Seventy Years of Gastroenterology (1943–2013)
2013; Elsevier BV; Volume: 145; Issue: 1 Linguagem: Inglês
10.1053/j.gastro.2013.05.020
ISSN1528-0012
Autores Tópico(s)Colorectal Cancer Screening and Detection
ResumoThere are many valuable sources of historical data about Gastroenterology. A brief history of the Journal and its editors (1943–1968) was included in the silver anniversary issue (Almy TP et al, Gastroenterology, 1968). A chapter on AGA publications, including Gastroenterology, is included in a history of the first 75 years of the AGA (Boyle JD, The American Gastroenterological Association: History of its First Seventy-Five Years, 1973). From time to time, some editors have provided a status report of the Journal. Examples include “Gastroenterology 1943–1960: A Change in Editorship” (Wilbur DL, Gastroenterology, 1960), “A Statement of Aims” (Grossman MI, Gastroenterology, 1960), “A Departing Look at the Journal in the Seventies” (Donaldson RM, Gastroenterology, 1977), “Our New Publisher” (Goyal RK, Gastroenterology, 1990), “100 Volumes and Going Strong” (Goyal RK, Gastroenterology, 1991), and “Passing the Torch: A Look Back at Our Editorship” (LaRusso NF et al, Gastroenterology, 1996). In 2008, then–Editor-in-Chief Anil K. Rustgi compiled comments by the living past editors of Gastroenterology on the most significant articles published during their tenures (Rustgi AK, Gastroenterology, 2008).Important facts about the Journal are also found in the monograph “The American Gastroenterological Association 1897–1997,” commissioned by the AGA (Smith DC, The American Gastroenterological Association 1897–1997: A Century of Service to the Profession and the Public, 1999). Another important source was the series of tape-recorded interviews with many leaders of the AGA assembled as “An Oral History of the AGA” by J. D. Boyle. Some of these tapes provided important information about Gastroenterology. One of these documents, “Morton I. Grossman, MD, PhD: An Oral History,” has been published (Boyle JD, Gastroenterology, 1982); however, others about J. Arnold Bargen, MD (1868), Andrew Convay Ivy, MD, PhD (1969), Franz Joseph Ingelfinger, MD (1978), and Walter Lincoln Palmer, MD, PhD (1978), are available in the archives of the AGA central office. There are also other papers written on the history of the AGA that provide some information about the Journal (Fridenwald J, Gastroenterology, 1962; Greenberger N, Gastroenterology, 1985; McGill DB, Gastroenterology, 1987). In addition, excellent electronic records of the annual meetings of the editorial board are available from 2002 onward. Paper records before were discarded in recurrent house cleanings and the need for space conservation. For this report, I have liberally borrowed from all of these resources as well as from volumes of Gastroenterology resting in the basement of Harvard's Countway Library. In some instances, material in the AGA archives did not provide context or understanding of certain important events. In such instances, Google was an important source of information.This review describes the circumstances leading to the birth of Gastroenterology, the foundation of the mission of Gastroenterology, how the editorial teams of the Journal have navigated Gastroenterology through the ever-changing field of gastrointestinal (GI) sciences and the methods of communication during its 70 years of existence, and my perspective of the history of the Journal and speculation about its future. An accompanying paper, “Gastroenterology's Editors-in-Chief: Historical and Personal Perspectives of Their Editorships,” describes previous editors' personalities, approaches, challenges, and successes in advancing Gastroenterology.BirthAlthough the AGA is the oldest GI society in the world, the risk-aversive leaders of the AGA did not publish the first GI journal. The first GI journal was the German Archiv fur Verdauungs-Krankheiten mit Einschluss der Diatetik (1895–1939), which continued as Gastroenterologia (1939–1968) and thereafter as Digestion (1968–present). The first American GI journal, American Journal of Gastro-Enterology, was only published for a brief period (1914–1916) by Anthony Bassler, who later proposed the name Gastroenterology for our journal. The AGA's annual scientific meetings (now referred to as Digestive Disease Week) started in 1898. The proceedings of these meetings were published in Transactions of the American Gastroenterological Association. All papers presented at the meetings were supplied to the secretary of the AGA and, after 1922, to the recorder for printing. Transactions of the American Gastroenterological Association was distributed to members without cost, and publication ceased in 1939.Many members of the AGA at the time believed that the association should have a legitimate journal. However, this suggestion was not realized until much later. In 1934, two important GI journals were launched: the American College of Gastroenterology (which was