BURRILL BERNARD CROHN, M. D. :


              AN ORAL HISTORY




                  Recorded by

            JAMES D. BOYLE, M.D.
            February 27-29, 1968




The American Gastr,oenterological Association
          Wilmington, Delaware 1968
BURRILL B. CROHN   1
                       FORWARD



      This is the first of a series of oral histories
undertaken by ~he American Gastroenterological Association
to document the history of gastroenterology in this
country. The interview was conducted in 3 late-afternoon
sessions, February 27-29, 1968, in the consultation room
of Dr. Crohn's office at 1000 Park Avenue, New York, New
York.

     Dr. Crohn was born in New York City on June 13, 1884.
He graduated from College of Physicians and Surgeons,
Columbia University, in 1907 and began his internship at
Mount Sinai Hospital, New York. He developed a special
interest in digestive diseases which led to a long career
in research, teaching and the clinical practice of gastro­
enterology. An international authority on intestinal
diseases, Dr. Crohn is perhaps best known for his discovery
and later delineation of regional ileitis (Crohn's disease~)
Dr. Crohn was President of the American Gastroenterological
Association in 1932 and was awarded the organization's
Julius Friedenwald Medal in 1953.

     At 84, Dr. Crohn renains active as a consultant and
practicing gastroenterologis~ as an ,author, and as a man of
cultural pursuits. He and his wife, Rose, reside in
New York City, and have their country home in South Kent,
Connecticut.

                                    JAMES DAVID BOYLE, M.D.
                      ~ONI'ENI'S



auRRILL B. CROHN (photograph} • • • • • • • • • F~ontispiece
FORWARD • • • • • • • •           • • • • • • • • . • • 1
EARLY YEARS • • • • • • • • • • • • • • • • • • • • • 3
INVESTIGATIVE CAREER • • • • • • • • • • • • • • • • 10
GASTROENTEROLOGY IN NEW YORK CITY • • • • • • • • • • 24
THE AMERICAN GASTROENI'EROLOGICAL
   ASSOCIATION: REMINISCENCES • • • • • • • • • • • 32
THE AMERICAN GASTROENTEROLOGICAL
   ASSOCIATION: HISTORICAL TRENDS • • • • • • • • • 48
BURRILL B. CROHN: BIBLIOGRAPHY • • • • • • • • • • • 61
INDEX CF PERSONAL NAMES • • • • • • • • • • • • • • • 70
EARLY   YEARS
                                                                 3




                          EARLY YEARS



BOYLE: Dr. Crohn, I am interested in your early back­
   ground. Where were you born?

CROHN: Here in New York, on 112th Street and Madison
   Avenue.

BOYLE:   Tell me about your parents.

CROHN: My parents were interesting. Both my grandparents
   were 49'ers in the Gold Craze of California -- came from
   the old country; one from Poland the other from Germany,
   religious, fully-bearded, Orthodox Jews. Forced out of
   the old country by the repression of the Poles and the
   Russians during 184R, which you will remember as a
   year of revolution throughout Europe -- a year of up­
   rising against the so-called Holy Alliance of three
   emperors after the downfall of Napoleon -- '48 was the
   year of great revolution in Poland and elsewhere. They
   crossed the continent, presumably in a wagon train or
   else down by boat to the isthmus of Panama and across
   the peninsula to Sacramento, California: They returned
   to New York after the brief gold craze was over.

        My mother saw the funeral cortege of Lincoln pass
   through New York City when she was a little girl.
   During the race riots she was told by her father, "Girls,
   today you stay indoors. Nobody goes out. They're
   hanging niggers from the lamp posts." These were the
   draft and race riots in the New York City streets.

        My father came over independently, during the Civil
   War and, as a little boy, sat in Central Park and watched
   the training of the volunteers for the Northern Army.
   With the discovery of oil in Oil City, Pennsylvania, he
   picked himself up from New York, where he was earning all
   of three dollars a week as a runner in a mercantile
   business of some kind, and went to Oil City, Pennsylvania.
   When the big play with oil diminished, and the great ex­
   citement over the discovery of oil was allayed, he migrated
   to Central City, Colorado attracted by the discovery of
   lead and silver. Here he established with his brother-in­
   law a very successful mercantile business. A fire swept
   Central City, wiped out most of the buildings and his en­
   tire establishment.  In those days insurance against catas­
   trophe had not been foreseen and his business was ruined.

         Rather than build the business up again he followed
                                                               4




the next craze, which was the cotton boom down South.
They sat him on top of a Wells Fargo Express with a rifle
across his knees and so he journeyed from Colorado to
Rockdale, Texas, a small town in the far interior of
eastern Texas. Again he established a large mercantile
business, selling merchandise on credit to the planters
during the year. When the crop in the form of cotton
ripened and was sold, the planters would pay their debts,
clear their record, and then set out for another year of
credit. It was customary for a merchant to come North to
bµy merchandice; on one such visit he met my very charming
and motherly mother, who had a voice like a nightingale,
and came from a deeply-rooted family. She sang in Saint
Bartholomew's Church on Sundays and in the temple Emanuel
on Saturdays. She sang in the chorus for Leopold Damrosch
with the first Oratorial Society that came to this country.
My father met her, married her, and brought her South.
But she as a New Yorker, just couldn't take the Deep South
having lived in New York all her life and accustomed to
the New York cultural life. She told my father he'd have
to give up his business and come to New York; and he was
amenable.

     He sold his business in Texas and became a member of
the New York Stock and Petroleum Exchange: for the rest
of his life, we eleven children were brought up on "eighths
and quarters." The New York Stock and Petroleum Exchange
was a smaller exchange, associated with the large New York
Stock Exchange:   the smaller exchange dealt in fractions of
shares, because the Big Exchange dealt only with multiples
of a hundred.• The fractional shares were sold at an in­
crease commission of an eighth or a quarter of a dollar.
By selling fractions of stocks at the spread of an eighth
and a quarter, my father was able to raise 11 children -­
well brought up and educated in the public school system
of that large metropolis.
     As one might expect of a man who had roamed all over
the country as he did, he followed speculative hunches.   I
asked him once how he enjoyed the train trip coming from
Texas to New York. "All right," he said. "What did you
do?" "We played poker on the train." I said, "With whom,
friends?" "No." he said, "Strangers. You just walked into
a poker party, of complete strangers, and sat down" "What
did you play for?" "Stakes, big stakes." "How did you
come out?" "Well," he said, "between New York and St. Louis,
I lost three thousand dollars." "What? That was terrible!
Three thousand dollars." "Yes," he said. "but between
St. Louis and New York I not only made back the three thousand
dollars, but a couple of thousand dollars more."
                                                                 5




        Can you imagine times such as these! A little
   German boy becomes an American citizen, a Southerner,
   who'd lost all signs of religion, marries my mother
   and becomes obsessed with her cultural religious back­
   ground. Like all late converts he became the most
   zealous Orthodox that I ever met in my life.

        Saturdays we weren't allowed to move. Speak about
   the Puritans or the Pilgrims, or the Methodist observance
   of a Sunday! On Saturday morning you weren't allowed to
   walk outside the limits of the buildings; one spent his
   entire morning, afternoon, and evening in the synagogue
   and could eat only the restricted Kosher food.

       With maturing years I hoped to escape from what I
  consideredl:iigotry. As an intern at Mount Sinai Hospital,
  I ate for the first time outside my home and was allowed
  to ride on a Saturday trolly when the occasion demanded.
  This was the first time I could break away from this ultra­
  pharisaical tradition of which I had been a part.

BOYLE: What lead you to go into the profession of medicine,
   Dr. Crohn?

CROHN: I don't exactly know.   It was not a known tradition
   of the family.  I just made up my mind that I was going
   to study medicine. Perhaps my father's constant complaints
   about "indigestion" concentrated my attention on intestinal
   diseases.

       There were no high schools in my day, as strange as
  that may seem, and it's very difficult for me to convince
  people that when I graduated from public grammer school in
  1897, there was only one high school, the Townserxi Harris
  High School on the west side of New.York; there were no
  other high schools. One went directly from public school
  to college. The public school system in New York City
  conducted competitive examinations for entrance into
  college. Out of all the graduating classes of all the
  public schools, 200 boys with the highest standings entered
  City College -- fortunate that I could pass the examination
  among the upper 200. My father told the only lie of his
  life when he deliberately misstated my age. The minimum
  age for entrance into the City College was 14; I was only
  13. At the age of 18, I had already a degree of Bachelor
  of Arts (B .A.).

       In 1907, I graduated f~om the College of Physicians
  and Surgeons, one of the best medical schools in the city
  or the country; a marvelous medical education. Even as a
  medical student, I was already interested in the laboratory.
                                                                  6




   I found the study of medicine very strenuous and very
   difficult, particularly the memorizing of anatomy and
   the pathology. My love was with the laboratory, and
   I was a volunteer in the Biological Laboratory of
   P. & S. under Professor Geis. Incidently during the
   first year I taught night school, English to foreigners,
   to help pay my expenses through college.

        In spite of the intensity of medical school program,
   some of us as students were still able to learn the tech­
   nique of laboratory research. A classmate of mine, Fred
   s. Weingarten, and I undertook a research project on
   "The Effect of Massive Intraperitoneal Hemorrhage Upon
   the Chemistry of the Body." Dogs were bleed from the
   femoral artery into their own peritoneal cavity until
   they were practically exsanguinated; we then spent weeks
   and months analyzing urine and stool for nitrogen,
   phosphorus, potassium, calcium -- fantastically useless
   research, but marvelous for technique. We learnt the
   technique of experimentation and of operation; and we
   learnt the technique of fine biochemical estimations.
   For an M.A. Degree, Fred and I published this thesis which
   was accepted for publication. Columbia University offered
   us both an M.A. and a Ph.D. and a Sigma Xi. But I didn't
   have and I didn't want to ask my father for the $35 for
   the parchment of the Ph.D., so the degrees were declined
   without too much concern.

BOYLE: Tell me about your internship, Dr. Crohn, at Mount
   Sinai Hospital.

CROHN: I interned first in pathology, for one year, and later
   internal medicine for two and a half years.   But pathology,
   of course, was a very special privilage. There was only
   one such position open. Of all the -interns and externs
   accepted, only one was chosen by competitive oral examina­
   tion. Only one out of the entire group, and Dr. Emanuel
   Libman was giving the oral examination. He found it very
   difficult to pick one out of so many "smart" men. Suddenly
   he bent his body over into sort of a cork-screw posture
   and walked up and down the room. "Can anybody define the
   disease this posture represents?" Silence, and then I said,
   "Spondylitis rhizomelique." He was evidently surprised.
   "How did you know that?" I said, "Alongside of my Osler,
   I read Strum.pell." He said "In German?" "Yes." "You get
   the job." So my German education at City College stood
   me in good place.

       It was the pathological internship that sent me on the
  path of combined scientific, laboratory, and clinical medi­
  cine. That gave me the beautiful balance which has served
                                                                   7




   me through my professional career. It eventually lead
   me to "ileitis," because that observation required the
   combination of clinical observations and laboratory
   experience to both of which I had had access.

BOYLE:   When you left your internship, did you visit Europe?

CROHN:   No.

BOYLE: Why did many men go to Europe to study?    Was it a
   great educational 9pportunity?

CROHN: Oh, yes. They had well-established laboratories
   in Europe; they had teachers and were set up for teaching
   and for courses in advanced studies. Men who would look
   forward to specializing in a subject went abroad to
   Europe. This was prestige without a question, and val­
   uable education.

BOYLE: When did you begin to consider yourself a "gastro­
   enterologist," or was that word used back then?

CROHN: No. We invented the term "gastroenterology."     My
   generation invented the term -- when, I don't know
   early.

BOYLE:   Did you limit your cases at first to internal medicine?

CROHN: I had a very large general practice all my earliest
   years and only became a specialist when at Mount Sinai
   we were able to develope for the first time a Department
   of Gastroenterology which I helped found with Dr. A. A.
   Berg.

BOYLE:   Could you date that approximately?

CROHN: Somewhere about 1920. The publication by Crohn and
   Wilensky (12) threw doubt on late results of the operation
   of gastroenterostomy. Very shortly, all the criticism
   that I'd made of gastroenterostomy as a "cure" was justi­
   fied by the enthusiasm with which a new operation of sub­
   total gastrectomy was accepted. Professor von Haberer of
   Innsbruck, Bavaria introduced the more radical procedure.
   Dr. Berg, who would criticize severly all the doubt and
   skepticism which I had cast upon gastroenterostomy be­
   came the greatest convert to the newer radical operation
   of sub-total gastrectomy. He and I and Dr. Richard
   Lewisohn, his associate, toured the country selling this
   new operation. Berg who was the master technician, was
   able to perform a sub-total gastrectomy with minimum
   mortality. We became soon at Mount Sinai one of the
                                                                   8




   leading schools of gastrointestinal surgery, with Berg,
   the master surgeon, and I and my radical associates with
   an interest in medicine, physiology and gastroenterology.
   The two interests were combined in the Department of
   Gastroenterology.

