The History of IBD

Crohn's Disease first became known as a medical entity when it was described by Crohn, Ginsberg and Oppenheimer in 1932. However, reports of manifestations of Crohn's Disease have been reported as early as 850AD when King Alfred, "England's Darling", suffered from an illness which caused pain on eating, discomfort, and much embarrassment. This affliction plagued the King from the age of 20, without remission. At the time the illness was thought to be due to witchcraft, or a punishment for the King's infidelities. In retrospect, however, the illness was probably Crohn's Disease.

Crohn and his partners were not the first to recognize the condition;

In 1612 a Doctor performed an autopsy on a young boy, who had complained of abdominal pain, and noted ulcerations in the intestine, similar to those found in IBD. Similar reports by others during the 19th century identified the intestinal pathology of what we know today as IBD.

An article was published in the British Medical Journal of 1913 by T. Kennedy Dalziel, who reported treating 13 patients who had suffered from intestinal obstruction. On autopsy he found that all 13 patients had inflamed gut, especially in the jejunal, ileal and colonic areas. On examining the inflamed bowel more closely, the transmural inflammation that is characteristic of the disease was clearly seen.

Between the 1920s and the 1930s increasingly more patients, particularly young adults, were being seen for symptoms that resembled appendicitis - abdominal cramps, fevers, diarrhoea, and weight loss.

Then, in 1923, Drs.Berg, Oppenheimer, and Ginzberg, surgeons at the Mt Sinai Hospital in New York, collected 12 patients with similar symptoms, and showed that these symptoms were not the result of any other known disease or organism.

Burril Crohn, in 1930, showed similar findings in two patients that he was treating. On the suggestion of Paul Klemperer, the two groups of doctors combined their information, and published their findings in the 1932 JAMA. At the time the disease was called "terminal ileitis", in view of the predilection of the disease for the end portion of the small bowel. However, the term "terminal" has rather unfortunate implications, and the disease is not solely confined to the small bowel. The term "Crohn's Disease" is now generally accepted.

The JAMA article was published at a time when the medical community were receptive to the new findings, and the paper was presented to a large medical audience. As a result Crohn's et al findings were given a large amount of recognition and publicity, while Dalziel article in the British medical Journal of 1913 was not.

Therefore, as in many medical findings, Crohn's Disease is only termed Crohn's Disease due to serendipity - Crohn's was named as the first author of the article published in JAMA, and the article was published at the "correct time" and was given a great deal of publicity.

Ulcerative Colitis was first described by Wilks and Moxon in 1875. Before this discovery, all diarrhoeal diseases were believed to be caused by infectious agents and bacteria. Wilks and Moxon, were therefore the first to identify the disease as being from a non-infectious cause. However, as with Crohn's Disease, the reports of the disease, or symptoms which we now know are due to ulcerative colitis, had been reported many years before. An obstetrician, with an interest in digestive diseases, known by the unfortunate name of Soranus, described diarrhoeal disease in 130AD.

This disease was once again reported by Aretaeus of Cappadocia in 300AD."Bloody Flux" was a term given to a dairrhoeal disease in the late 1600's by Thomas Sydenham, and this description aptly describes Ulcerative Colitis.

Even though Sir Samuel Wilks described the first case of Ulcerative Colitis, and hence the discovery has been linked to his name, the true article that was written was in fact a letter to The Medical Times and Gazette in 1859. The letter contained a description of a post-mortem that Sir Wilks had performed on a young girl, Isabella, who had died after a 3 week illness. In the letter, it was stated that even though the women had suffered from dysentery from a non-infectious cause, she had died as a result of taking a poison that was supposed to induce abortion. The lady in question was the mistress of Dr. Thomas Smethurst, who was then accused of murdering her.At the doctor's trial there was great controversy over the cause of death. Some said that Isabella had died from dysentery, while others claimed that she had died due to poisoning. At the end of the trial the Doctor was found guilty of murder.The case was highly controversial and many wrote letters of support for Dr. Smethurst to the local newpaper. As a result of these letters, and the conflict over the cause of death, Dr. Smethurst was granted a pardon by the Home Secretary. If the pardon had never been granted, the doctor would have been put to death, because his mistress had died from Inflammatory Bowel Disease!

When Crohn's first described Crohn's disease, it was thought that the two diseases were distinct from each other. However, more recently it has become apparent that the two disease may "overlap each other" and the term "indeterminate colitis" is fequently used.

For More Info http://www.mssm.edu/msjournal/67/page263-268.pdf (Dr B Crohn 1932 Paper in Jama.

UpdatedApril 2005