founded in 1932) started publishing American Journal of Gastroenterology, and Beaumont Cornell, an internist and owner of Sandfield Publishing Company, founded American Journal of Digestive Diseases and Nutrition. Cornell was the journal's supervising editor, and Frank Smithies was the editor-in-chief. Frank Smithies was well connected with the AGA and had been its president in 1929. Smithies convinced the AGA to make American Journal of Digestive Diseases and Nutrition the official journal of the association, with joint editorial control by the AGA and Cornell; Smithies would remain as the journal's editor-in-chief. In 1937, Smithies passed away, and on the recommendation of the AGA and Cornell, Walter Alvarez was appointed editor-in-chief. For 8 years (1934–1942), American Journal of Digestive Diseases and Nutrition was an official organ of the AGA. However, in 1937, Cornell did something that infuriated the AGA; he published a supplement to the journal about his own cancer research without consulting anyone. Very unhappy with this event, the AGA tried to buy the journal and become its sole owner or start its own journal. On June 15, 1942, because mutually acceptable terms could not be reached, the AGA terminated the contract with Cornell. Cornell continued to publish the journal until 1955, when he sold it to Paul B. Hoeber Inc for an undisclosed amount.The excitement of the AGA members about having their own journal was tempered by financial concerns. Members wanted a journal of high editorial standards with a policy of rigid advertising screening, but such screening might negatively affect the financial viability of the journal. One prominent member of the AGA, Andrew Ivy, had publishing experience with American Journal of Physiology. Based on this experience, he proposed that an AGA journal could break even with 1000 subscribers, which was a reasonable goal. Moreover, any income from “ethical” advertisements could be used by the AGA to fund research. Ultimately, Ivy secured a financially risk-free contract with the publishing house Williams and Wilkins. The contract was signed on July 15, 1942, and Gastroenterology was born and became the official journal of the AGA. The title of Gastroenterology was chosen because the other suggested titles would confuse it with existing journals such as American Journal of Gastroenterology; in addition, it was selected over the competing suggestion of Gastroenterology & Nutrition because the field of nutrition was moving away from GI physiology and disease.Mission and ScopeTo understand the mission and scope of Gastroenterology, it is necessary to understand the origin of the AGA and its founding members. The AGA was founded on June 3, 1897, during an annual meeting of the American Medical Association in Philadelphia. A draft constitution with bylaws was presented, and David Stewart was elected temporary secretary; he was later replaced by Charles D. Aaron, who was barely 31 years old. Although Charles Aaron is generally accepted as the founder of the AGA, he never served as president of the organization.The founders of the AGA were young (the average age was 35 years), academically oriented, and searching for new knowledge in the broad field of gastroenterology. The AGA was originally formed as an elite society of members of the American Medical Association who were interested in all aspects of diseases of the alimentary tract. Many of its founders were members of the American Association of Physicians (founded in 1886) and the American Society of Clinical Investigation (founded in 1909). It is worth noting that the American Society of Clinical Investigation was founded by a young academic gastroenterologist, Samuel Meltzer of New York, who played an important role in shaping the AGA. The American Society of Clinical Investigation and the AGA were both founded by like-minded clinical investigators.The AGA started as a small closed group with very restricted membership that included 22 members. The young founders of the AGA were a heterogeneous group who had different motivations; most were in it for the love of GI sciences, and their practice of the profession was mainly to obtain material for research observation and comparisons. The majority of the members were internists with an interest in gastroenterology, with appointments at hospitals and medical schools. The AGA was a research-oriented association of academicians.In 1945, membership was expanded so that active membership was unlimited, but only to those with research interest. For “associate membership status,” the individual had to demonstrate interest in research, and he or she must have published at least a few credible papers. Quality was considered more important than quantity. Unprecedented expansion in tools and knowledge for the clinical practice of gastroenterology made the research requirement impossible for most practicing gastroenterologists. In 1968, Morton Grossman led the AGA to a membership policy