YALE JOURNAL OF BIOLOGY AND MEDICINE 67 (1994), pp. 61-62.


FOREWORD

Lester Reynolds Dragstedt
At the time of the birth of Lester Dragstedt in 1893, there existed little information regarding the physiology of the stomach. Although Prout in 1823 had recognized hydrochloric acid as the main secretory product, little was known of the regulation of its secretion. Some ten years later, Beaumont elegantly described aspects of gastric physiolo-gy and confirmed the secretion of hydrochloric acid. However, the precise mechanism of acid production itself was a cellular mystery that remained to be unveiled. By 1870, Heidenhein of Breslau had identified parietal cells, and, in Oxford, Langley pondered the semantics of the oxyntic mucosa and the mechanisms of pepsin secretion. Although this zymogen had been identified by Schwann of Berlin in 1834 and its digestive properties recognized, its biology and clinical relevance were obscure. In Vienna, Billroth in 1881 was preparing to undertake the first gastrectomy, which unbeknownst to him had already been performed, albeit unsuccessfully, by Pean in Paris in 1879 and by Rydigier of Chelmno in 1880. Overall, even in the most sophisticated of cities and universities, the treatment of stomach disease was largely encumbered by superstitions, dogma, mineral waters and dietary exoticism. Into this world of gastric darkness Lester R. Dragstedt was delivered on October 22, 1893, in Anaconda, Montana.
    One hundred years later, at this meeting held in honor of the centennial of his birth, we celebrate the extraordinary advances that have occurred in the field of gastric physiology, to which he devoted so much of his life. Within the span of a century, the cells which secrete acid have been isolated and both their regulatory mechanisms and secretory pathways defined. The role of histamine described by Dale and that of gastrin first noted by Edkins have been extensively catalogued. In addition, the final common denominator of acid secretion, the proton pump, has been identified and characterized. Such physiological advances have led to the evolution of rational therapeutic strategies for the treatment of acid related diseases including the design of specific targeted molecular probes. Thus the introduction of histamine 2 receptor antagonists enabled inhibition of acid secretion to the extent that the face of peptic ulcer disease was utterly changed within a decade. The subsequent introduction of H-/K-ATPase inhibitors has resulted in ablation of acid secretion to a level that the concept of acid peptic disease as a rare clinical entity may even be considered. Indeed, it is felt by some that the contemplated eradication of antipodean bacteria may yet enable this holy grail to be realized.
    As a physiologist turned surgeon, Dragstedt contributed substantially to the evaluation of vagal function and acceptance of therapeutic vagotomy. In addition, his elucidation not only of the role of the antrum in gastric physiology, but also in ulcer disease, substantiated Edkin's original observations in regard to gastrin. In so doing, he provided a rationale for the utility of subtotal gastrectomy in decreasing acid secretion. His role as a teacher and scholar provided a template for the development of academic gastrointestinal surgery in this country. By demonstrating that physiological skills could be incorporated into the surgical discipline, he was the first to define the surgeon scientist as the new force in a previously technique-oriented guild. Above all, by example and leadership, he imbued a new generation of surgeons with the zeal to pose rigorous scientific questions, as well as to care and to cure their patients. As the son of untutored immigrants he rose by diligence and application from humble origins to great heights without ever losing the common touch.
    Dragstedt was raised in Montana, spent much of his professional life at the University of Chicago and was finally laid to rest at Elk Lake, Michigan on July 16, 1975. This son of Sweden brought to fruition the dream of his youth and epitomized the credo of his new country. His work and the path that he bestrode provide an example that future generations of surgeons will always treasure.
    This volume is dedicated to the memory of Lester R. Dragstedt and all whom his spirit touched.

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