Charles Halsted
Davis, California, United States

I listened with care to her history of weight loss, grain aversion, abdominal cramps, and frequent diarrhea. Her great-grandfather was an early California settler who had experienced the same symptoms for many years before he died. My patient, now in the middle years of her life, appeared normal, except for her too-thin frame and a tongue as smooth as the palm of her hand.

Loud gurgles of fluid rushed beneath my stethoscope when I pressed it hard on her abdomen. She felt nothing when I gently pricked her lower legs with a pin. Her examination and bloodwork all pointed to a celiac disease diagnosis, but a full evaluation would be complicated. She lived a four-hour drive to the north, whereas our university hospital in Sacramento lacked a metabolic ward to evaluate patients with complex diseases.

She would require a three-day stool collection, a five-hour urine collection, and a capsule biopsy from the surface of her small intestine. My wife agreed that she could stay in our guest room with a private bathroom for the three days required for sample collections.

She rode in my car to the hospital lab to deposit the samples and complete her testing. That afternoon, I passed a special tube through her nose and performed the capsule biopsy. All tests confirmed a diagnosis of celiac disease. She began her treatment with a gluten-free diet.

Now when I travel north past her mountain town, I recall the days when she stayed in one of our bedrooms. I think of her pioneer ancestors who were most likely afflicted with celiac disease, about a generation before its discovery and treatment during World War II.