to include all board-certified gastroenterologists regardless of research experience. This completely changed the composition of the stakeholders of the AGA.The founders of the AGA were committed to a broad definition of gastroenterology covering all aspects of basic science, including anatomy, pathology, physiology, pathophysiology, and GI practice such as GI pathology, GI surgery, and pediatric gastroenterology. However, as advancements and specialization in different aspects of clinical and basic science and practice grew, it became impossible to hold all aspects of gastroenterology under one tent. GI radiology and endoscopy presented particular “conflicts” as they rapidly grew to be independent in their own right. Walter B. Cannon, who is considered the father of GI radiology, served as president of the AGA (1910–1911). However, GI radiology soon became a discipline outside of gastroenterology. That was not the case for GI endoscopy, although some conflicts were obvious. An endoscopy society was founded in 1949, known as the American Gastroscopic Society, and renamed the American Society for Gastrointestinal Endoscopy (ASGE) in 1961. Rapid developments in fiber-optic endoscopy in the late 1950s and 1960s were primarily reported at the annual meetings of the ASGE. Technical improvements resulted in the availability of commercial endoscopes by the 1970s. Further improvements in endoscopes resulted in their use by all practicing gastroenterologists.In the beginning, Gastroenterology struggled with balancing its mission of being a house organ for communication to its members and disseminating the best research and advances in the field while maintaining its image as a top international journal (Grossman MI, Gastroenterology, 1960). Over the 70 years of its existence, Gastroenterology has had an unwavering commitment to translating complicated research findings and concepts for its readers. Another commitment has been for the Journal to represent all aspects of gastroenterology, clinical and basic science alike. Editors have also attempted to maintain a balance between original research papers and other editorial material.Three PeriodsGastroenterology is only a window into what is happening in GI sciences and clinical practice. Because the field of research is dynamic and ever changing, the expertise of the editors has changed with evolving research environments. Changes in technology, particularly the invention of the Internet and other media technologies, required the editors to make timely adjustments in the operations of the Journal.To appreciate the underlying reasons for these changes, I have arbitrarily divided the 70 years of Gastroenterology into 3 periods. Period 1 (1943–1965) was a period of growing pains and conversion of the Journal from papers containing clinical observations presented at the AGA annual meeting to the foundation of a modern journal. The modern journal sought to have an impact on the science of gastroenterology that extended outside the specific interest of AGA members. Period 2 (1966–1991) was one of maturation, and the editors built on the concepts established in period 1. With time, the scientific and clinical fields and research opportunities in gastroenterology changed. Changes in the field of digestive diseases brought different flavors to the content of the Journal. Period 3 (1992–present) was a time of coping with changes in the science and revolution in information technology.Period 1 (1943–1965)Gastroenterology had a great start and rapid growth. The success of Gastroenterology in the early 1960s reflected a growing number of training programs, many of which had a research component, and was due to its visionary editors and chair of the editorial board and to the understanding of the AGA Governing Boards. Alvarez has been called the father of Gastroenterology, but Morton Grossman may deserve to be designated the father of modern Gastroenterology.During the 1940s, most research was focused on clinical observations. Pavlov's work was still a dominant influence in the field. Clinical topics were dominated by dyspepsia and irritable bowel syndrome. Much research was repetitive, inconclusive, and not well designed by the increasingly vigorous standards of the 1950s. The observational clinical work with extrapolation to science that might apply was challenged by a younger generation committed to biostatistics and biochemistry. Experimental physiology took center stage, and studies of GI hormones became a dominant topic. Many young trainees and investigators were attracted to the excitement of the science of gastroenterology, and Gastroenterology was the highest-quality medium for publication of their research. The Grossman period was dominated by physiology of GI hormones and pathophysiology of peptic ulcer disease.According to Walter Palmer, “The two persons most responsible for the organization of Gastroenterology were Walter Alvarez and Andrew Ivy” (Boyle JD, Walter Lincoln Palmer