Eighty years ago, the landmark paper on regional ileitis was published,1 which gave rise to the eponym of Crohn's disease (CD). Currently, CD involves the ileum alone in less than 1 of 2 cases.2 Indeed, eponym is noncommittal, it is memorable. In terms of history, any searcher-after-truth knows that the further one looks back, the more references may come to light: indeed clinical descriptions of diarrhea with or without blood go back thousands of years, and case descriptions of probable CD published beforehand and not cited by Crohn et al.1 have been reviewed in comprehensive historical papers.3,4 The most recent one outlined that Europe, especially Great Britain, was the only part of the world to publish, since the 19th century, single cases of, in retrospect, classical regional enteritis, and the first American contribution was only reported in the early 1900s.4
Revisiting the question, we discovered that was published, as early as 1813, in a prestigious American medical journal,5 an original syndrome of chronic bowel disease, perfectly compatible with the current CD phenotype, but never quoted in any historical review. Indeed, Gorham5 reported clinico-anatomical observations on “chronic diarrhea arising from an ulcerated state of the intestines”, a slowly progressing, commonly fatal disease within several years. Clinically, a severe purging mixed with blood and pus was associated with emaciation and progressive universal dropsy. On repeated dissections, gross inflammation, transmural or of the internal coat, involved the lower ileum, cecum and colon almost to the rectum, and, in some cases, the stomach, duodenum and jejunum. Lesions, “most numerous at or near the ileocecal junction”, consisted mainly of erosions or linear ulcerations, some being penetrating jagged ulcers, with occasional redness of the peritoneal coat. No macroscopic lesions were described in the mucosa between ulcerations or ulcers, except around them. Pelvic abscess, but no strictures, fibrous hyperplasia, peritoneal nodules or serosal tubercles, caseation or pleuropulmonary abnormalities were reported except for hydrothorax related to universal dropsy.5 Histological and microbiological studies were not yet commonly feasible in the early 1810s. Thus, could these cases of chronic ulcerated enterocolitis5 have been early cases of secondary or primary intestinal tuberculosis? Quite probably not, in addition because (a) ulcerated, non-stricturing intestinal tuberculosis was shown, throughout the late 19th and early 20th centuries, to be almost constantly secondary, in the temperate zone, to pulmonary tuberculous lesions; and (b) primary intestinal tuberculosis was described as chronic hyperplastic, stricturing gross lesions by the early 20th century.4
Gorham's findings5 are particularly consistent with CD ileocolitis in its current non-stricturing but internally penetrating phenotype2 and thus are worth being quoted, for the first time, in the pre-eponym story of CD.