Burrill Bernard Crohn.
In 1932 an article appeared in the Journal of the American Medical
Association (JAMA) which must be one of the most quoted papers in the
whole field of gastroenterology. It took up seven pages and was entitled
'Regional ileitis, a pathological and clinical entity'. It
emanated from Mount Sinai Hospital, New York and its three authors were
given in alphabetic order: B.B.Crohn, L.Ginzburg and G.Oppenheimer.
KEYWORDS Crohn's disease / Burrill Bernard Crohn
|Subject:||Crohn's disease (Care and treatment)|
|Publication:||Name: Journal of Perioperative Practice Publisher: Association for Perioperative Practice Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2012 Association for Perioperative Practice ISSN: 1750-4589|
|Issue:||Date: July, 2012 Source Volume: 22 Source Issue: 7|
|Persons:||Biographee: Crohn, Burrill Bernard|
|Geographic:||Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom|
Throughout the world today this entity is given the eponym of
'Crohn's disease', except in the U.S A, where this term
is not in common use and the condition is referred to by the term used
in the original article, 'regional ileitis'. I suspect this is
because Crohn was not especially popular among his colleagues!
Of course, this does not mean that the condition suddenly appeared out of the blue in 1932. Indeed, there is a good description of the naked eye appearance of the disease in 'The Seats and Causes of Disease', published by the physician, anatomist and pathologist Giovanni Morgagni of Padua, Italy in 1761. Coombe and Saunders, in 1813 in the UK, described a 'singular case of stricture and thickening of the ileum', while Rudolph Virchow, of Berlin, perhaps the greatest of all pathologists, had obviously seen the condition and described an 'inflammatory fibrous colon tumour' in 1853.
However, there is no doubt that Crohn and his colleagues put this pathological and clinical entity onto the map. In many centres, pathological specimens were re-examined and found to fit in with the description of the entity in the JAMA article. Indeed, the pathologist at Westminster Medical School told me, when I was professor there in the 1960s, that he himself had gone to the pathology museum at Westminster, re-examined a specimen labeled 'tuberculosis of the terminal ileum' and realised it was, indeed, a typical example of Crohn's disease!
In the early years after publication of this paper, the disease was believed to be more or less confined to the terminal ileum. However, in the 1950s and 60s a similar pathology, of chronic inflammation, giant cell infiltration and tendency to adhere to, and even fistulate into surrounding structures, was being described in many centres, in particular at St. Mark's Hospital, London. Indeed, we now recognise that, although undoubtedly most commonly affecting the terminal ileum, Crohn's disease can be found anywhere along the alimentary tract from the dental surgeon finding lesions in the patient's mouth to the proctologist seeing it involving the anal canal and fistulating, through multiple openings, into the perianal skin.
Crohn himself believed that the condition was due to a bacterial infection, probably the Mycobacterium paratuberculosum, related to the causative organism of tuberculosis and similar to the bacterium responsible for a bowel infection in cows called Johne's disease. However, no specific organism could be cultured from the affected intestine in man.
Since the time of Crohn's early work until the present day an enormous amount of clinical, experimental and laboratory work has been carried out on this disease, but one has to confess that it remains an aetiological problem. The search for a specific bacterium continues, using more and more histicated bacteriological techniques, but without, to date, a convincing organism being identified. One serious problem is that the pathology cannot be induced into any laboratory species. Moreover, a wide range of antibiotics have been tried without success in its treatment, again arguing against its infective origin.
Other researchers have invoked focal ischaemia as a cause, possibly as result of a vasculitis produced by some immunological reaction. However, no food factor has been shown to be a cause. The response of the disease in its advanced stage to immunosuppressive drugs such as azothioprine suggests a possible autoimmune cause and argues against an infective aetiology. As you might imagine, patients and population groups have come under careful study. Smoking trebles the risk of the disease. Men and women are equally affected - one in ten patients give a positive family history, however, it may not affect an identical twin!
The disease is commonest in North America and Europe, and mainly affects young adults in the second and third decade, (although there is another small group of patients in their 60s). It is uncommon in the African black population, yet in the USA, it affects blacks and whites equally. There is a higher incidence in Jews.
It seems to me that a Nobel Prize awaits the research worker who answers the question 'What causes Crohn's disease'?
So what of the man himself? Burrill Bernard Crohn was born in New York in 1884. It was in that city that he qualified in medicine and spent most of his long active clinical life. His colleagues in his famous 1932 publication were Leon Ginzburg, clinical professor of surgery, and Gordon Oppenheimer, consultant physician and gastroenterologist at Mount Sinai Hospital. At the time of publication, Crohn himself was a local general practitioner, who referred most of his patients to Mount Sinai, then as now a prestigious teaching and post graduate hospital.
Crohn rapidly built up an extensive practice in this condition, with patients coming to him from all over North America. He became a member of the medical staff of Sinai and was eventually promoted to chief of gastroenterology. He continued to practice well into his 90s, dying in 1983. In that year, the Burrill B. Crohn Research Foundation was established at Mount Sinai Hospital in his memory.
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Correspondence address: Department of Anatomy, University of London, Guy's Campus, London, SE1 1UL.
About the author
Professor Harold Ellis
Emeritus Professor of Surgery, University of London; Department of Anatomy, Guy's Hospital, London
No competing interests declared
|Gale Copyright:||Copyright 2012 Gale, Cengage Learning. All rights reserved.|