MD, PhD: An Oral History, 1978). In 1943, Alvarez became the first editor-in-chief. Ivy was the managing editor, and it was his “persistent pushing, making of arrangements, and carrying out the details that was primarily responsible” for the Journal. Palmer states that “Alvarez had a great capacity to write. He could sit down and dictate an editorial that wouldn't have to be revised.”In 1950, the AGA structured the appointments and tenures of the editors, editorial boards, and editorial board chairs of Gastroenterology. These individuals were appointed for 5-year terms, and the terms overlapped the period of transition between editors. The editors and editorial board chairs could be reappointed once, but editorial board members could serve only one term. The AGA appointed an editorial board of 7 members who were entrusted to make final decisions on all editorial matters. This number was later expanded to more than 20. In addition, the AGA also appointed a 62-member editorial council and 19 associate editors. These individuals were those with a special field of interest. The editorial council and associate editors provided reviews of all submitted papers. The chair of the editorial board played a very important role as liaison between the governing board and the editor. The first editorial board chair was Walter L. Palmer (1950–1956), followed by Sara Jordan (1956–1958), Dwight Wilbur (1958–1963), and Franz Ingelfinger (1963–1968).When Ivy resigned as managing editor in 1953 for personal reasons, Abe Aaron took over the position. This arrangement lasted several years, and “when Abe announced that he would take over the editorship, no one objected.” “He became editor as well as managing editor—everything.” In 1960, Dwight Wilbur was chair of the editorial board when Morton Grossman (1960–1965) was appointed editor. In 1963, the editorial council and the associate editors were no longer appointed and reviewers with expertise were drawn informally from a large pool of experts, including those who were not members of the AGA. Grossman appointed Hans Popper as associate editor of liver disease, and he handled all manuscripts about the liver (Table 1). Grossman is primarily responsible for the current shape of Gastroenterology.Table 1Editorial Teams During the 3 PeriodsEditor-in-ChiefAssociate and Special Section EditorsPeriod 1 (1943–1965) William C. Alvarez (1943–1950)Andrew C. IvyFranklin HollanderMorton I. GrossmanRussel S. Boles Andrew C. Ivy and Walter L. Palmer (1950–1952)Morton I. GrossmanFranklin HollanderArmand LittmanRussel S. Boles Abraham H. Aaron (1953–1959)Armand LittmanFranklin HollanderRussel S. Boles Morton I. Grossman (1959–1965)Armand LittmanFranklin HollanderHans PopperRussel S. BolesPeriod 2 (1966–1991) Marvin H. Sleisenger (1965–1970)Graham H. JeffriesRobert M. DonaldsonCharles S. LieberThomas R. HendrixRussel S. Boles Robert M. Donaldson (1970–1977)Jerry TrierTheodore M. BaylessRoger LesterHarold ConnRussel S. Boles John S. Fordtran (1977–1981)Burton CombsJohn WalshAthol WareRaj K. GoyalMarvin ShusterGuenter KrejsJon IsenbergArmand Littman Robert K. Ockner (1981–1986)Rudi SchmidYoung KimRobert GlickmanMarvin SleisengerBruce ScharschmidtJames ChristensenJohn WalshArmand LittmanJon Isenberg Raj K. Goyal (1986–1991)John GollanJames MadaraMark PeppercornJules DienstagAlan WalkerJose BeharHoward SpiroWilliam SilenSatish RattanStuart SpechlerHelen ShieldsMark FeldmanPeriod 3 (1992–present) Nicholas F. LaRusso (1991–1996)Sidney F. PhilipsJoseph R. BloomerC. Richard BolandEugene B. ChangEugene P. DimagnoRalph A. GianellaGregory S. GoresRichard H. HuntJuan R. MalageladaLaurence J. MillerJorge RakelaJoseph H. SzurszewskiJ. Thomas LaMontHenry J. Binder Daniel K. Podolsky (1996–2001)Jake LiangTim WangJames MadaraFred GorelickJules DienstagAnil K. RustgiJeffrey MatthewAnn OuyangRick BlumbergNeil KaplowitzMichael CamilleriGuido Tytgat David A. Brenner (2001–2006)R. Balfour SartorJohn J. LemastersDavid F. RansohoffAnil K. RustgiJonathan A. CohnMichael W. FriedP. Kay LundHenry J. BinderDouglas A. DrossmanSamuel KleinRobert S. SandlerLoren LaineWilliam E. WhiteheadLloyd MayerEugene B. ChangIan S. GrimmRaymond N. DuBoisRodger A. LiddleDavid M. Warshauer Anil K. Rustgi (2006–2011)Gary D. WuGail HechtJohn M. CarethersDavid A. KatzkaVincent W. YangKyong-Mi ChangJames D. LewisJan F. TackRexford S. AhimaHashem B. El-SeragEmeran A. MayerGary R. LichtensteinM. Bishr OmaryRoland M. SchmidTimothy C. WangMichael B. WallaceBruce R. BaconRebecca G. WellsHenry J. BinderWafik S. El-DeiryDavid C. MetzDavid L. Jaffe M. Bishr Omary (2011–present)John M. CarethersNaga P. ChalasaniDavid LiebermanDiane M. SimeoneGrace L. SuAnna S. LokMalcolm J. LowJerrold R. TunerJohn Del ValleChung OwyangJean-Michel PawlotskyJohn A. WilliamsGrace EltaJonathan BraunLinda C. SamuelsonJohn F. KuemmerleRobert J. FontanaDouglas A. CorleyBruce E. SandsAnson W. LoweRalph KiesslichWilliam L. HaslerDetlef SchuppanRichard H. MoseleyThomas D. WangPhilip