BOYLE:   This is something that grew gradually?

CROHN: It grew gradually. Of course, after the spreading
   knowledge of ileitis and the vast new clinical material
   in colitis, we were a rapidly developing department, and
   since we had such an enormous supply of material we be­
   came a rather outstanding institution. My own personal
   files from my private practice include 1100-1200 cases
   of regional ileitis, at least 3000-4000 cases of ulcer­
   ative colitis and about 270 cases of "granulomatous
   colitis." This is, I think, next to the Mayo Clinic one
   of the largest collection of such clinical material. In
   the course of years cases were referred from all over the
   country and all over the world.

BOYLE: Now in 1917, when you became a member of the AGA,
   did you consider yourself at that time a specialist, one
   who limited his practice to gastroenterology?

CROHN: No, gastroenterology was my "special" interest.
   Primarily I regarded myself as a doctor of internal medicine.
   But it is the public that makes a specialist, and the public
   made me a specialist in gastrointestinal disease, partic­
   cularly the intestinal diseases -- to such an extent that
   if they had their way, they:would crowd me into the ter­
   minal ileum and up against the ileocecal valve. I resent
   these specializations, and always preferred to have much
   broader interests.
INVESTIGATIVE CAREER
                                                             10




                    INVESTIGATIVE CAREER



BOYLE: After you finished internship, how did your
   investigative career unfold, Dr. Crohn?

CROHN: After graduation from the House Staff, I
   began as a general practitioner; my afternoon job was
   Associate or Assistant in the Biological Laboratory.
   My great interest outside of clinical medicine was
   chemistry.

       At that time, all cases of gastric distress were
  operated upon, if they were intractable to medical
  treatment. The operation was invariably a gastro­
  enterostomy whether there was an ulcer or not. The
  operation was highly recommended for ulcer, particularly
  of course if there was obstruction. If there was py­
  loric obstruction, gastroenterostomy was a wonderful
  operation, but if gastroenterostomy was performed for
  an active ulcer without obstruction, in the large
  percentage of cases, a recurrent gastrojejunal ulcer
  might occur. The gastric motility was not improved,
  frequently the ulcer persisted. The results of ulcer
  operations were very disappointing. Also, the diag­
  nosis could not be made with any definitiveness, in
  the primitive state of X-rays which we had at that
  time, (or in the absence of X-rays when I first be­
  gan.) The diagnosis was made by history, by deduction,
  by abdominal palpation, since no definite X-ray
  evidence of the disease was established. Intractable
  cases were usually operated upon; whether an ulcer was
  found or not, gastroenterostomy was performed to re­
  lieve atony, to relieve hypomotility, to relieve sub­
  jective symptoms of pain. Of course those functional
  cases in which gastroenterostomy was performed usually
  ended up very badly with a continuation of all the
  symptpms without relief.

       Dr. Ae O. Wilensky and myself were analyzing the
  results of gastric operations. We were in possession
  of a kymograph that would show motility of the stomach
  by tracings. We now had the fractional test meals
  which Rehfuss had introduced, which I took up so
  enthusiastically. And we had our clinical studies and
  to a certain extent X-ray studies. We were dis­
  contented with the results and showed: 1) that the op­
  eration of the gastroenterostomy did not improve
  motility unless there was pyloric obstruction; 2)
                                                            11




  it did not lower the acidity of the stomach; and
  3) it did not relieve the symptoms. I was engaged
  in the, at that time, very heretical endeavor to
  discountenance the operation of gastroenterostomy (12).
       While working one afternoon, Dr. Litman, who
  was the Associate Pathologist and also the Associate
  Physician in Medicine, entered. He doubled as
  clinician and laboratory head, in that double manner
  being invaluable. Besides supervising the laboratory
  work, he performed most of the autopsies. As the
  pathological intern in Mount Sinai, it was my function
  to assist at autopsies with him for a year and there­
  after, 1907-1908. That afternoon, Dr. Libman walking
  through the laboratory introduced me to a stranger
  named Dr. William J. Mayo, who was paying a visit to
  the laboratory. Dr. Libman said to Dr. Mayo, "You
  might like to sit down with that young man. He's
  doing some interesting work." And Will Mayo said,
  "Well, I'll spend a few minutes with him." Three
  quarters of an hour later, he was still talking with
  me, examining the records. "Young man, would you
  like to do us a favor? Would you come down to the
  American Gastroenterological Association and deliver
  a paper on your studies?" I was quite swept off my
  feet and hesitated but Libman encouraged me to accept.

      That May we went to Atlantic City, my associate
 Dr. Wilensky and myself. The paper was received with
 such interest that when I finished with the discussion,
 Dr. Mayo moved a rising vote of thanks to the young men.
 for their interesting paper. Never having heard of    a
 rising vote of thanks before, I stood up with the
 rest, whereupon somebody put his hand on my shoulder
 and said "YounQ man, you're supposed to sit."

      The next year, 1917, I was made a member in the
 American Gastro. Max Einhorn, Jacob Kaufmann, and
 Morris Manges of this city signed my application.
 Thereafter I was in attendance, missed none of the
 meetings and by 1933 was president of the Association,
 truly a rapid rise!

BOYLE: Dr. Crohn, how did your interest in the small
  intestine begin? Was there widespread clinical and
  research interest in the small intestine in those
  years?

CROHN: There was not much interest. If you look over
  some of the papers presented at the AGA, for instance
                                                            12




here is one in the 1921 Transactions, by Walter Mills
of St. Louis, "X-ray Evidence of Abdominal Small
Intestinal States Embodying a Hypothesis of the Trans­
mission of Gastrointestinal Tension." You can see
from the title that the small intestine was a closed
book at that time. To him the small intestine could
be part of a tension mechanism, but nobody could con­
ceive of organic disease. He says, "There seems to be
no considerable effort made to investigate the small
intestine normal or abnormal conditions by means of the
X-ray, with the exception of the duodenum." And now he
talks about, "The strikingly apparent dilated and
ribboned loops of the obstructed small intestine made
visible on the plate by gas and fluid." '!It is remark­
able that so little has been done toward our investi­
gating the services of the small intestine, the most
essential and indispensable part of the alimentary
tract."' With the exception of gastrojejunal ulcer,
there does not appear to have been any conception that
direct evidence of involvement of the small intestine
might occur nor any effort made to elicit evidence of
involvement or impairment or dysfunction other than
the instances of "ileocecal valve incompetence" and
"ileal stasis."

     The fact of the matter is that the small intestine
was so badly neglected that when I assisted Dr. Libman
in the autopsies, he always insisted that I open the
small intestine. His insistence that I open the small
intestines was evidence of the fact that most other
pathologists did not.  In the course of an autopsy
people would throw the small intestine aside as though
of no importance, having no pathological significance.
I did open the small intestine of every autopsy, about
150 in the course of my year as a pathological intern.
Thereafter for years we religiously attended every weekly
conference on pathology at which all the autopsy material
of the week was exhibited.  If disease in the small bowel
existed we should have picked it up, if it existed at the
time in the autopsy material. We never found ileitis or
similar diseases in the autopsy material, nor did we find
it in the surgical pathology material.

     The importance of the whole subject of ileitis and
colitis is stressed by the fact that we did not recog­
nize these diseases when I was an intern in 1907 to 1911.
It was during that internship that I saw my first case
of ulcerative colitis, as I explained in the history of
                                                          13




ileitis which I wrote (159). The wards of our
hospital are crowded now with intestinal cases.

     Two months ago at the invitation of Dr. Joseph
Kirsner I visited the Billings Institute in Chicago~
"Burrill, what's happened to the practice of medicine?
We have 65 patients. In the olden days if you had 65
patients, you'd probably have 65 cases of ulcer, duo­
denal or gastric, and liver diseases. Now out of 65
cases, we have 45 to 50 of intestinal cases and very
few ulcers. Do you have the same experience?" And I
said, "Yes." In our hospital, we have predominantly
intestinal cases, and ulcers have become relatively
far less common. Something has happened in the
course of these 60 years to introduce a whole new
series of diseases and to relegate the other ones
relatively into the background. Whether there are
today numerically fewer ulcer cases than formerly,
I don't know. We seem to have fewer ulcer~ just as
we see very few cases of acute appendicitis today.
The intestinal cases have just taken over the field.

     Naturally we are all interested in the etiology
of this change. What has happened? I like to surmise,
to think aloud, just as an exercise in imagination.
Is there something in our food, for instance, which
is present now which wasn't present 60 years ago?
For instance toxic agents or preservatives. When I
was young, sodium benzoate was suspect but they seem
to have disproved sodium benzoate for there is hardly
any toxic effect. Our crops are now sprayed with in­
secticides whose effects we don't know. The air is
polluted with everything. You're eating the same food,
but there is something that enters the colon today
which either produces colitis or goes into the ileum
and colon to produce ileitis or colitis or both.
What is there in the last 60 years which was not pre­
sent before? What is there in the last 60 years that
has caused a whole new series of intestinal diseases
such that dilutes out the other diseases which pre­
viously engaged our attention?

     Nor di.d we know diverticulitis in those years.
When a case with an abscess was opened, a foreign
body was frequently found, tooth pick, fishbone, or
the fragment of the false tooth of a denture. The
abscess cavity was opened and the condition was -
termed "foreign body absc.ess." Before the X-ray,
we knew nothing about diverticulitis or diverticulosis.
                                                                  14




   Whether it was there or not before us is not certain.
   With the X-ray we became cognizant that these foreign
   body abscess near the sigmoid were not actually
   foreign,. body abscess, ~ ~ - These were compli­
   cations of diverticulitis. And Einhorn asked me, "Do
   you think that diverticulitis is a disease of this
   century or was it present in the past centuries?" I
   don't know.    I don't think that we could have opened
   tha colon routinely of every case that was autopsied
   and not have discovered diverticulitis. But something
   is happening in the colon to cause a disease in it
   which apparently was not previously present.

        Here in my hand is an abstract of a medical re­
   port showing the incidence of diverticulitis in
   Africa (Nigeria); diverticulitis is reported as 40
   times greater among Europeans than among non-Europeans
   living in Nigeria. This would almost look as if diet
   were the determining factor in producing diverticulitis,
   because diet of the European is entirely different than
   the diet of the non-European in Nigeria. Naturally if
   they live on rice all their lives, they may escape
   having foreign body effects or something else may be
   absent. They do not develop diverticulitis.

        At any rate, the whole complexion of medicine
   seems to be changing. Whether it's diet or whether
   it's something in our food or whether it's something as
   simple as aspirin or coal tar products, something has
   so changed the complexion of medicine that the intestinal
   cases are displacing the other things that were equally
   interesting.

         Here is the case history of the first case of ileitis:

BOYLE:   (Reading from record)

        Case of Emanuel Solomon, 920 Hudson Street, Hoboken.
   Age-17. Single, Ward B - Crohn Service. Admission No.
   298868. First admitted January 20, 1929, discharged
   February 3, 1929. Diagnosis on first 3 admissions:
   "Tuberculosis of Colon, Hyperplastic Ileocecal Type."
   Diagnosis on 4th admission, 1931: "Terminal Ileitis."

CR0HN: The patient was admitted in 1929. A young man, 17
   years old, with fever, abdominal mass and diarrhea. And
   I put down the diagnosis as "Tuberculosis" because it
   was the only etiologic agent that could cause this. The
   patient was readmitted in 1930. This time I left the
   diagnosis out because I couldn't determine it. He was
                                                              15




   readmitted the 3rd time in 1930; again the diagnosis:
   "Tuberculosis of the Colon, Hyperplastic Ileocecal
   Type", given oxygen intraperitoneal insufflation with
   improvement. Admitted the 4th time in 1931, he was
   operated upon. Now the old diagnosis of tuberculosis
   was out and the diagnosis became: "Terminal Ileitis,
   with resection of terminal ileum, cecum, ascending
   colon and of the transverse colon." And that was
   case number one of regional ileitis. And then, as I
   said in my book, (112), we began to look for granu­
   lomas of the intestinal wall, because Dr. Leon
   Ginzberg and Dr. Eli Moschcowitz had studied granu­
   lomas in the laboratory as pathological specimens but
   without any clinical collaboration or correlation
   between the laboratory findings and clinical aspects
   of the cases; they were doing pure pathology research.
   It was my opportunity to combine pathology and clinical
   medicine, having had training in both disciplines. Dr.
   A. A. Berg and I then re-examined all the obscure cases
   of diarrhea with abdominal mass and with fistulas; very
   shortly we had the data on the first 14 cases.

BOYLE: This was the classical article (45) which appeared
   in the J.A.M.A. in 1932.

