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Sir Arthur Hurst

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HISTORY OF THE BRITISH SOCIETY OFGASTROENTEROLOGY

BY

THOMAS HUNT

The early history of the British Society of Gastro-enterology is the history of Arthur Hurst. Son of aBradford wool merchant, he was born in 1879 anddied in 1944. He studied physiology at Oxford in1899 and 1900 under Gotch and Haldane at the timewhen Sir Henry Acland, at the age of 85, had justbeen succeeded as Regius Professor of Physic bySir John Burdon-Sanderson.

Hurst qualified from Guy's Hospital in 1905, andwas elected to the staff of that hospital at the ageof 27. Before this he travelled in Germany asRadcliffe Travelling Fellow of Oxford Universityand had worked both in Munich and (in 1906) inBoston and other cities in America.The 64 years of his life covered a wonderful period

of medical progress which began with the discoveryof the tubercle bacillus by Robert Koch and endedwith the first full use of penicillin in 1944. Hurstwas at school, aged 16 years, when Rontgen dis-covered x rays (1895); he was 31 when Moynihanwrote his classic monograph on duodenal ulcer(1910); 45 when Elsner, Schindler, Henning, andothers invented the gastroscope; and 59 whenneedle biopsy of the liver first showed the truenature of infective hepatitis (1939).

Hurst was born only 20 years after the publicationof the Origin of Species, and the world of medicinein his early lifetime saw those advances in funda-mental principles associated with the names ofPavlov, Ehrlich, James Mackenzie, Sherrington,and Thomas Lewis.His earliest work began in 1906 when he was

almost the first-ifnot the very first-man in Englandto use radiography for investigating the alimentarytract. His first subjects were students at Guy'sHospital to whom he was teaching physiology, andthe reports of his findings on the act of swallowing abismuth meal mark the beginning of that great stepforward which barium meal examinations and all thelater developments in gastroenterological radiologymade in the diagnosis of digestive disorders.

This was at the time (1906) when gastric neuras-thenia was much in vogue, and treatment by staticelectricity or by bitter tonics, such as the popular

condurango, or by silver nitrate was especiallyfavoured. Gastroenterology was almost whollyempirical and there was much discussion of suchconditions as gastric myasthenia or- atony of thestomach and ptosis of the viscera. Popular biliarystimulants were sarsaparilla and dandelion, and thestrenuous Weir Mitchell treatment was in great usewith isolation, rest, massage, forced feeding, andelectrical stimulation of the skin from an inductioncoil; beef tea was the universal standby in diet.

Hurst's work with the bismuth meal led to know-ledge of the movements of the alimentary tract andto recognition of the great variations in size andposition in the abdomen of the stomach and colon innormal individuals. His paper on this subjectpublished in the British Medical Journal (1907) is alandmark in gastroenterology, if only because itmeant the end of much loose and speculative think-ing on visceroptosis in general. This was followedby his book on constipation, and later, after hisasso-ciation with A. E. Barclay, by a series of in-vestigations on the radiology of the digestive organs.Coincident with these advances in radiology whatis now the great field of chemical pathology was alsobeginning. Though Hurst's interests were partlybiochemical, his clinical activities spread tocardiology and neurology. With G. Goodhart herecorded the earliest case of auricular flutter afterthe discovery of the electrocardiograph by SirThomas Lewis in 1910, and as neurologist to Guy'sHospital he began to develop his interest in neurosisand hysteria. He was a fascinated attender in Parisat the clinics of Babinski and Dejerine and PierreMarie. At about the same time (1908) he boughthis first motor car, a two-cylinder Wolseley, whichwas the first consultant's car to penetrate into thecourtyard of Guy's, hitherto sacred to the horseand carriage.

