The Clinical Value of Gastric Secretion Tests

A Lectmre lelivereti at the Queen's University of Belfast on October 3ist, 1955, un/er the auspices of the British Council. You all know the story about William Beaumont, the army surgeon, who took care of Alexis St. Martin, the young French Canadian, who was severely wounded by an accidental discharge of a shotgun, which left him for the rest of his life with a hole in his side, through which his stomach could be inspected. William Osler, in an address in 1902, gave a fascinating picture of how the man and the opportunity meet-and match. The opinions on gastric physiology in the beginning of the nineteenth century were so confusing that we understand William Hunter's pithy remark, "Some physiologists will have it, that the stomach is a mill, others that it is a fermenting vat, others, again, that it is a stew-pan: but, in my view of the matter, it is neither a mill, a fermenting vat, nor a stew-pan; but a stomach, gentlemen, a stomach." Beaumont's observations, published in 1833, anticipated our present knowledge of gastric function. His observations on gastric secretion and on the gastric mucosa were of such fundamental importance that very little was added before the works of Pavlov. However important Beaumont's observations were, they had very little influence on the opinion concerning gastric diseases of his contemporaries, who were rooted in the anatomical conception of gastritis, as being the most common cause of stomach trouble. This conception had been presented by Broussais, the Frenchman, and was based on post-mortem findings, which later were shown to be due to an erroneous interpretation of post-mortem putrification. The introduction of the stomach tube as a routine diagnostic aid (Kussmaul, 1867) and the test meal of Ewald-Boas brought on a change of this anatomical view on gastric diseases. The interest during the last decades of the nineteenth century with regard to gastric disorders was mainly focused on the diagnosis of