CROHN:  In 1932, in New Orleans at the Annual Session of
   the American Medical Association I sat next to Dr. J. A.
   Bargen, and as I returned to the audience to discuss
   Jake Bargen said to me, "Burrill, I think you ought to
   change that title to something else, because this dis­
   ease may appear elsewhere than the terminal ileum.   It
   may involve other areas of the small and large bowel,
   so maybe you should anticipate." I, having an open
   mind, accepted his suggestion and changed it to "re­
   gional ileitis." That was a fortunate suggestion be­
   cause it wasn't long before the entire aspect or thesis
   of ileitis was advanced to include all of the small
   bowel and eventually part of the large bowel combined
   with the small bowel.  In the course of the next few
   years, we followed-up "ileitis" and finally encountered
   a case of isolated lesions in the large bowel which
   were not ulcerative colitis because the sigmoidoscopies
   were always negative.

       That lead me to the concept of regional colitis
  (59), which I also call segmental colitis or right­
  sided colitis -- right-sided in so far as it did not in­
  volve the rectum.  I accepted this as ulcerative colitis
  and not as a granulomatous disease. And to this day the
  question is still open.   If isolated segmental coiitis
  in the right colon is granulomato~s in 100% of the cases,
                                                          16




then my pathologists at Mount Sinai let me down.
Other writers have made the same comment, that the
pathologist let them down in the resection of these
right-sided colitis cases. These segmented cases
were classed as ulcerative colitis until the English
clinicians -- Morson and Lockhardt-Mummery -- brought
up that this was granulomatous disease.

     The English pathologists and clinicians have now
gone to the extreme of calling all this group 100%
granulomatous and have changed the name to "Crohn's
Disease of the Colon" over my protest. When I said,
"Why do you do a thing like that?" "Because," they
said to us, "If we say to our students 'Crohn's
Disease of the Colon' they know this is granulomatous
disease. We want to impress the point upon them that
this is not ulcerative colitis, this is granulomatous."
I question that this is truly scientific, because I
am convinced on restudying my cases and reviewing the
literature that probably only 50% of these cases can
be shown histologically to be granulomatous. The
other 50% act clinically like granulomatous disease,
but cannot be proven histologically and microscopically
to be granulomatous. One cannot demonstrate the
pseudomiliary tubercles which are characteristic of
granulomatous disease, nor can one demonstrate the
foreign body inclusions. At least 50% of these cases
of segmental colitis are pathologically ulcerative
colitis. Now those enthusiastic "granulomatists",
clinicians, and pathologists, have now conceded that
there is such a thing as "clinical granulomatous dis­
ease without pathological demonstration." In other
words, they're straddling. They're saying "Yes, we
will concede the point that at least 50% 0£ these
cases act clinically like granulomatous disease rather
than ulcerative colitis, but the rectum is not in­
volved, the sigmoidoscopy is negative. Even though
they act like granulomatous disease clinically, we
admit that when it comes to pathologically true,
critical, dissection, you cannot prove that they are
granulomatous." But for the sake of harmony, I'm
willing to concede or call these cases granulomatous
disease of the colon even though in half the cases you
can't demonstrate the granuloma. Granulomatous disease
0£ the colon differs from colitis.  It behaves differ­
ently, is less subject to carcinoma, less subject to
toxic dilation and is a much milder disease, more a­
menable to treatment, either surgical or by cortico­
steroid therapy.
                                                             17




BOYLE: Dr. Crohn, how did other medical centers react
   to your reporting of the first cases of regional
   enteritis?

CROHN: The interesting thing about regional ileitis
   was the rapidity with which the concept was taken up
   all over the world. As I said in that article on the
   history of ileitis (159), within less than a year they
   were discussing regional ileitis in a Surgical Congress
   in Middle Europe and Germany. Nobody ever questioned
   the concept. Everybody accepted it as such and con­
   firmed it, so that the paper (42) as it was originally
   written stands as a classic today without the change of
   a single iota. Of course, many facts were missing
   which were added in later years. That was the interes­
   ting thing about regional ileitis:  that unlike many
   discoveries which people criticized, this one was taken
   for granted from the start.

       J. Arnold Bargen was one of the first to concede
  it. He was terribly upset that he hadn't found re­
  gional ileitis. As I told you, he had sat next to me
  at that New Orleans meeting and after he went back to
  the Mayo Clinic, he wrote me a few weeks later. They
  had reviewed all the old X-ray films in the light of
  what I had shown them and wrote me to say they had
  overlooked this new concept. It was right there as
  I'd said it was, and now that their eyes were open,
  they realized that what I said was absolutely true.
  He was generally first and foremost in almost every­
  thing. Bargen was ahead of me in describing granulo­
  matous colitis or ulcerative segmental colitis, which
  they call today "Crohn's Disease of the Colon." Actu­
  ally Bargen was ahead of me in that by several years
  but called it "sclerosing colitis." ·He described ex­
  actly granulomatous colitis involving the left colon
  but missed the boat because he thought he had found a
  bacteria, Bacterium necrotans. Nevertheless, he was a
  peculiar acute observer and a very hard worker. Even
  to this day, as you know, he's down in Texas in the
  Scott-White Clinic and he's in his 8O's, just as hard
  working as ever from what I hear.

BOYLE: Was Azulfadine synthesized for use in ulcerative
  colitis specifically to treat the bacillus which Bargen
  believed caused ulcerative colitis?

CROHN: No, Azulfadine or Azopyridine came from Sweden
  from the woman doctor who was head of the Swedish
                                                             18




   institute. She was the one that introduced it, but
   Bargen was very enthusiastic about her use of it.
   He was the one that introduced it here, though. My
   big argument with Bargen over all these years was that
   he wouldn't use corticosteroids £or ulcerative colitis
   when everybody else was accepting it. He was sticking
   to his Azul£adine. Azul£adine, I £ind, is a very
   annoying drug which reduces appetite, produces discom­
   fort and is exceedingly weak as an antibacterial drug.
   Before we had Azu.lfadine, we had sul£athalidine and
   sulfasuxidine for years. You'll note my reprints on
   the use of sulfasuxidine for ulcerative colitis {84),
   which, lacking anything else, we thought was a good
   drug.

        But the effectiveness of nonabsorbable sulfa in
   the intestinal tract is exceedingly mild compared to
   the antibiotics or compared to corticosteroids.
   After we had already accepted corticosteroids, £or
   years Bargen wouldn't give and wouldn't give and he
   stuck to his sulfa drugs •. It took years before Bargen
   finally broke down and used the corticosteroids.    I
   recall a meeting in which I sat with Bargen and some­
   body from the audience stood up and asked, "How long
   would you continue corticosteroid therapy once you
   achieve a therapeutic result with it?" Bargen said,
   "I'd discontinue it as soon as I had a therapeutic
   result." "And Dr. Crohn, what do you think?" I said,
   "I'd continue maintenance doses 0£ it £or the rest of
   the life of the patient." Of course, I really believe
   that in ulcerative colitis or ileitis or any of these
   diseases, if you administer corticosteroids you must
   keep the patient on a maintenance dose for fear of
   recurrence of disease because these diseases have so
   great a tendency to recur.

BOYLE: Dr. Crohn, what did you use for ulcerative
   colitis before introduction of corticosteroid therapy?

CROHN:  I introduced the typhoid vaccine treatment of
   ulcerative colitis before we had corticosteroids.
   That's an interesting story.  I had a patient on the
   wards at Mount Sinai who had ulcerative colitis and
   was anemic. We decided to transfuse him. This was
   many years ago. We took the nearest donor who was
   another husky male in the ward. His blood was com­
   patible, so we gave this ulcerative colitis case a
   blood transfusion from the donor. Two or three days
   later, the recipient developed a terrific chill and
   a rise in temperature, and shook the bed.  I never
   saw such a chill; it lasted several hours. We pre-
                                                            19




   sumed it was incompatibility. It subsided, and we
   were perfectly contented. Exactly 48 hours later,
   this man had another terrific chill and a rise of
   temperature to l04°F and over. At this point some
   of us became very inquisitive, decided to look at
   the patient's blood, and discovered the patient's
   blood was full of malarial plasmodia. We went back
   to the donor and discovered that he had come from
   Russia where he had had malaria. We realized that
   we had transmitted malaria to the ulcerative colitis
   case and we gave him quinine. He got perfectly well,
   and not only was the malaria cured, but he became
   perfectly well of his colitis.

        To speak of serendipity, I never saw anything so
   striking.  I decided we'd try to reproduce this, but
   since I didn't have malarial plasmodia at my finger­
   tips, I decided to use typhoid vaccine intravenously.
   I expected that would do the same thing, because at
   that time the favorite treatment for arthritis was
   intravenous typhoid vaccine deliberately to produce
   a chill and rise in temperature. It was effective
   and used universally for chronic arthritis.  I dis­
   covered that I could take a very sick case of ulcer­
   ative colitis and deliberately, at 10 day intervals,
   give him intravenous typhoid vaccine, producing a
   chill and a rise in temperature. The patient would
   go through a very severe paroxysm but would end up
   very much better. Before we had corticosteroids,
   this was my routine treatment, and I had very good
   results.  I gave it up when corticosteroids came in
   because they were so much easier to handle.

       This is an instance of serendipity in medicine.
  Like Fleming's discovery of penicillin by actually
  seeing a mold. When I think back to my days in the
  laboratory, the number of times that I looked at plates
  of bacterial culture, took the cover off, saw a mold
  from the atmosphere which had accidentally deposited
  itself, and then without further looking at the dish
  I threw it in the carbolic acid solution and considered
  it as spoiled, contaminated. When I think of the num­
  ber of times that I did that and that if I would have
  looked at it more carefully, I might have discovered
  what Fleming discovered: where the mold was there was
  no bacteria.

BOYLE: Looking over your bibliography, Dr. Crohn, I see
   that you first wrote an article on acute glanders (1)
   in 1907.
                                                             20




CROHN: Yes, I was the first one to obtain a positive
   blood culture in human glanders (2).

BOYLE:  In 1910 you also wrote an article on "Duodenal
   and Stool Ferments in Health and Disease" (3).

CROHN:  I then had become interested in the pancreas.
   I was a young man on the wards; Dr. Max Einhorn paid
   a courtesy visit to Mount Sinai, to his friend Dr.
   Nathan Brill the attending physician. He walked
   through the wards with us; he took out from his poc­
   ket a long rubber tube and said, "I am using this
   tube to pass through the nose or mouth to intubate
   the duodenum and make diagnoses of liver diseases, by
   the examination of the bile specimen. Would anybody
   be interested in it?" Everybody said, "No," but I
   put up my hand. "Well, young man, I'll make you a
   present of the tube." I was the first one to use
   this tube, along with Reh£uss in Philadelphia who
   was more interested in gastric secretion. I was
   more interested in pancreatic ferments.

        I needed normal controls to £ind out what the
   normal pancreatic secretion was.   I didn't have the
   heart to intubate those poor patients in the hospitals
   and to leave the tube in overnight.   It wasn't very
   difficult to £ind the normal control I needed.   I was
   the best subject there was and every night before I
   went to bed, I'd pass that tube into my duodenum,
   sleep with the tube overnight.   In the morning, I'd
   aspirate the secretion, take it up to the laboratory
   and estimate the pancreatic ferments, in the afternoon.
   I also used all of the pathological patient material on
   the wards. Then I began to be able to make the diag­
   nosis of common duct obstruction and/or partial or
   complete obstruction of the pancreatic duct. I de­
   vel9ped the whole subject of diagnosis by means of
   pancreatic secretions (3,S,8,9).

BOYLE: One of your first papers on intestinal disease
   was in 1925, "The Sigmoidoscope Picture of Chronic
   Ulcerative Coli tis, (non-specific.)" (29).

CROHN: For the first time we had electrically lighted
   sigmoidoscopes, and we began really to scrutinize the
   mucosa.  In that article I explained that previously
   our primitive sigmoidoscope was nothing but a great
   big long lead tube, not even plated inside. For
   lighting, the nurse would hold up a candle or an in­
   candescent bulb; by means of a head mirror you'd try to
   shoot that little beam 0£ light down the small tube.
                                                              21




   Then finally we were given electrically lighted
   sigmoidoscopes.

BOYLE:  In 1929 you wrote a paper on aluminum hydroxide
   as a gastric antacid (39), Dr. Crohn.

CROHN: That's an interesting story.    It nearly cost me
   my career. A drug company borrowed a new drug from
   Europe, aluminum hydroxide, and said, "We'd like to
   have somebody test this out on gastric secretions and
   determine whether it's a good neutralizing agent or
   not." Somebody suggested me, and they came to me and
   said, "We'll pay you $500 if you'll test this out." I
   was very much interested in the drug anyway and so I
   tested it out. I simply went to the wards, introduced
   a tube into the stomach, withdrew fasting secretion,
   gave them aluminum hydroxide, and saw what happened.
   I discovered it was an excellent antacid, and it did
   not have the rebound that bicarbonate of soda and
   magnesia had. My studies on alkalies showed you that
   if you give alkalies, the gastric acidity would drop
   way down and then it would rise high again, in what
   we called "rebound". I taught them to use very modest
   doses of the alkalizer and to distribute them over a
   long course of time, otherwise you would get a vicious
   rebound which defeated your purpose. The aluminum hy­
   droxide was a good antacid and did not cause rebound.
   When I came up for presidency of the American Gastro,
   Dr. Frank Smithies of Chicago, in committee, said "I
   don't think that Crohn should be allowed to be Presi­
   dent because he has commercialized himself by doing a
   piece of research for a fee." Of course I accepted
   a fee to do a scientific bit of work on the antacid.
   Since then, aluminum hydroxide is the basic ingredient
   in every alkaline powder and in every antacid, and I
   was responsible for its acceptance throughout the coun­
   try. What he thought was commercialization in those
   days is today accepted as common usage.