Hurst was a man who brought warmth and vitalityinto both his social and professional life, and alwaysfelt the importance of linking the two together infriendship and good fellowship. He was an originalmember of the Association of Physicians founded byOsler in 1907, and of the Medical Travelling Club

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THOMAS HUNT

formed in 1927. When, as in cardiology, there arosethe need for someone to bring together thoseworking in this subject Sir James Mackenzie wasthere, so in gastroenterology was there ArthurHurst. It was in 1936 that he first conceived theidea of forming a small gastroenterological club andasked one or two colleagues to dinner at theAthenaeum Club to discuss the project. In 1937 heproposed that a council of five be set up who woulddraft detailed plans for the club, and onNovember 19 and 20, 1937, the first meeting washeld at the Royal Society of Medicine in Londonwith Hurst as Chairman, the other members ofCouncil being T. L. Hardy, T. C. Hunt, Sir HenryTidy, and L. J. Witts. At this first meeting36 members attended and there were seven visitors;the draft rules for the club were approved. Themain subject discussed was gastroscopy, opened byHartfall, followed by a discussion on alkalosisopened by Ryle and Dodds. At the dinner of theclub held at the Langham Hotel (now an officebuilding since suffering severe bomb damage in thewar) Hurst gave his ideas and purpose in formingthe club, the first rule of which was to read: "Theobjects shall be the advancement of gastroenterologyand the promotion of friendship amongst those whohave a special interest in disorders of the alimentarytract". Sir Robert Hutchison spoke of the de-sirability of admitting surgeons to membership.It is recorded in the minutes that "after discussionit was resolved that as the club numbered oneradiologist (A. E. Barclay), one morbid anatomist(M. J. Stewart), and one biochemist (E. C. Dodds)of eminence, a surgeon occupying a similar standingshould be elected, and it was unanimously agreedthat Sir David Wilkie should be invited to occupythis position".The second meeting of the club in 1938 was held

at Cambridge with Sir John Ryle, who was thenRegius Professor of Physic at the University, in thechair. Papers were read on many different subjects,and it was at this meeting that psychosomatic factorsin ulcerative colitis, the action of aspirin on thegastric mucosa, and the biochemical changes in theblood after gastro-intestinal bleeding were firstdiscussed. At this meeting T. L. Hardy was electedsecretary. It is to him that a great part of the latersuccess of the club is due, and his contribution toBritish gastroenterology is gratefully recognized bythe Society which owes him so much.An important decision, which Hurst himself re-

garded as a vital one, was also made at Cambridge,and it was to the effect that the club should choosefor itself a new President every year, as opposed toelecting a President who should hold office forthree, five, 10 years, or longer. Since the first

meeting in 1937 up to the present there haveaccordingly been 19 Presidents, the disparity beingdue to Hurst acting as unofficial chairman at twowar-time meetings. Their names are as follows:

1937193819404219431945194619471948194919501951195219531954195519561957195819591960

Sir Arthur HurstSir John RyleSir Arthur Hurst (Chairman)Sir Henry TidyDr. Izod BennettSir H. AbrahamsSir Ernest SpriggsProf. T. L. HardyDr. Geoffrey EvansSir John McNeeProf. W. MacAdamDr. A. H. DouthwaiteSir Stanley DavidsonDr. S. PattersonProf. L. J. WittsDr. T. C. HuntProf. C. F. IllingworthSir Charles DoddsProf. H. RodgersMr. Harold Edwards

During the 193945 war two meetings were held,one at Oxford in 1941 when the subject of dyspepsiain members of the Forces was discussed, and one inLondon when it was suggested that the club mightexert its authority in the form of some publishedstatement on the prevention of peptic ulcer recur-rences. This arose from Hurst's criticism of hisown methods for ulcer prevention. Discussion soonmade it clear that the club was in no position toissue any agreed advice, and as Hardy recorded:"Although there was no agreement on either funda-mentals or details, there was abundant evidence of ahealthy individualism and a dislike for any sort ofauthoritarian regime." The meeting arranged forMay 10; 1940, was cancelled owing to the invasion ofHolland, but a few members dined together asguests of Hurst at the Athenaeum.On August 17, 1944, Hurst died suddenly in

Hardy's house at Birmingham, and no meeting ofthe club was held that year. Hurst's spirit andvitality had stood up well to the period of war strainwhen he had returned to work at the Oxford heloved, and in spite of asthma and the deafness whichhad taxed him for many years he was full of energyand his own enthusiasm to the end of his life.Though some of his many original ideas provedwrong, his brilliant work on achalasia of the cardia,on dyschezia, and on chronic gastritis as a precursorof gastric cancer, are only three examples of hisfar-sighted conceptions which have been confirmedby the passage of time. His role as a stimulator ofmedical thought, and as a promoter of internationalcooperation, research, and friendship is not lessimportant than his achievements in the advancementof knowledge.

