Traditions in Medical History
Ancient doctors learned much about the inner
structures and workings of the body from wounds
that occurred on the battlefield. The writings of
the Roman physician Celsus (14–37 C.E.) docu-
mented his recommendations to his students that
they take advantage of such natural opportunities.
One student who took the advice to heart was
GALEN(130–200 C.E.), whose own teachings and
writings would shape the understanding and prac-
tice of Western medicine for centuries. Galen
learned much of the practice of medicine while
treating soldiers and gladiators. Of the digestive
process, Galen believed stomach liquefied food
that then passed to the intestines. From the intes-
tines the mixture traveled to the liver, where it
mysteriously became blood that the veins carried
around to the various tissues of the body. Though
wrong in some fundamental ways, the extrapola-
tion was not so far off from the reality.
In 1822, U.S. Army surgeon William Beaumont
became the first physician to witness and explore
the functions of the stomach in “real time.” In
June of that year French-Canadian trader Alexis
St. Martin suffered a musket wound to his left side
that opened a fist-size hole in his stomach. St.
Martin’s comrades brought him to Beaumont for
treatment. Miraculously in an era of no antibiotics
and limited surgical expertise, St. Martin survived.
With great scientific curiosity, over several decades
Beaumont observed the activities of St. Martin’s
stomach through this window. He conducted
experiments with various items of food tied to
string that he periodically withdrew to assess the
extent of their demolition in the stomach. He
measured the volume and temperature of stomach
juices. And he watched the digestive process as
much as his schedule and St. Martin’s patience
permitted.
Finally, in 1833 Beaumont published his find-
ings in a book, Experiments and Observations on the
Gastric Juice and the Physiology of Digestion.St. Mar-
tin lived 58 years with the hole in his stomach,
outliving Beaumont by 27 years and dying at age
- Beaumont’s detailed observations and experi-
ments gave modern medicine the most extensive
understanding of digestion possible until the
1940s when ANESTHESIAand ANTIBIOTIC MEDICATIONS
made surgery practical, and surgeons could more
carefully explore the stomach and other gastroin-
testinal structures.Breakthrough Research and Treatment Advances
The 21st century arrived on the heels of amazing
advances in medical and surgical treatments for
gastrointestinal conditions. Among the most signif-
icant advances have been those in ORGAN TRANS-
PLANTATION, which result from a blend of improved
surgical techniques, organ harvesting procedures,
and immunosuppressive methods. In 1984 LIVER
TRANSPLANTATIONbecame the standard treatment for
end-stage LIVER FAILURE, a milestone in its progres-
sion from experiment to therapeutic solution.
Within 15 years surgeons in the United States were
performing more than 5,000 liver transplantations
a year. Surgeons are now exploring applications for
transplantation technology in other conditions,
such as to replace the severely diseased small intes-
tine, stomach, and even pancreas. Though these
transplant operations remain largely investiga-
tional, they hold great promise for people who
have disorders such as CYSTIC FIBROSIS, SHORT BOWEL
SYNDROME, DIABETES, and severe diverticulosis.
Other advances in diagnostic and operative
procedures take advantage of fiberoptic technol-
ogy. Endoscopic surgery has transformed once-
grueling operations, procedures such as open
CHOLECYSTECTOMY, which often required up to 12
weeks of recuperation, to a few minor incisions
and a third of the recovery time. Surgeons now
can perform APPENDECTOMY, herniorrhaphy and
hernioplasty, colon resection, and even operations
on the stomach with minimally invasive tech-
niques. COLOSTOMY (a surgically created opening
through the abdominal wall for the passage of
solid digestive waste), once nearly certain after
most operations on the colon, now is often tempo-
rary or can be avoided altogether. Surgeons have
developed methods for anastamosing, or connect-
ing, the remaining segments of the bowel to
restore near-normal function. Medications help
soothe the bowel and control BACTERIA during
HEALING.
The HUMANGENOMEPROJECT, the complete map-
ping of the human genetic structure, has led to
discoveries that have altered the understanding,
course of treatment, outlook, and prevention
measures for a number of gastrointestinal disor-6 The Gastrointestinal System