        Today, drugs are tested out by practitioners in
   offices, in hospitals, in laboratories, and this is a
   regular procedure. The pharmaceutical firms pay very
   well for that type of clinical research, and they base
   their drug advertisements on what the clinician finds.
   "Other times, other manners."

BOYLE:  I see here in your bibliography an article, "Dr.
   Israel Moses, Surgeon" (37), written in 1944. Was
   that an obituary, Dr. Crohn?

CROHN:   No.   I'm a Civil War buff.   I've been interested
                                                                       22




            in the Civil War all my life.  Israel Moses was the
            first surgeon appointed to Mount Sinai Hospital.   I
            was on the committee which set up the exhibit for
            the 90th and later the 100th anniversary of Mount
            Sinai Hospital (30). Going over the writings and
            history of Mount Sinai Hospital, I came across this
            very interesting character, Israel Moses, who was
            the first surgeon appointed to Mount Sinai Hospital,
/ ., ,.     in 1959. When the Civil War began, he left Mount
            Sinai Hospital and became a lieutenant colonel in the
            militia. He organized his own regiment, trained it
            on Staten Island, and took it down to General George
            H. McClellan in the Peninsula campaign. Moses fought
            as a lieutenant colonel in charge of his regiment. In
            1863 he gave up command of his regiment and joined the
            Army Medical Corps. He's a very interesting character:
            it was only recently that I learnt that he was the
            physician who accompanied the crazy contingent which
            invaded Nicaragua and tried to shoot the President and
            initiate a revolution. They were caught and nearly all
            were killed by Nicaraguans. My hero Israel Moses es­
            caped because he was a physician. They let him off, he
            came back to the United States but I haven't been able
            to find him again after that date. He simply dis­
            appeared.

          BOYLE: Dr. Crohn, you are known for your interest in medi­
             cal history and you are frequently asked to prepare
             historical articles and obituaries.

          CROHN: I would side with Chekhov who said that "medicine
             was his wife but history was his mistress". The same
             is true of me -- when I'm not reading medicine, I'm
             reading history.

                 Last year I went abroad to attend the soth anni­
            versary of the Russian Revolution.  I just went there
            out of interest and I had a very interesting time.   I
            was in Moscow on May Day with that great big parade and
            celebration. We spent 3 weeks in Moscow. When I came
            back, and I was asked to give a lecture on Russia, I
            prepared 2 illustrated lectures: one on Czarist Russia
            and one on post-revolutionary Russia.
GASTROENTEROLOGY IN
   NEW YORK CITY
                                                               24




                    GASTROENrEROLOGY IN
                      NEW YORK CITY



BOYLE:  I would like to ask you about the local history
   of gastroenterology in New York. You have written 2
   articles on the history of gastroenterology at Mount
   Sinai Hospital {92,118). What other hospitals played
   an early role in gastroenterology in New York?

CROHN: Lenox Hill Hospital was the only other institu­
   tion, with Max Einhorn and Jacob Kaufmann. Max
   Einhorn was really the Father of Gastroenterology in
   this city. Meltzer was older than Einhorn, but
   Meltzer was a physiologist and not a practicing gastro­
   enterologist. Einhorn and Kaufmann were among the
   pioneers in the American Gastroenterological Association.

BOYLE: What kind of a man was Max Einhorn?   How did he
   impress one on first meeting?

CROHN: He was a mousey little man with a slight foreign
   accent. He came from Europe to the Lenox Hill German
   Hospital, and he was the first man that I know in this
   area who was interested in gastroenterology. He was a
   pure clinician but loved novelties; he devised the
   Einhorn String Test for hemorrhage. The patient swal­
   lowed a string: on withdrawing the string a red color­
   ation determined what level the hemorrhage had occured.

       He also devised this tube, the Einhorn Duodenal
  Tube, for intubation of the duodenum, and he hoped
  thus to make diagnosis of liver disturbances. Then
  Rehfuss took the tube, put a metal t,ube on the end of
  it, and used it to study gastric secretions. Then I
  used both the Rehfuss tube for the stomach and the
  Einhorn tube, which he gave me, for duodenal contents.
  But I carried it further to the diagnosis of pancre­
  atic diseases and was able by obtaining duodenal con­
  tents to determine the amount and the activity of
  pancreatic and biliary secretions.   I could tell whether
  the ducts were open or not and to what extent the pan­
  creatic secretion was diminished in disease. And then
  parallel to that, of course, would be the determination
  of fat of the stool, and blood determinations of the
  pancreatic ferments {3,5,7-9). The A.M.A. gave me a
  very brilliant editorial at that time though I haven't
  been able to find the reference to it. Einhorn was a
  very ingenous and clever man, and as I say, had a broad
  interest in gastroenterology. He and Kaufmann began at
                                                              25




   what was then called the German Hospital; after the
   Second World War the name was changed to the Lenox
   Hill Hospital.

BOYLE: Did their Gastroenterology Department start with
   Max Einhorn?

CROHN: Yes, but it was never a separate department, nor
   did they have a specialty ward or clinic. Einhorn
   was the first one in New York City that limited his
   practice and specialized to such an extent that he
   had a reputation of being a gastroenterologist.

BOYLE:  I see. He was one of the 8 founders of the A.G.A.
   Another founder from New York was at Mount Sinai Hos­
   pital, Morris Manges.  I wonder what your recollections
   are of him.  I could find very little written about him.

CROHN: Yes, he was a member of the American Gastro, but
   he was really an internist and he contributed nothing
   to gastroenterology itself. He was a good routine,
   competent internist, who wrote very little.

BOYLE:   Tell me about Arthur Chace of New York.

CROHN: He bacame president of the A.G.A. in 1924 and he
   was a very good clinician. He was very interesting and
   a very pleasant man. He had very good routine, sound
   judgment, and personally was a fine gentleman.

BOYLE: At Lenox Hill Hospital there were 2 other A.G.A.
   members, William Stewart the radiologist and DeWitt
   Stetten the surgeon. Can you tell me about them?

CROHN: DeWitt Stetten was a surgeon at Lenox Hill and
   did most of the surgery for Einhorn's cases. He was
   an outstanding surgeon and of good progressive mind.
   DeWitt Stetten was one of the first ones to take up sub­
   total gastrectomy when it was introduced to replace the
   gastroenterostomy.

       Stewart, the radiologist, was one of the best radi­
  ologist of that time and was recognized as an outstand­
  ing authority.   I recall him particularly in connection
  with the idea from the Mayo Clinic which was highly pub­
  licized at the time that benign gastric ulcers underwent
  malignant degeneration. This was taught all over and
  Mayo Clinic was responsible for this to a large extent.
  The radiologists seemed never able to differentiate
                                                               26




   the two, and the pathologists were at times unable
   to. We, in our section at Mount Sinai, never believed
   that benign ulcer underwent malignant degeneration.
   We were very skeptical about it. We said that a gas­
   tric ulcer was a gastric ulcer, and a malignancy was
   a malignancy, and that the one did not become the other.
   I recall once that Stewart, the radiologist, along
   with an internist, I think it may have been Arthur Chace,
   invited us to come down to his home without explaining
   why he wanted us. We came down that evening and found
   a battery of microscopes set up and under each micro­
   scope was a slide of a gastric ulcer. He asked each
   one of us, who was supposed to be prominent, to sit
   down under a microscope and write down his own opinion
   as to whether this was a benign ulcer or a:malignant
   ulcer. Each one of us went through this test --looked
   through the microscope, studied the section, and wrote
   down, "This is benign," or "This is malignant." When
   we were through he showed us the scores. He showed us
   how differently we each approached the same subject
   and how different our opinions were. He convinced us
   that microscopically you couldn't always tell the 2
   apart unless it was a clear-cut malignancy or a clear
   cut benign ulcer.                         ·

BOYLE: Considerably later at Lenox Hill there was Henry
   Rafsky.

CROHN: Ra:fsky was the son-in-law of Max Einhorn, a gastro­
   enterologist who died rather early. His daughter still
   runs a fairly large GI practice in Lenox Hill.

BOYLE:  I see. You mentioned some things about Albert
   Berg (122) in your two articles in the history of gas­
   troenterology at Mount Sinai. I am wondering how he
   began in gastroenterological surgery, and whether you
   know anything about his early life?

CROHN: He was graduated from College of the City of New
   York. He was an outstanding surgical technician.
   People came from all over to see his technique; he was
   a fast operator. In those days with the crude ana­
   esthesia, speed was important and he could operate
   quickly with fine technique. He was very venturesome,
   very brave, and he was capable of doing things in the
   surgical field that nobody else attempted. His tech­
   nique was really outstanding. In those days the usual
   hospital stay for an abdominal operation was at least
   6 weeks. The convalescence was long, and post-oper­
   ative distention was a problem before we had the Levin
                                                             27




   tube and the Cantor tube to decompress the intestine
   after operations. These operations were followed by
   days and days of gastrointestinal atony from which
   the patient s~uffered tremendous amounts of discom­
   fort. This has all been alleviated now by the use of
   the Cantor tube and the Levin tube. One can even do,
   as you know, a gastrostomy to prevent the post­
   operative distention.

        I remember a case of hypoglycemia that Berg op­
  erated upon. The woman would wake up in the morning
  completely dazed, semi-conscious; her husband would
  slap her face and bring her a glass of milk or fruit
  Juice!" She'd wake and say, "Where am I?" I took her
  blood sugar, and her fasting blood sugar was 46, and
  I suspected she had a benign adenoma of the pancreas.
  She had an ulcer like most of these cases; this was
  before the Zollinger-Ellison syndrome was known.
  But already we were on the track of these benign tu­
  mors. She had a huge benign ulcer with repeated
  gross hemorrhages. I asked Dr. Berg to operate; he
  palpated the pancreas and could find no tumor. Fi­
  nally I said, "Look on the under surface," and he
  incised the peritoneal covering of the pancreas, and
  found a tiny benign tumor and resected it. This must
  be at least 30 years ago. That woman is alive and
  well today, perfectly cured of her ulcer and one of
  my most devoted followers.

        You could do that with a man like Berg, as in
   later years you could do it with Garlock and Colp;
   but Berg was outstanding and capable of his technique.
   He was adventuresome enough to that you could force
   him into doing sub-total gastrectomies and overcome
   his prejudice against them. You could get him to op­
   erate ileitis cases and colitis cases when nobody else
   would tackle them, because he had a successful tech­
   nique.

BOYLE: I understand that Dr. Berg had rounds on Sunday
   mornings attended by both the surgeons and internists.

CROHN: Yes. Everybody went to the rounds on Sunday
   mornings and spent much of the day discussing GI cases
   and going around the wards. There are still at Mount
   Sinai no individual GI surgical or medical wards.
   There are many GI units that visit the wards, and study
   the cases, but there is still no In-Patient GI Depart­
   ment at Mount Sinai.
                                                               28




BOYLE: Walter Bastedo was president of the A.G.A. in
   1918 and he was from New York. What are your re­
   collections of him?

CROHN: Delightful man. I believe he was from Saint
   Luke's Hospital. He was a very delightful man, good
   thinking, honest, and very progressive. He made
   friends with everybody, a very good clinician. In
   fact, Walter Bastedo also taught me pharmacology
   down at P. & S.• When I was a student. That was my
   first contact with him.

BOYLE: You mentioned Dr. J. H. Garlock and Dr. R. Colp
   and their role at Mount Sinai in your two historical
   articles. I wonder if you can say anything about
   them as persons? What they were like?

CROHN: They succeeded Dr. Berg. When Dr. Berg stepped
   out, Dr. Richard Lewisohn took over. He was the one.
   who devised the citrated blood transfusion and made
   modern transfusion possible. Dr. Richard Lewisohn
   took over Dr. Berg's services, but he didn't have
   Berg's technique. He was followed by Dr. Colp and Dr.
   Garlock. The service was divided between these two.
   They were brilliant surgeons, brilliant in technique,
   brilliant in concepts. Both were delightful leaders.
   Colp carried on the Berg rounds for many years on
   Wednesday mornings until he quit, and then Garlock took
   over and continued it. Both had good judgment and both
   were particularly interested in gastroenterology and in
   gastrointestinal surgery.

       Colp was a magnificent technician. I'll always
  recall his removing an appendix for me. He said he
  would began to operate at half past-one, and I arrived
  at 25 minutes to two:   he was sewing up the patient.
  I said, "When are you going to do my case?" He said
  "I just finished it." I said, "You said half past one."
  "That's right," he said, "I began at half past one, and
  now I'm sewing up at 25 minutes to two." Perfect tech­
  nique, tremendous rapidity, and a very good judgment.