S. SchoenfeldJoel Rubenstein Open table in a new tab During this period, editors received no honoraria. The editor's institution provided space and postage. There was no designated editorial staff, so the editor's institutional secretaries provided administrative support. Williams and Wilkins provided excellent technical support for the Journal.When Gastroenterology was launched, all papers were invited, although a number of author-initiated papers were submitted as time passed. In 1945, more than 100 credible papers were submitted for publication (Mateer JG, Gastroenterology, 1951). Almost all papers published in Gastroenterology were from domestic authors. With time, the number of author-initiated submissions grew and Grossman discontinued the invited submissions.Initially the editors depended on the associate editors and the members of the editorial council for review of all submissions. Grossman was the first editor to invite the participation of non-AGA members as reviewers. Grossman also used the review process for author education. All of the submitted papers received careful reviews. Papers were not rejected based entirely on the assigned priority. Grossman took particular interest in papers that had strong science but were not well written. He “never rejected a paper only because of its English and writing style.” Instead, he spent countless hours improving the presentation of the paper.At first, all invited papers and some author-initiated papers were accepted for publication. In 1945, of 100 papers, 42 were accepted for publication. Grossman reported that during Palmer/Ivy's time, the acceptance rate was 81%; it dropped to 57% in 1961 and to 45% in 1964 (Figure 1).Figure 1Overall number of submissions, pages available for publication, and acceptance rate. Note that the number of submissions rapidly increased starting in 1943, with the first issue of the Journal, to approximately 2000 by 1976. The number of pages available for publication in the Journal also increased and has now reached a peak of approximately 4500 pages. However, this increase in publication pages was not sufficient to accommodate the increased submissions; the acceptance rate fell and is now approximately 12% to 15%. Note that page numbers represent the double-column, full-size page format. Numbers of the older single-column or double-column formats of small-sized pages have been converted to equivalent full-size pages.View Large Image Figure ViewerDownload Hi-res image Download (PPT)The front cover of the January 1943 issue of Gastroenterology had a picture of the Friedenwald Medal, under which there was a statement dedicating the issue to William Beaumont. For the next 4 years, the July issue was similarly dedicated to that year's winner of the Friedenwald Medal: Anton Julius Carlson in 1944, Lewis Gregory Cole in 1945, Frank Howard Lahey in 1946 and George B Eusterman in 1947. Starting in 1948, the front cover of each issue contained a list of the articles published in that issue.Gastroenterology has been published monthly, with 12 issues a year, and is mostly divided into 2 volumes containing 6 issues each. However, there were 2 exceptions that disrupted the relationship between the number of years of publication and the volume number of the Journal: in 1943, all 12 issues were included in volume 1; and from 1950 to 1953, the volumes included only 4 issues each. Thus, by the end of 1953, volume 23 of Gastroenterology had been published rather than the expected volume 20 if the journal volumes had consistently contained 6 monthly issues. After 1953, Gastroenterology always was 3 volumes ahead of the predicted number based on its age.In 1943, 1161 small-format pages were published. During the first few years, the number of published pages remained more or less constant but then began to increase rapidly. By 1948, the number of printed pages had doubled to approximately 2000. The AGA Governing Board tightly controlled the page limit of the Journal, because it was directly related to the revenue earned from the publisher. In 1959, a double-column format was adopted that could hold 50% more words per page to increase the number of articles without increasing the number of pages. By the end of Grossman's term, the number of published pages was approximately 2000 double-column, small-size pages. This represented an almost 3-fold increase of printed papers in the Journal since its inception (Figure 1).The articles in Gastroenterology reflected what was going on in the field. The first issue contained 11 original articles, all by the stars of gastroenterology at that time: Sara M. Jordan, Frank H. Lahey, A. J. Carlson, B. B. Crohn, R. Schindler, E. B. Benedict, W. C. Alvarez, and Joseph Kirsner. There was substantial discussion of issues related to World War II. Burrill Crohn wrote an editorial titled “Inequities of the Selective Service,” and Sara Jordan wrote an editorial suggesting that all soldiers should be checked for achlorhydria because