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The Influence of Twentieth-Century Biomedical Thought on the Origins of Inflammatory Bowel Disease Therapy

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Inflammatory Bowel Disease

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Abstract

I wish first to thank the organizers of this symposium for inviting me to speak on the origins of inflammatory bowel disease (IBD) drug discovery during the twentieth century. My own involvement with ulcerative colitis and Crohn’s disease began in January 1936 [2]. My first patient, a severely malnourished woman of 40 gravely ill with ulcerative colitis, weighed a mere 85 lb. Treatment with the available ­nutritional supplements, subcutaneous fluids and small blood transfusions, was inadequate and the patient soon died – an experience that stimulated my interest in IBD and in the importance of nutritional support therapy. Between 1880 and 1900, 21 microorganisms had been identified as the specific causes of human disease; more pathogens were recognized early in the twentieth century [3]. So, during the 1930s, we searched unsuccessfully for pathogenic organisms in the stools of ­ulcerative colitis (UC) patients. We also were impressed with the emotional ­difficulties of IBD patients and yielded to prevailing psychosomatic concepts of disease and endorsed psychotherapy, which, though helpful for some patients, was ineffective. The discovery of sulphanilamide in 1938 [3], the availability of penicillin in the 1940s, and the subsequent sulphonamides and antibiotics were major ­accomplishments; but for IBD, initial optimism soon ended in disappointment. In the autumn of 1950, the clinical effects of adrenocorticotrophic hormone (ACTH) and the adrenal corticosteroids in rheumatoid arthritis, in IBD, and in other diseases were even more dramatic and suggested the soon-disproved possibility of a hormonal deficiency. Patients with UC improved within 48 h, but recurrences soon followed. Fifty years later, we recognize steroids as useful anti-inflammatory and immunosuppressive agents, but not as long-term therapy. Immunological ­mechanisms now were being proposed for a variety of diseases, and their implication in IBD soon followed, especially as we became aware of the gut mucosal immune system – you have learned more of this concept from the experts on the earlier program.

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Acknowledgment

This project was supported in part by the Gastro-Intestinal Research Foundation of Chicago. Special thanks to Ms. Amanda Serrano for retyping this manuscript.

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  1. Department of Medicine, Section of Gastroenterology, University of Chicago Medical Center, MC 2100, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA

    Joseph B. Kirsner

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    Russell D. Cohen

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Kirsner, J.B. (2011). The Influence of Twentieth-Century Biomedical Thought on the Origins of Inflammatory Bowel Disease Therapy. In: Cohen, R. (eds) Inflammatory Bowel Disease. Clinical Gastroenterology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-433-3_1

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