       Garlock was really outstanding. He died only 2
  years ago of a ruptured aneurysm of the aorta, which he
  diagnosed on his way to the hospital. He began to bleed
  on a Sunday afternoon of massive hemorrhage," he had had
  practically no previous symptoms. He told his wife and
  the doctors that it was a ruptured aneurysm: he just
  managed to reach the hospital but died almost immediately.
  There has just been published his volume on gastrointes­
  tinal surgery, which is a masterpiece. He had finished
  all except the last chapter when he died suddenly. I'm
                                                               29




   sorry that I don't have it here to show you, but it
   is the most marvelous description of technique, judg­
   ment, experience and results.  It will probably re­
   ceive the highest encomium and praise. He was my
   surgeon of choice in all complicated and difficult
   gastrointestinal cases. He could do anything and it
   was marvelous to work with him. I can't speak too
   highly of Dr. Garlock. I have spent a couple of
   years raising for him a substantial fund in memorium.
   The new Mount Sinai School of Medicine has accepted
   it and will establish a special John H. Garlock Mem­
   orial Room for consultations among the surgical staff,
   discussions of surgical material, and surgical con­
   ferences along side the operating room.

        It's a great loss. He and Colp were both a great
   loss very difficult to replace. Garlock's surgery of
   the esophagus was really pioneer work. He and Colp
   could tackle the massive operation of total gastrectomy
   or resection of the esophagus. These were outstanding
   men, and they did most of my gastrointestinal surgeries
   after Berg's death. Colp left 10 years ago and Garlock
   took over and continued until 2 years ago. Brilliant
   surgeons.

BOYLE:  I wonder if there are any names that I've omitted
   that stand out in early New York Gastroenterology?
   There are 2 other A.G.A. members from New York City:
   John Killian, a biochemist, and George Daniels, a
   p~ychiatrist.

CR0HN: Who was the man over Roosevelt Hospital? Cave,
   Henry Cave. Southern with an accent -- a gentleman.
   He never appeared in public without white starched cuffs;
   all 0£, the grand manner of a Southern gentleman.

BOYLE: Speaking of surgeons, I'm wondering if back 40-50
   years ago the role of the surgeon in GI diagnosis was
   any different? Was he his own diagnostician or his own
   medical consultant? I am speaking of surgeons in gen­
   eral?

CR0HN: Surgeons are, in my experience, their own diagnos­
   ticians, their own medical men, their own technicians,
   and their own everything else. Always were and always
   will be. I have probably referred more medical cases
   to surgeons than any medical man alive that you know.
   I keep them busy with every type of gastrointestinal
   surgery.  I don't believe in my entire experience that
                                                          30




on more than two occasions they ever called me in
consultation or asked me to help them out with the
medical aspects of their cases. Surgeons are very self­
confident and self reliant. Medical men are dependent
upon the surgeon, while the surgeon is never dependent
upon the medical man.
THE AMERICAN GASTROENTEROLOGICAL ASSOCIATION:
                 REMINISCENCES
                                                               32




         THE AMERICAN GASTROENrEROLOGICAL ASSOCIATION:
                          REMINISCENCES



BOYLE: I am interested in your recollections of the
   founders of the American Gastroenterological Association
   Do you recall S. J. Meltzer?

CROHN: I have a very unique distinction in regard to S. J.
   Meltzer in that he was our family physician in New York
   City, and he delivered me into the world. And I recall
   him distinctly in his general practice in those days
   with no telephon~ and his office was on 122nd Street.
   We lived at 82nd Street. My mother had 11 children,
   and when any of the children took sick, r,as the oldest
   child, was asked to take the trolly car or the horse
   car and ride up to 122nd Street where his office was
   and leave a note with the colored boy that somebody was
   sick in the Crohn household and would Dr. Meltzer please
   pay a call. Some time later you would see Dr. Meltzer's
   barouche with a horse -- single horse usually -- and Dr.
   Meltzer in it,a big, portly set man with a German accent.
   -- typical, countenance of a Bismarck, but underneath
   it, gentle and kind and very devoted to our family. On
   one occasion I recall that I saw him to his carriage,
   and noticed in the bottom of his vehicle that he had a
   cage with rabbits in it: he was taking the opportunity
   to observe his experimental rabbits while he was taking
   these long drives, paying his professional calls.

BOYLE: Do you recall Charles Dettie Aaron, the uncle of
   Abe Aaron?

CROHN: I remember that he was one of the founders, but I
   don't think that I ever met him personally. I think
   he had already died or retired before I joined.

BOYLE:   Do you recall A. L. Benedict from Buffalo?

CROHN:   No.

BOYLE:   Do you recall Henry Elsner from Syracuse?

CROHN: I recall him only by name.    I think that he was de­
   ceased at the time I joined.

BOYLE:   How about Allen A. Jones from Buffalo?

CROHN: Oh a very tall man, lanky, 6 ft. s, with a mid­
   western drawl, typical of an old-time clinician. Very
   tall.
                                                                33




BOYLE: How about Charles Simon of Baltimore.      You re­
   call?

CROHN: An interesting man, but there is nothing I can
   recall that was of a personal nature.

BOYLE: Now D. D. Stewart, who I believe was the second
   president, from Philadelphia?

CROHN:   No I don't remember.

BOYLE: How about Charles G. Stockton?     He was the first
   president?

CROHN: He was from Buffalo, but I recall little about
   him.

BOYLE: Julius Friedenwald.      What do you remember of
   him?

CROHN: Julius Friedenwald was a gentleman. He was of
   the famous Friedenwald family of Baltimore. He was
   a gastroenterologist, his brother was an ophthamol­
   ogist, and there was a third. Julius Friedenwald was
   a delightful gentleman and an excellent clinician. A
   man of great probity and broad interest not only in
   gastroenterology, but in his view of medicine as a
   whole. The Friedenwald medal, which I have over there
   on the wall, is the award which was founded by him.
   It's that gold one to the left over there (pointing).
   Good clinician -- excellent clinician -- eultured -­
   historical. He had a fine family background and was
   a very fine gentleman. I don't know that I can point
   to any particular type of interest within gastroenter­
   ology that he had. His interests were broad, not
   specific.

BOYLE: Let me ask you, Dr. Crohn, for your recollections
   of your contemporaries in The American Gastroenterological
   Association, the people you know best and who impressed
   you most?

CROHN: Well in my time the inside clique consisted of Sara
   Jordan and Abe Aaron of Buffalo, Russell Boles from
   Philadelphia, Harry Backus of Philadelphia, Jake Bargen
   out west. This small number of us visited from one
   city to another, informally between Annual Meetings,
   and we would demonstrate our newest findings to within
   this group. I recall, for instance, that Sara Jordan
   and Russell Boles came up to Mount Sinai to see my work.
   I went to Boston to see Sara Jordan's material. We
   were an intimate group hiding nothing to receive
                                                              34




   the inside reports and have the privelege or rree
   discussion. It was intimate and good. As an ex­
   ample, we questioned Jake Bargen's discovery of the
   bacillus which "caused" ulcerative colitis; we put
   that aside by acclamation and convinced him and the
   Mayo Clinic that he was wrong about it.

BOYLE: Sara Jordan accomplished so much in gastro­
   enterology, yet didn't she also manage to have a
   family?

CROHN: She married, fairly late in life (Penfield f4ower,)
   and she had a daughter, I think. Pen was a very quiet,
   nice fellow who gave her rull swing for her scientific
   activities with all the time she needed for her
   scientific work. The only hobby she liked was to play
   bridge; crossing the continent with her on a train to
   a San Francisco meeting, Sara Jordan and her husband
   and I and some fourth person played bridge all the way
   across. She was very pleasant and most intelligent.
   She entertained us in Boston when we visited that city.
   I attended her funeral, as did all her friends and
   associates. A devout Catholic, all the hierarchy paid
   tribute to her £or her lire of devotion. Not only
   for her devotion to medicine, but £or her activities
   on various civic boards and as one of the active
   participants in reform movements in Boston. She had
   broad interests besides those of medicine.

BOYLE: You mentioned Henry Backus as a member of your
   group.

CROHN: Yes, Henry Backus, the stormy petrel. He was
   known £or his sharp tongue, his keen sense of humor and
   his very critical judgment. Most people were afraid
   of his tongue. I gave a paper once on cau3es of upper
   gastrointestinal hemorrhage, and my figures showed
   that predominantly duodenal and gastric ulcers were
   responsible for the hemorrhage. This was many years
   ago, before I realized the importance or esophageal
   varices. I gave a very satisfactory paper with much
   discussion. Finally Backus was asked to join the
   discussion. "It's a very nice paper. I agree more or
   less with my friend Burrill Crohn, but don't they have
   any real alcoholics in New York on the Bowery? Maybe
   at Mount Sinai they don't see those bums in the Bowery
   with their esophageal varices.  I don't think Burrill
   realizes the extent to which esophageal varices are
   responsible for hemorrhage in the upper gastrointestinal
   tract." And that was the type of discussion he would
   use with his sharp tone but he never hurt, always ex­
   ceedingly critical but never personal or unkindly.
                                                             35




     He trained a whole generation of gastroenterologists.
If you note, there's the Bockus International Society of
Gastroenterology and his Fellows are distributed all
over the world. Wherever he goes, you'll find his stu­
dents who adore him because he was an excellent if a
very critical teacher.

     He asked me once to help out in the examination
for the American Board of Internal Medicine Sub-specialty
Examination in Gastroenterology. He was short of an
examiner; he called me from Philadelphia and asked me if
I'd come down and help out. I did. When I got down
there he handed me a list of questions. For instance,
"Ask the students to give the differential manometric
pressure between the pancreatic duct and the common bile
duct," and questions of that sort. I looked at him
and said, "Harry; I can't answer these myself." He had
been studying these matters particularly, had been
teaching the students basic science. But it seemed to
me unneccessary to ask such examination questions. I
thought it was improper but that's the way his mind ran
and he was teaching his men accordingly.

     He was one of the great enthusiasts of the Meltzer­
Lyon biliary drainage.  I was down once to visit him,
and found cubicles all over his offices and in each
cubicle there was a patient lying there, with a tube
hanging out of his mouth, undergoing differential bi­
liary drainages. He was very enthusiastic about that
type of examination. That was one of my big bases of
difference with him but Henry Bockus cannot be commended
highly enough for his School of Postgraduate Medicine in
Philadelphia, and a whole generation that he taught all
over the world. I recall one incident that was typical
of Henry Bockus. I called him up and said, ''Henry, I'd
like you to come to New York for a consultation on the
wife of one of the directdrs at our hospital. She has
a carcinoma of the pancreas invading the duodenum with
gross hemorrhage -- an obscure.case, and I've found
that I'd like another opinion, and I have chosen you
to come over from Philadelphia." "I can't come," he
said, "I'm too busy." "Nonsense, Henry," I said, there's
a thousand dollar fee in it for you, and you can spare
the time." "I'm sorry, Burrill, but I'm too busy. I'm
teaching, and my teaching comes first and I'm not in­
terested in the fee." This is characteristic of the sort
of man he was. True to his instincts -- true as he un­
derstood them.

     Another incident: Do you recall the superior mes­
senteric artery syndrome? I never understooa the syndrome,
                                                                36




   but he was asked to speak at the Bronx Medical Society
   on that subject, and I was chosen to open the dis­
   cussion. We had dinner together, a very pleasant cor­
   dial time and we went to the Bronx Medical Society
   meeting. He talked at a great length about this bril­
   liant syndrome: the compression of the 3rd portion of
   the duodenum by the superior mesenteric artery crossing
   it. I rose and gave one of those white-washing dis­
   cussions which said neither yes or no and really.just
   got myself out of it by saying it's very interesting
   and so forth and not being critical, because I was the
   host and I just couldn't tell him, as my guest, what
   were my real doubts. There was much applause, and
   everybody left for the coat room. I was in line wait­
   ing for my coat when one of the B~onx doctors walked
   up behind me and whispered in my ear, "Dr. Crohn, we
   know all about this "syndrome". We said 'Crohn will
   put him in his place.' We all expected you would but
   you didn't. You let us down." I felt I wasn't in a
   position as his host to really tell him what I thought
   about it, but shortly after that the superior mesenteric
   artery syndrome disappeared from the literature.

         These concepts such as biliary drainages, mesenteric
   artery syndrome, chronic appendicitis, adhesions, and
   vagaries of that type -- I have witnessed through my
   life.time. These concepts came up with a tremendous
   wave of enthusiasm, the rank and file accept them. The
   truth comes out sometlm,e later. In arriving at the
   truth, the fallacies of the past must be disproved.

BOYLE: Dr. Crohn, you must have known Frank Lahey, the
   surgeon from Boston.