they were at increased risk for tropical GI infections.The first volume of Gastroenterology contained 82 main articles, of which 7 dealt with the liver or biliary tract. Sixty-four papers were clinical reports, including one on “the coated tongue,” and 12 were concerned with clinical investigation. In the early and middle part of this period, most of the articles were clinical observations. The clinical topics were dominated by discussion of acid secretion, peptic ulcers, obesity, and psychosomatic medicine, including dyspepsia and functional bowel disease. In the later part of this period, experimental physiology took center stage as studies of GI hormones became the dominant topic. During this period, the Journal reported advances in the mechanism of acid secretion, morphology of gastric mucosa, and pathogenesis of and clinical aspects of peptic ulcer disease. The Journal also reported on the significance of intestinal mucosal and liver biopsies, intestinal malabsorption, hepatic coma, and pancreatic physiology and disease. Contributions and advances in gastroenterology during this period were summarized in a silver jubilee special edition of Gastroenterology (Almy TP et al, Gastroenterology, 1968).Alvarez also started several new sections, including editorials, Abstracts of Current Literature, and book reviews. The Abstracts of Current Literature section was edited by Franklin Hollander and contained summaries of papers from other journals. The first edition of the textbook Bockus Gastroenterology was reviewed in one of the issues. Editorials, Abstracts of Current Literature, and book reviews remained prominent features during his editorship. A lively letter to the editor section was also part of the Journal.A hot topic at that time was whether Gastroenterology should be a house organ of the AGA or if it should be a journal that published the best research in gastroenterology. Some of the leaders of the Journal wished it to publish all materials that may be of interest to the membership of the AGA. In 1956, Clifford Barborka organized the first AGA Postgraduate Course as the AGA–University of Colorado Medical Center Course. The course was a huge success and was attended by nearly 700 physicians. At that time, the question of publishing the contents of the course in Gastroenterology was raised but not pursued. The issue of publishing course materials arose again in 1960 after the successful second postgraduate course, held in New Orleans under the direction of Gordon McHardy. Many members of the AGA Governing Board supported the idea. However, the newly appointed editor, Morton Grossman, did not want to publish that material or any other solicited material in Gastroenterology. He argued that the Journal was facing a backlog, and the rejection rate was almost 43% in 1961. Moreover, solicited papers often failed to meet the high standards that he wished to promote. Grossman wanted the Journal to be more than a house organ of the AGA. He believed that the best way to achieve that goal was to publish the best scientific material and dedicate fewer pages to AGA administrative matters. At this point, questions were raised about the relationship of the Journal, its editor, and the AGA. Dwight Wilbur, chair of the editorial board, understood what Grossman was trying to do. He convinced the AGA Governing Board to not push for publication of the course in Gastroenterology and to publish only the essential AGA material, including abstracts of the annual meeting, listings of training programs, Our New President, and the Friedenwald Award. The postgraduate course was published separately as a book, Current Gastroenterology, which earned more than $1000.During the first period of Gastroenterology, advertising helped support the financial operations of the Journal. In 1950, there was growing concern that many of the claims in advertisements were not substantiated. Abe Aaron (nephew of Charles Aaron) was appointed associate editor in charge of advertising. Abe writes, “Those early years were not easy. The association was small and sources of income scant … we could have stuffed the profits by loose advertising policy.” However, he insisted on high ethical standards of advertisements in Gastroenterology. He initiated a process of peer review of all advertisements and insisted that all claims made in an advertisement be substantiated by credible references. He accepted advertisements only after all concerns about their claims were resolved (Aaron, Presidential Address, 1958).The Journal was also financially supported by subscriptions. In 1943, there were approximately 1500 paid subscribers; this number increased to 2000 in 1946, 3000 in 1953, 4000 in 1959, and 5000 in 1964 (Figure 2). Profit from the Journal was set aside to support research and scholarships.Figure 2Number of subscribers to Gastroenterology. Note that the number of subscribers increased exponentially and reache
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