastroenterology as well as art. Bottom Line: This is a unique compilation and it is a “good read” as well.
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