CROHN: Frank Lahey was a wonderful man. He organized
   the whole Lahey clinic, carried it through Depression.
   "Frank," I said, "Why are you working so hard. You
   look tired and you've a duodenal ulcer. You ought to
   know better; take care of your ulcer! Why don't you
   have it operated upon and get rid of it?" "I haven't
   got time." "Why haven't you got time?" "Because of
   the Depression." "What's that got to do with your
   having your ulcer operated?" "My mortgages," he said,
   "I've got to work for my mortgages. I can't stop to
   be operated~" Hard working, very hard working. A
   charming, frank delightful man and a delightful com­
   panion. After he had a drink or two his tongue would
   loosen up, and he'd become very much more interesting.
   I recall a conversation about Howard University. He
   said "Burrill, you know Howard University?" and I
   said "I certainly do. That's the Negro university in
                                                           37




Washington D.C." A .funny thing arose; this was the
time when the Jewish medical students thought they
were subject to prejudice in the .form o.f numerous
discriminatory clauses that prevented them .from .free
admission to the medical schools -- which was never
so, but thus went the argument. "Yes," I said, "I
know it's a good school. All colored_people?" He
said, "Not all." I said, nr thought it was." "One,"
he said, "little Jewish boy came down .from Brooklyn
and applied for entrance to the Medical School at
Howard University. Howard University was complimented
that they had a white boy coming down so they accepted
him. Then he received such a good education that he
went back to Brooklyn and told all his .friends there
about this colored medical school and what a .fine
medical education he was receiving. Very shortly
Howard University was overwhelmed with white appli­
cants .from Brooklyn, and Howard University had to put
in some restrictive clauses."

      Frank Lahey attented a consultation on President
Franklin D. Roosevelt. When the President was about
to run .for his .fourth term at the end o.f the Second
World War, several consultants including Frank Lahey
were called to Washington to see Roosevelt. Franklin
D.'s legs were swollen; he was edematous, he was
short o.f breath, and he looked terrible. He had a
very poor heart action, he had rales at the bottom
o.f his chest posteriorly. Frank Lahey said, "I was
one o.f the consultants and a.fter our examination, we
gathered outside and decided the President should
not run again .for o.f.fice. He was in no physical con­
dition to run .for o.f.fice and he had to be told so. We
all agreed. They appointed me as the spokesman .for
the group; Franklin D. sat there in ·his chair with a
cigarette in a great big cigarette holder jutting out
o.f his mouth.  I said, 'Mr. President, we don't think
you ought to run .for o.f.fice. You're in no physical
condition to do so,' and I went on to explain to him
the reasons why not. Franklin D. listened to me and
when I .finished, we waited for his response. There
was a pause, and he looked at me and he said, "Dr.
Lahey, you come .from Boston?" and I said "Yes." "So
I assume you're a Republican!"

     Frank Lahey was .full of interesting anecdotes and
was such a hard worker. He was devoted to Sara Jordan
whom he trained, took her as a young student, put her
through college, through medical school, carried her
through all her internship, took her in to his clinic
and made her the head o.f the Department of Gastroenter-
                                                              38




   ology. she was the prot4ge and close associate of
   Frank Lahey~ They ran a magnificant institution and
   built it up beautifully, and as long as ·she was there
   Frank Lahey was there -- Sara Jordan, Mandred Comfort
   and the rest of the staff. After Frank Lahey died and
   Sara Jordan died many of the old staff passed away or
   retired. I don't think it was the same institution as
   it was in the olden days.

        There are many anecdotes about these interesting
   fine men. Good fellows, generous, open-hearted, good
   friends. There was only one incident of anti-Semitism.
   I've often been asked about anti-Semitism, but I al-
   ways answer without any hesitation: it doesn't exist
   among men of culture and education and broad scientific
   interests.   But as I say, there was one exception.  I
   was on the Executive Board and was asked to go to Pitts­
   burgh to sit in on a meeting of which B.B. Vincent Lyon.
   was the chairman. I was assigned to a hotel, in Pitts­
   burgh to be on call for the whole day Sunday. I landed
   there Saturday night by train, registered, and looked
   around for the rest of the men. Nobody else had regis­
   tered, which I thought was strange.   I went to bed and
   in the morning the phone rang, and they said, "Come on
   over, Burrill, we're waiting for you at the club over
   here. At the Fort Duquesne Club." I went over and dis­
   covered that all the other members had spent the night
   at that club, and suddenly I realized that as a Jew I
   wasn't eligible so I'd been assigned to the hotel in the
   city.of Pittsburgh. The social aspects were relatively
   unimportant, because we were all very close friends.
   We spent a very interesting lunch and finally dinner
   time arrived. We were sitting around, having a very
   pleasant dinner. It was Prohibition time. At the dinner
   everybody remarked that the wine was so exceptionably
   delightful. Everybody wanted to taste that wine; it
   was good.  I was curious myself and as the waiter came
   alone, I said, "Waiter, allow me to have that bottle
   for a moment. I'd like to see what it is." I took
   the napkin away from it and read "Kosher Wine, Shel
   Pesach." Kosher wine for use at Passover! So that was
   my one experience with anti-Semitism.

BOYLE: We haven't mentioned Russell Boles, Sr. except in
   passing. Can you tell me about him as a person?

CROHN: Oh, very lovely, as is Mary, is wife. Russell is
   a most sociable fellow.  I can recall one anecdote, a­
   bout when we invited Arthur Hurst over from London. I
   had visited Arthur Hurst in London, and was a tremendous
                                                                     39




         a(ll1lirer of him. He later became Sir Arthur Hurst.  I
         had visited with him and made rounds at Guy's Hospital
         with him. We went on the very wards that Bright had
         been attending when he described Bright's Disease, and
         this was quite a thrill. Arthur Hurst was a lovely host
         and a very interesting man. When I was President of
         the American Gastroenterological Association, I invited
         Arthur Hurst over. We entertained him in New York, and
         we entertained him elsewhere. We were all on the way to
         Washington for the annual meeting which I think was
         there that year, and we stopped overnight in Philadelphia
         to be entertained at Russell Boles' house. Arthur Hurst
         was sleeping as a guest in the home of Russell and Mary
         Boles. Mary would do anything because she was really
         one of us. When it came to sociability or arranging our
        ;programs or dinners or anything else, Mary Boles was al­
         ways ready. Arthur Hurst was the guest overnight and
         the next morning I saw Mary. She said "You know I don't
         mind being hostess here.    I don't mind doing anything,
         but when Arthur Hurst takes his pants off at night and
         throws them under the bed and says, 'I expect to have
         them pressed by tomorrow morning!' I'll do anything,
         but I'll be damned if I'm going to press his pants." I
         said "You know it's an English custom." But that was
         tYPical of Russell and Mary Boles.    In later years
         Russell was interested in carcinoma of the stomach; he
         performed statistical studies on carcinoma of the
         stomach. Afterwards he was in charge of the Abstract
         section in Gastroenterology for years. Lovely, pleasant,
         he and his wife. They were the center for all social
         and scientific activities.

,.-   BOYLE: George Eusterman at the Mayo Clinic who died re­
         cently was a notable member of the American Gastro­
         enterological Association.  I wonder if you knew him?

      CROHN: Did I know him? I most sincerely did. He was,
         next to Walter Alvarez, the closest one that I knew
         at the Mayo Clinic. George was absolutely stalwart
         and scientific, honest and good and much more critical
         than many of the other men. As an example, he didn't
         fall for the mistake of the previous years in regarding
         gastric ulcers as prone to malignant degeneration.

             Again, when at the Mayo Clinic they made the state­
        ment that as many as 10 or 20% of the cases of gastro­
        enterostomy developed gastrojejunal ulcers, everybody
        else was astounded at it~  In the East here, we knew
        that there was at least a 2% and perhaps as high as a
        5% incidence recurrent gastrojejunal ulcer following
                                                             40




   gastroenterostomy, but these high figures from the
   Mayo Clinic were absolutely startling and we didn't
   accept their figures.  I must say that Geroge
   Eusterman stood out, as I recall, against his own
   people and agreed with us on the much lower inci­
   dence of gastrojejunal ulcer following gastroent~~~
   ostomy.

        The interesting point is that if you perform a
   gastroenterostomy for a functional gastric disturbance
   or for anything except peptic ulcer, a gastrojejunal
   ulcer never forms; but if you do a gastroenterostomy
   for a duodenal ulcer or gastric ulcer, then you in­
   vite a recurrence of peptic ulcer. We were in com­
   bat with the Mayo clinic with their reports of a
   very high incidence of gastrojejunal ulcer. Never­
   theless, it was their insistence upon it that finally
   lead to the introduction of sub-total gastrectomy as
   a substitute for a gastroenterostomy and eventually to
   Dragsted~s operation of vagotomy, because we realized
   "no acid, no ulcer," which was the common saying. No
   acid, no ulcer, and anything that eliminated the acid
   in the stomach eliminated the ulcer. I recall Owen
   Wangensteen, who introduced me to vagotomy. For years,
   many of the A.G.A.'s papers concerned vagotomy: its
   influence, results, effects on acid, and The Hollander
   test. I went to London some years ago, I spent the
   whole morning with Mr. Burge, the surgeon.

BOYLE: He had devised an electrical check test for com­
   pleteness of vagotomy.

CROHN: I spent a whole morning with him and this compli­
   cated apparatus, seeing him cutting the vagus nerve and
   then using this electrical check to.see if there was a
   response, until finally he eliminated every part he
   thought was a fiber of the vagus nerve. Now we know
   that it was practically impossible to do.

       At Mount Sinai it was Ralph Colp who was partic­
  ularly interested in that subject. Colp felt that no
  matter how difficult the technique was, he wanted to
  master it, and he went all the way out West to Wan­
  gensteen and spent some time in his surgical clinic
  watching his technique of vagotomy. Later, when he
  came back, he would do vagotomies on our ulcer ulcer
  patients. We would check the Hollander insulin test
  later and would prove to him that he had not severed
  all the fibers, because acid could still be stimulated.
  Yet the vagotomy was one of the big additions to gas­
  trointestinal surgery of this generation.
                                                               41




BOYLE: Dr. Crohn, you mentioned how Will Mayo invited
   you to deliver a paper on gastroenterostomy to the
   A.G.A. meeting. Had you been down to the meetings
   at Atlantic City before, or was that the first meet­
   ing that you had attended in the A.G.A.?

CROHN: Oh yes. That was the first time that I had
   attended, in 1916. I gave my talk in 1916. Apparently
   it was published in '17 and I was made a member in '17.

       In my day the association was restricted to a
  hundred members in the whole United States, so it was
  quite a distinction to be one of the hundred. But
  also gastroenterology was a new specialty. When I
  first attended the meetings of the American Gastro,
  a Congress of all the medical specialty associations
  was held in Washington: our gastroenterological group
  was not yet recognized. Of course there was no such
  thing as a specialty in stomach and intestinal disease.
  The men who controlled internal medicine wouldn't allow
  any such specialty at that time. This Congress was the
  parent group and the parent would have nothing to do
  with the insurgent youngsters. I remember attending the
  Congress. We were not recognized and we were not allowed
  to participate as gastroenterologists in the Congress.
  Then later, the A.M.A. Section on Gastroenterology and
  Proctology was formed. Of course it was many years be­
  fore we became a sub-specialty group of the American
  Board of Internal Medicine.

BOYLE:  I see. Could you recall some of the color and
   flavor of A.G.A. meetings other than the scientific as­
   pects. I understand that there was an annual banquet.
   Did you attend any of the early banquets?

CROHN:    I attended them all.  I think the banquet was very
   interesting and we invited distinguished guests. When
   I was President in 1933, this was the time of the great
   communist spread in Europe and the beginning of Hitler.
   The meeting was in Washington, that year, not in Atlantic
   City. The guest speaker, by my invitation, was one of
   the Paulist Fathers from the Catholic community, whom I
   invited to come over and explain to us the dangers of
   communism, because the Catholic church was beginning to
   be very
        I
             conscious of the threat of communism to the
   church. He accepted the invitation and spoke to us a-
   bout the dangers of communism. Of course 1933 was al­
   ready the period of Stalin and this was before the war,
   before '39 the period of rapid spread of communism
   which we thought was a great threat to our democracy.

       Many of these banquets were well attended and were
                                                              42




   very sociable; I regret very much that they don't have
   the banquets now as they did in the past.

BOYLE: Yes. Did the meeting last a single day in your
   recollection or was it 2 days long?

CROHN:   No, 2 days, as far as I can recall.

BOYLE: And were there any offshoot meetings held in as­
   sociation with it or did the members gather strictly
   £or the A.G.A. meeting and then disperse?

CROHN: The meeting was nearly always arranged at the
   same time or just preceeding the meetings 0£ the A.M.A.,
   so it was an offshoot 0£ the A.M.A., as it were. The
   A.G.A. had no related meetings associated with it. We
   would go down a few days before the A.M.A., hold the
   meetings 0£ the American Gastro, and from there stay
   on and attend the A.M.A. meetings. Many 0£ the A.M.A.
   meetings were in Atlantic City and we always would
   precede them there but we would usually follow the
   A.M.A. to other places, too, as to make it possible
   to attend both.

