Anagha Brahmajosyula
Bangalore, Karnataka, India

Crohn’s disease, a form of inflammatory bowel disease, may cause inflammation in any part of the gastrointestinal tract, from the mouth to the anus, with a predilection for the ileum. While much is known today about the underlying pathology of the disease, historically, this condition was thought to be a form of tuberculosis. Its earliest description dates to the 1700s, but it was not until 1932 that it was identified as a separate entity by Burrill Bernard Crohn, Leon Ginzburg, and Gordon D. Oppenheimer, who were working together at Mount Sinai Hospital in New York.

In 1761, Giovanni Battista Morgagni, popularly known as the “father of modern anatomical pathology,” was probably the first to describe a suspected case of Crohn’s disease. In his five-volume text of all known disorders, De sedibus et causis morborum per anatomen indagates, he described autopsy findings of transmural inflammation and perforation in the terminal ileum and proximal colon in a twenty-year-old man, accompanied by mesenteric lymph node enlargement. These classic findings are known today to be associated with Crohn’s disease. The young man had suffered repeated bouts of bloody diarrhea, abdominal pain, and fever before his death.¹

Later reports of similar cases followed, the most notable by Thomas Kennedy Dalziel, a Scottish surgeon, who in 1913 documented chronic interstitial enteritis in a historic paper.² In his studies, tuberculosis had been carefully eliminated as a cause for the condition. Other notable descriptions include those given by Coombe and Saunders in 1813, who described a “singular case of stricture and thickening of the ileum,” and Rudolph Virchow in Berlin who referred to an “inflammatory fibrous tumor” in 1853.³ However, until the groundbreaking case series by Crohn et al, there was no clear documentation that the disease was its own entity.

Burrill Bernard Crohn, born to a Jewish family in 1884 in New York City, attended Columbia University’s College of Physicians and Surgeons in 1907. Having seen his father’s struggles with digestive problems, Crohn was motivated to pursue the field of gastroenterology with the sole purpose of helping his father with his condition. Most of his clinical pursuits in this field occurred after he joined the clinical staff of Mount Sinai Hospital in New York after an internship in pathology.

In the early 1930s, A.A. Berg, a surgeon at Mount Sinai Hospital was operating on patients with inflammatory diseases of the bowel. He encouraged his colleagues Leon Ginzburg and Gordon Oppenheimer to collaborate with Burrill Crohn in an attempt to uncover the cause of the unusual lesions he had encountered. After gathering sufficient evidence to support their diagnosis, they prepared a case series of fourteen patients who had been operated on by Berg. Their report, “Terminal ileitis: a new clinical entity,” was presented at the 1932 American Medical Association meeting.

As the word “terminal” could be misinterpreted as an end-stage form of a disease resulting in death, the name was changed to “regional ileitis.”⁴ The case series was submitted to the Journal of the American Medical Association (JAMA) for publication. Berg requested that his name not be included in the author list as he had not been involved in the initial presentation of the cases. The report was submitted to the journal with the names of three investigators: Crohn, Ginzburg, and Oppenheimer. JAMA’s rule at that time was for the names of the authors to be listed in alphabetical order; thus, Crohn’s name was listed first and the eponym “Crohn’s disease” was coined, although the report itself did not use the term. Of course, if Berg had included his name in the report, this condition would likely be known today as “Berg’s disease.”

References

1. Kirsner JB. Historical origins of current IBD concepts. World Journal of Gastroenterology 2001;7(2):175. doi:10.3748/wjg.v7.i2.175.
2. Dalziel TK. Thomas Kennedy Dalziel 1861-1924. Diseases of the Colon & Rectum 1989;32(12):1076-1078. doi:10.1007/bf02553886.
3. Aufses AH. The History of Crohn’s Disease. Surgical Clinics of North America 2001;81(1):1-11. doi:10.1016/s0039-6109(05)70270-x.
4. De Campos, FG and PG Kotze. Burrill Bernard Crohn (1884-1983): The man behind the disease. Arquivos brasileiros de cirurgia digestiva 2013;26(4): 253-5. doi:10.1590/s0102-67202013000400001