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HISTOR Y OF THE BRITISH SOCIETY OF GASTROENTEROLOG Y

In 1945 the club which he had founded recordedthe following resolution:

"That the Club records its deep regret at the death ofits founder the first Chairman, Sir Arthur Hurst, anddesires to place on record its great appreciation of hisservices to the Club, his many original contributionsto gastro-enterology and his outstanding qualitiesas a physician and teacher."

After Hurst's death the small club of 40 originalmembers decided to change its title to that of the"British Society of Gastro-Enterologists" and theexisting rules were slightly changed; in 1949 thepresent title of "British Society of Gastroenterology"was adopted. During the 15 years of its existencethe Society has grown in strength and prestige.Dr. Hunt, Mr. Hermon Taylor, and Dr. W. Bournehave successively followed Dr. Hardy as secretaries.Gastro-Enterologia has published the proceedingsof the meetings which have been. held yearly inNovember. In 1948, a proposal to establish aBritish Journal of Gastroenterology was studied bya small committee. It was then thought that therewere not more good gastroenterological papersthan could be satisfactorily-if not better-publishedin general medical journals than in a specializedjournal which might only be read by a limitednumber of doctors. The proposal was accordinglydecisively outvoted at the Society's meeting, and itwas not until 10 years later that it was again broughtforward.During these 10 years a number of notable

happenings took place both in the life of the Societyand in gastroenterology in general. In the firstplace the Society began again to take an active partin international meetings. It had been agreed inParis in 1937 to hold the third International Con-gress of Gastro-Enterology in London in 1940 withSir Arthur Hurst as President and Dr. Hunt assecretary. This meeting was of course cancelledand it was not until 1952, when truly internationalmeetings again became possible after the war, thatthe British Society was officially represented at themeeting of the Association of the National Europeanand Mediterranean Societies of Gastro-Enterologyat Bologna. In July, 1956, the British Society actedas host in London at the fifth meeting of thisAssociation. It was attended by over 800 visitorsand delegates, including many distinguished phy-sicians, surgeons, and others from North Americaand other parts of the world. It was generallyagreed that this meeting reached a high standard andboth the scientific and social programmes werecarried through with great success.The proceedings of this Congress were splendidly

edited by Harold Edwards and published by Messrs.Karger within a few months of the end of the

meeting. The 800-page volume which emerged isundoubtedly an important addition to gastro-enterological literature. Since the London meeting,the World Organization of Gastro-Enterology hasbeen founded and has held its first meeting inWashington, U.S.A., in 1958, under the brilliantPresidency of Dr. H. Bockus. The British Societygives its strongest support to this Association,as it does to the Association of European Societies,and hopes to play an increasingly active role inthe field of international research and postgraduateeducation.

In addition to these developments in Europeanand world meetings, the Society's own meetingshave brought forward an increasing number of newcontributions to knowledge, and there has been arapidly mounting number of younger Britishphysicians, surgeons, and research workersspecializing in gastroenterology.The volume of new papers, both scientific and

clinical, is shown by some examples of the subjectsdiscussed at the Society's meetings.

1948, Birmingham, disorders of the small intestine1949, London, gastric acid secretion1950, London, post-gastrectomy syndrome1951, Leeds, hiatus hernia1952, London, haemopoiesis in relation to disorders

of the alimentary tract1955, Edinburgh, abdominal visceral blood flow1956, Oxford, carcinoid tumours; anticholinergic

drugs; the secretion of mucus, etc.1958, London, blood groups1959, Belfast, hormones and the alimentary tract

At the Society's meetings many short papers areread and in most cases there are demonstrations andmedical exhibitions so that new contributions havegrown steadily in number and sometimes in com-plexity. At the same time more visitors interestedin gastroenterology have attended, and in 1939 thenumber of members elected was increased from 65to over 100.And so, in 1960, the time has come for a journal,

a time when both the special interests of gastro-enterology, and the size and authority of the BritishSociety of Gastroenterology have justified it.British medicine has a mistrust of narrow specializa-tion and holds that just as a specialist must not losetouch with the main strain of medicine or surgery,so a specialist journal must be born out of thedevelopment of general medicine and must retainits contact with it; it must be a necessity fulfilledbecause the specialty needs it as an essentialdevelopment of an advancing subject. Such, Ibelieve, is Gut. As the Journal of the British Societyof Gastroenterology it has an established parentageand background, and a future that, I am confident,will add distinction to gastroenterology.

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