BOYLE: Do you recall some 0£ the committee assignments
   that you held in the A.G.A., Dr. Crohn?

CROHN: I was chairman 0£ the A.G.A.'s Committee £or the
   study 0£ Gastro-Intestinal Hemorrhage. We were very
   much interested in internal hemorrhage. We were in­
   terested in whether patients with gastrointestinal hem­
   orrhage should or should not undergo emergency surgery.
   The big problem in emergency gastric hemorrhage in
   ulcer cases was when to operate upon them and when to
   treat them conservatively. At that• time, surgery was
   less safe than medicine~   In the early days o! crude
  anesthesias and the crude technique    or
                                          operating on
  a hemorrhage case, surgery was known to be associated
  with 10% mortality, but gross hemorrhage itself had a
  mortality, unoperated, 0£ 10% and up. I was just in
  the generation in which surgery became possible in
  those cases.

       I became an advocate of surgery for hemorrhage,
  emergency surgery particularly, having such a brilliant
  surgeon as Berg as my right hand who could carry out
  the emergency operation of hemorrhage and get away with
  it. By this time we had transfusions and infusions.
  When I started my early career in medicine, we didn't
  even have a transfusion and we did not have an infusion
                                                               43




   nor know how to thread a vein. That's how primitive
   we were. But my generation took over this hemorrhage
   problem, and little by little we advocated the radical
   resort to surgery in massive hemorrhage, particularly
   in the older age group.

BOYLE: What were the meetings like around the time that
   you became President or the A.G.A. in 1932?

CROHN: My memory or the meetings previous to the early
   1930's was that they were the stu££iest lot or sessions.
   There was nothing reported at those meetings except
   clinical experiences and clinical experiences which
   usually were not really substantiated by scientific
   studies. Don't forget that laboratory work at that time
   was still in its incipiency except £or pathology, that
   biochemical researches were slow in developing. The
  ·members, particularly the older men, would occupy the
   front seats. Clinical problems would come up, and all
   they would do was to discuss their experiences and tell
   about the interesting case they had and their interesting
   conclusions, which would usually be surmises on clinical
   bases.

        My associates, when I became president, were the
   more radical group, headed mostly by Walter Alvarez and
   myself, and Henry Bockus, and Sara Jordan who was be­
   loved by us all and with her open mind -- and or course
   Frank Lahey. Walter Alvarez came from the laboratory
   or the Mayo Clinic. He had both clinical experience
   and laboratory experience, and the rest or our radical
   group all had not only laboratory experience but were
   clearly progressive in our minds, and we really £eel
   that we took the American Gastro out of that old rut of
   staid, repetitious, clinical observations and put a
   new light into it. We established it as a scientific
   body.

BOYLE:     Did you know Walter B. Cannon?

CROHN: Yes, I certainly did.    I remember him particularly
   because I have a guilty conscience about one thing. I
   sat next to him at a banquet and he said, "Dr. Crohn,
   you must contribute to the Spanish cause. This Spanish
   Civil War is very important. The Russians and partic­
   ularly the Germans are flexing their muscles and using
   their newer armanentariwn. There'll be war certainly,
   international ~ar, and you should contribute liberally
   to the loyalist cause because if Franco takes over, a
   depotism will be established and he'll be followed by
   Hitler and Mussolini, so you must help us." I said,
                                                                44




   "Dr. Cannon, I'd like to help them, but I think they
   are nihilists and anarchists and socialists. They're
   a disorganized group and I'm really too conservative
   to contribute to a cause which is so discoordinated-: arid
   so chaotic." As I look back, I probably was wrong.
   Enthusiastically, he was raising funds for the Loyal­
   ists in the Spanish Civil War.

        He described to me his first use of X-rays and
   the goose with the long neck down which he pushed the
   bismuth -- made the goose swallow the bismuth and took
   his X-ray films and demonstrated progress of the bolus~
   -- the earliest experiments in physiology with X-ray.
   When I was an intern at Mount Sinai in 1907, they
   showed us a single X-ray film of the hand of a mummy
   showing all the bones. I remember how startled I was
   at this new discovery of X-ray that could photograph
   opaque objects.

BOYLE: Do you recall A. J. Carlson? I understand that
   he had a very interesting personality.

CROHN: Ajax Carlson! A Norwegian with a Norwegian accent.
   Very critical. Not a clinician but laboratory -- very
   interesting work -- similar to that of Pavlov and the
   Babkin school. He was the American correspondent of
   Pavlov and Babkin in Russia, and he followed all their
   work. I have the first editions of his work at home in
   my library. A. J. Carlson was a very fine scientific
   and a very critical man; it was known that you just
   couldn't get away with a statement in front of A. J.
   Carlson if it wasn't absolutely accurate. I spoke with
   him on a platform before a Vermont medical audience.   I
   wasn't being very critical in my remarks; I spoke about
   "hyperacidity", hyperacid secretion,of the stomach.
   Ajax followed my discussion and said "I'm surprised Dr.
   Crohn doesn't know better. The secretion of gastric
   juice, its acidity is always at the same level. There's
   no such thing as hyperacidity; there's only such a thing
   as hypersecretion."

       That was Ajax. He was the type that, "i:f it was
  not, it was not." If you stepped out and made the
  slighest error in a statement which was then open to
  scientific criticism, Ajax was there. He'd pick you up
  on it right away, which was good. It made all of us
  careful about making statements, and this was what we
  needed in those days more than anything else, because
  the amount of clinical drool which the clinicians would
  get off on the basis o:f surmises or guess work was so
                                                              45




   legion that it took out generation of critical in­
   dividuals to take the whole of gastroenterology out
   of the mythology of the past, out of the loose state­
   ments based on so-called clinical judgment and to pin
   the thing down to scientific statements. It was our
   generation that pinned things, so that if a man made
   a statement, he'd have to stand up and prove it.

BOYLE: Ajax Carlson was from Chicago, as was Walter
   Palmer. What can you tell me about him?

CROHN: Now you're talking about an outstanding indi­
   vidual. Walter Palmer, at the University of Chicago,
   Professor of Medicine. He organized their whole Gas­
   trointestinal Department. It was Joe Kirsner who was
   assistant to Walter Palmer, and who succeeded him and
   is now the Chairman. Walter Palmer is now practicing
   privately as a consultant in Chicago, and I understand
   he has a very large practice. Walter Palmer was the
   leader of the whole Chicago coterie and could not be
   excelled for good clinical medicine, good clinical
   judgment and a very progressive mind. Delightful per­
   sonality.

BOYLE: Do you recall Babkin and Komaroff? Did they have
   much interaction with the other members of the A.G.A.

CROHN: No. I don't remember even meeting Babkin. I
   know that Pavlov came to this country on a visit. I
   remember particularly the very unhappy incident of his
   falling asleep on a bench in Grand Central Station wait­
   ing for a train; somebody picked his pocket and took
   his money. The Rockefeller Institute reimbursed him
   immediately, but it was very embarrassing for the old
   man.

BOYLE: What can you tell me of Frank Smithies? He was
   the original editor of the American Journal of Diges­
   tive Diseases. He died in 1938. Apparently there was
   some difficulty between him and Beaumont Cornell who
   owned and published the journal. I have heard Smithies
   was rather difficult at times.

CROHN: It wouldn't be surprising that there were diffi­
   culties between Frank Smithies and anybody else be­
   cause he was one of the most contentious men that I
   knew. He would insist on having his own way about
   everything. He was difficult to get along with, stiff­
   necked and obstinate, and most men found it difficult
   to work with him. He was a good clinician, he was an
THE AMERICAN GASTROEN"l'EROLOGICAL ASSOCIATION:
               HISTORICAL TRENDS
(••~       DEPARTMENT OF HEALTH &. HUMAN SERVICES   Public Health Service

~~~+~~~~
                                                    National Institutes of Health
                                                    National Library of Medicine
                                                    Bethesda, Maryland 20894




                 PAGE MISSING
                                                                48




         THE AMERICAN GASTROENTEROLOGICAL ASSOCIATION:
                       HISTORICAL TRENDS



BOYLE:   I have heard that a major reason for the founding
   of the A.G.A. was the bad atmosphere created in this
   country of many self-styled "stomach specialists"
   especially in the period of 1880-l900. Were these
   people giving the specialty of gastroenterology a bad
   name?

CROHN: There were several prominent so-called "stomach
   specialists" in New York City who had very large
   practices. While they did specialize in gastrointes­
   tinal diseases, the only qualification that they had
   was that they called themselves "stomach specialists."
   They had no special training, no particular clinical
   training, few hospital association. They conducted
   a huge office in a wholesale manner. Their only
   attribution to distinction was their own decision
   accepted by the public that they were "stomach special­
   ists."

BOYLE: So I take it that the legitimate internists and
   the general practitioners did not particularly look
   highly upon these men?

CROHN: On the contrary, they looked down on these fellows
   as being ambitious interlopers who called themselves
   specialists but had no qualifications except that their
   particular interest in gastrointestinal disease. They
   had office hours which would begin at 8:00 in the
   morning and go through 6 or 7:00 at night. They prac­
   ticed continuously, charged small fees, used no X-ray
   in those days. Everything was a clinical impression
   and empirical treatment.

BOYLE:   What diseases did they diagnose in those days?

CROHN: They knew very little about psychiatry or psycho­
   somatic medicine, but they knew usually enough to
   recognize a functional case from organic. They rarely
   had hospital associations or were at least not with
   any hospitals of good standards. Everything was office
   treatment. This was the period of colonic irrigations,
   where everything in the body that they did not under­
   stand was due to "auto-intoxication". The large bowel
   was the cesspool of the body as Metchnikoff, the Russian,
   had said, and all disturbances -- flatulence, indigestion,
                                                               49




   constipation, and gas -- everything was due to poison­
   ing from the large intestine. Many of them had outfits
   for continuous colonic irrigations.

        I must admit that even I at one time fell for this
   and established in my large office a special nurse and
   a special table for colonic irrigations and the patients'
   were supposed to come to the office and have their
   colonic irrigation once a week or once in 10 days to
   "wash the poisons out of the intestinal tract." Every
   cure was attributed to these marvelous colonic irri­
   gations. The nurse would wash bag after bag of soap
   suds and saline, and she would wash and wash until
   there was no more feces returning from the intestinal
   tract, and then she'd feel herself justified in say-
   ing she'd done a very successful colonic irrigation.
   Then when all the "poison was washed out of the
   patient," he came back once a week or once in 10 days
   to have this treatment renewed.  I had special nurses
   that would go to the homes of the patients to wash
   out the colon. Whole establishments were set up for
   colonic irrigations where you could send patients to
   have their colons washed out.

        I shortly came to the conclusion that this was a
   philosophy with no sense to it, and that whatever effects
   achieved were psychological. It made a tremendous im­
   pression upon the patient if he was sent to have his
   intestine washed out, to be cleansed from all his sins
   -- intestinal sins. Psychically it was a wonderful
   method of treatment, but I never convinced myself that it
   ever did anything £or the patient, and I discontinued it.

BOYLE: These men called themselves stomach specialists but
   they also did colon work and by the.term stomach they
   referred generally to the entire gastrointestinal tract.

CROHN: Don't forget that practically none of the intestinal
   diseases that we now treat, that fill our hospitals, were
   recognized then: ileitis, ulcerative colitis, diverti­
   culitis. None of those diseases were known or recognized.
   The only disease of the intestine was constipation, dis­
   tention, and gas. And there were acid conditions of
   various types. With a lack of a sigmoidoscope and with a
   lack of decent X-ray, it was very difficult to accumulate
   knowledge of intestinal diseases. Practically nothing
   was known.

BOYLE: Did these men persist £or long after the A.G.A. was
   founded? Were there any left when you entered practice?
                                                                50




CROHN: They had practices several times as large as my
   practice. They were financially most successful
   people. They died out very slowly.

BOYLE:   What was responsible for doing away with these men?

CROHN:  I believe it was the raising of the standards by the
   introduction of the American Board of Internal Medicine
   and then the es.tablishment of the Sub-specialty Certifi­
   cation in Gastroenterology. After that, if you wanted
   a hospital appointment of any kind, you had to prove
   that you were a member of the American Board. So the
   whole standard of hospital appointments was suddenly
   raised by the introduction of the American Board. People
   who couldn't take the examination couldn't have a hospital
   appointment, no matter how successful they were in their
   practice, and no matter how many hundreds of patients
   they saw in a day in the office at $2.00 for a call, un­
   less they were a Diplomate of The American Board. And
   of course, if they didn't have a hospital appointment
   they were not recognized. The establishment of the
   American Boards was the most remarkable event occuring
   during my professional life.

BOYLE: Then, you feel that the development of the American
   Board of Internal Medicine has had a bigger effect on
   deterring the practice of gastroenterology by unquali­
   fied specialists here in New York than the establishment
   of the A.G.A.?

CROHN: Yes, I think the American Board of Internal Medicine
   had the bigger effect. For instance, when I sat for
   years on the qualifying board of the Workman's Compen­
   sation in New York City, after I got interested in trauma,
   names would come up -- men wanting to be recognized as
   capable of testifying for Workman's Compensation -- and
   you'd ask them one question, "Are you a member of the
   American Board?" and if they were then automatically they
   were accepted.   If they were not, we had to look at the
   qualifications and decide further, but from the time of
   its origin, the American Board became the standard.

BOYLE: How about the role of the A.G.A. itself in medical
   practice in New York. Do you feel that the A.G.A. it­
   self has had any direct affect on improving practice in
   New York?

CROHN: No, again I think the Boards are the important thing.
   I think when a man comes up for hospital appointment,
   whether he is a member of the American Gastroenterological
r                                                                      51




       or not is very secondary importance to the Committee
       on Admissions in a large hospital. I don't think
       that the fact that he's a member of the American Gastro
       means an awful lot.   I'm sure that if he's a member of
       the American Board of Internal Medicine, if he's a
       Diplomate in his Sub-specialty, then they will accept
       that whether he's a member of the American Gastro­
       enterological Association or not. Membership depends
       upon the whim of the man as to whether he wants to be­
       long or not, whether he would be considered a valuable
       member and whether he would be accepted or not. Be­
       longing to an association is an optional thing but
       American Board certification is practically obligatory.

    BOYLE: What do you feel has been the A.G.A.'s role in
       shaping the practice of gastroenterology?

    CROHN: It has accomplished much by enlarging its sphere
       of interest. In its meetings it now includes all the
       res·earch work and endoscopy, when it established pre­
       liminary meetings a day or two ahead of the clinical
       meetings. So it has broadened its field to not only
       clinical medicine but to laboratory research and in
       that way it has done wonders. It has established re­
       search funds and fellowships and has encouraged research.

    BOYLE: Dr. Crohn, do you think the A.G.A. has been an
       effective force in shaping gastroenterological research
       today or in saying what is good research and what is bad
       research?

    CROHN: Yes, yes, I think it has been a factor for the good.
       I think that the Federal Government has been much too
       liberal in the matter of grants by the National Institutes
       of Heal th -- much too liberal with r,esearch. The amount
       of research that is completely wasted and funds which are
       wasted is enormous. There should be much more discrimi­
       nation in approving research grants. At times it seems
       that if you simply stand on your feet and wave your hand
       and ask for a grant from the N.I.H. and that's all that
       you have to do to obtain it. It's practically true that al­
       most anybody who asks for money can get it, no matter how
       abstruce the research is. The amount of repetitive re­
       search, the going over of old stuff and rehashing of the
       things which had been settled by our generation 30 years ago!
       The repetitive work going on today which you see in the lit­
       erature every day is almost to the point of nausea, and I
       think there's a tremendous wastage in you funds.

            There is a great excess of importance placed upon what
       a man does in the way of research as far as appointments
                                                                52




  within a hospital are concerned. You know perfectly
  well that appointments as heads of department are
  usually made not on the basis of one's stature as a
  clinician or physician but on, "What did you publish?"
  If you can't publish an article once a year, you can't
  hold your position as a full time Professor. This is
  an absurd emphasis on research. I think that it would
  make a tremendous saving if the federal government and
  the pharmaceutical houses would be much more discerning
  and discriminating in what and how they spend their
  money, without insisting on expanding laboratories all
  the time for non-essential research. This results in
  the denigration or deterioration of emphasis on clini­
  cal medicine, and heads of the department are brought
  in because they've done research not because they are
  good bed-side clinicians or diagnosticians. We in
  medicine decry today the fact that almost all of our
  medicine is computer medicine, to the point where the
  hospital beds are now so overcrowded that the really
  sick patient cannot find admission into a hospital be­
  cause the beds are all occupied by cases which are
  being sent in by the practitioners for a so-called
  study, and thorough review of the case. Doctors will
  send patients to the hospitals and not even visit the
  patient but just sit at their desk in the office and
  over the telephone order test, test, ad nauseam. Every
  test is to be done. Every little thing, every blood
  chemistry, and all sorts of studies to the point where
  there are times when the resident recites a case to you,
  he will forget to tell you that he did a physical exam­
  ination or took a history.   It's nothing but a recitation
  of laboratory figures. And now with the advent of Medi­
  cine, anybody over 65 can be sent to the hospital and
  have the government pay the whole bill, or with Blue
  Cross and other insurance schemes, overutilization of
  beds in the hospital has resulted, and now you can't ad­
  mit a case in even in an emergency.

BOYLE: You predicted some bad times ahead in your Presi­
   dential Address in 1933 concerning the dangers of social­
   ized medicine. Do you think you've seen some of these
   things come to pass?

CROHN:  In 1933, we had been warned by the British who al­
   ready had a form of socialized medicine. At one of our
   annual banquets we invited 2 English clinicians to address
   the annual banquet, and I never will forget how they
   described socialized medicine in England. They raised
   their hands in holy horror and said, "Gentlemen, if you
   know what you are doing, don't let Aneurin Bevan come
                                                               53




   anywhere near you because he'll subject you to social­
   ized medicine, and you'll be the sorriest people in the
   world." It was the English clinicians who came over
   and warned us to not let socialized medicine happen.
   And, of course you know the most conservative organi­
   zation in the world was the American Medical Association,
   and they felt the same way as we did against socialized
   medicine. Now it has. gotten to the point where we are
   all stymied. I had three emergency cases two weeks ago
   over the weekend and couldn't get one or the three cases
   into Mount Sinai or to the Doctor's Hospital. It is
   just impossible to have an emergency case admitted, be­
   cause the beds are crowded with cases being studied under
   Medicare and Medicaid.

BOYLE: Dr. Crohn, you spoke of the change in A.G.A. meet­
   ings which have taken place since you joined the asso­
   ciation. What factors do you feel were responsible for
   this?

CROHN: Such members as Boles, Bargen, Jordan, Lahey among
   others. The younger people, such as these, replaced the
   older clinicians completely. We took over and built up
   this institution.

BOYLE:   Was this before or after you were President?

CROHN: No, it was largely after I was President, because
   I was older and most of these men followed me. The
   only one of the group ahead of me was Walter Alvarez.
   Controlling the Executive Board, we saw that we could
   put into office men of our liking, men that we wanted
   who would build up the institution rapidly on a progres­
   sive and scientific basis, replacing the old clinicians.

BOYLE: That really started with your Presidency in 1932.
   The only one that was before you was Walter Alvarez.

CROHN: Walter Alvarez was President in 1928. Then came
   Frank Smithies, Ludwig Kast, and Clement Jones, who
   were the old-fashioned type of clinicians. I became
   President in 1932, and I was followed by John Bryant who
   was a clinician, and B.B. Vincent Lyon·, Howard Shattuck,
   and then Chester Jones in 1937. There's a man that you
   can't pass over. Chester Jones of Boston was very im­
   portant. Tfie last I heard of him, he was still actively
   practicing in Boston, one of the few members left over
   from the "old crowd". He is a man with critical judgment,
   strict scientific honesty and a good clinician.

BOYLE:   Dr. Crohn, in the early days of the Association,
                                                               54




   what types of scientific papers were presented at the
   Annual Meetings?

CROHN: As you look through these copies here of the
   transactions, you see there is nothing but clinical
   material, clinical discussions and observations usually
   not backed up by any scientific data, all clinical dis­
   cussions of clinical disorders. It was too bad that
   scientific medicine hadn't advanced further.

       For instance, there was the Meltzer-Lyon technique
  for non-surgical biliary tract drainage. That was the
  period when B. B. Vincent Lyon introduced his technique
  of Biliary drainage for the diagnosis of gall bladder
  disease. I was a heretic and didn't believe ·in it. I
  was castigated and criticized, because I became engaged
  in all of the discussions. Max Einhorn and I were the
  skeptics. We didn't go along with Backus and Vincent
  Lyon, the Philadelphia crowd, and all of the rest of
  the country that fell for this.

       We used to spend hours with biliary drainage just
  trying to make some sense out of it, and I never succeed­
  ed. Finally I went down to New York University, and
  asked for laboratory facilities.  I took dogs, injected
  india ink into their gall bladder, under anaesthesia of
  course, sewed them up, and I would wait 2 or 3 days and
  then open the abdomen and perfuse the duodenum with
  magnesium sulfate to see what would happen. According
  to the theories, when you perfuse the duodenum with the
  magnesium sulfate, the gall bladder should contract and
  the india ink should come out. It didn't.   I let the
  dogs rest for 2 or 3 days, went back and looked again
  and observed the fact that the india ink took a long time,
  several days, before it leaves the gall bladder. I
  couldn't convince myself that perfusing it with magnesium
  sulfate had helped it at all.

       I recall that old man Einhorn and I used to go all
  over the country discussing biliary drainage. One
  terribly wintery day, the old man and I went out to New
  Jersey and addressed the medical society. We were heretics
  and were the only two that held out -- to such an extent
  that apparently I was such a turbulent element that they
  appointed a committee to investig~te the subject.of the
  magnesium sulfate drainage to see·who was right. A
  committee was appointed and each one of us had to go up
  there and testify, and of course the committee was in no
  position to make a final decision. If anything, Einhorn
  and I were sort of relegated to limbo; we hadn't proven
                                                                 55




   the point that instilling magnesium sulfate was of
   any use, while the others were so enthusiastic about
   it that we lost out to the majority. But in the course
   of time in science, everything reaches its evident
   ultimate truth, and very shortly after that and little
   by little, the. whole subject was dropped. Of course,
   it is not used today.

BOYLE: Wasn't that unusual for a committee to be appointed
   to try to settle a scientific controversy?

CROHN: Yes, that was very unusual. In going back to some
   of these old transactions, here is a paper which was
   presented, "Opaque Meal Versus the Stomach Tube in the
   Diagnosis of Gastric Hypomotility." They were making
   a big to-do about atony of the stomach. These were some
   of the old fashioned ideas.

       "The Effect of Stasis in the Ileum." This was 1918.
  Stasis in the Ileum! Here is a group of 200 patients with
  X-ray examinations "6 to 12 hours after barium. In 42,
  the small intestine emptied slowly and there was a residue
  in the ileum.  In 3 cases, this persisted for 19, 48, and
  54 hours respectively." Even though there was stasis in
  the ileum, it never dawned upon these people that any
  disease could occur in the ileum, although they all played
  around with the ileum.

       About this time, we really had a blow-up with one of
  the biggest errors in medicine, "chronic appendicitis."
  Here is a paper on "Roentgen Rays in the Diagnosis of
  Chronic Appendicitis," by George Fowler, the outstanding
  roentgenologist of Philadelphia. Everything we had known
  which you couldn't explain when I was young was "chronic
  appendicitis." An appendicitis operation was an everyday
  affair. Every day there was an appendectomy, regardless.
  If you didn't know what was going on with an abdominal
  pain, every neurotic, every nervous woman, every histerical
  girl who had a belly ache immediately had "chronic appen­
  dicitis," and the appendix had to be removed. This was
  really very sad medicine, because it became quite obvious
  to a critical person like myself that we were getting no­
  where in removing the appendix in these cases. And if
  the appendix were removed and showed atrophy, as it
  naturally would, or fibrosis or something of that kind, or
  if they opened it up and found a little nugget of hardened
  feces in it, then they were elated. But it was clinically
  quite obvious that we were getting nowhere with it at all,
  and we were just operating upon neurotics. This craze of
  chronic appendicitis really was the dominant fashion of it's
                                                                56




   day.  I recall one instance -- we were making rounds
   with one distinguished physician -- I really shouldn't
   mention his name -- who was one of the most enthusiastic
   of the exponents of chronic appendicitis and every
   abdomen that he would palpate had chronic appendicitis.
   I was making rounds with him on the wards, and he
   demonstrated to a crowd surrounding the bedside. He
   said the man's diagnosis was chronic appendicitis,
   that he should have his appendix out, and that he
   would be cured, and he moved on to the next bed. Some­
   thing about the case attracted my attention. While the
   others of the crowd moved to the next bed, I went back
   to look at that abdomen and found a very fine scar where
   his appendix had previously been removed. This only
   confirmed all the skepticism I had about chronic appen­
   dicitis but it took a long time for everyone to overcome
   this enthusias~ this fixation to remove an appendix on
   the grounds of chronic appendicitis.  It wasn't until
   we got rid of that fixation that you could began to
   think of other diseases which might cause lower abdominal
   pain.

BOYLE: What do you think of the structure of current
   meetings of the A.G.A.?

CROHN: For 1 or 2 days preceeding the clinical meetings,
   the presentation of the laboratory work is very worth­
   while £or anyone really interested in the laboratory side.

        I haven't attended a meeting for years because I
  really think that the custom of making men who are past
  65 become senior members and denying them a space on the
  program -- not utilizing their talents at all for any­
  thing -- I think does themselves an injustice. These
  senior members are still around and•could contribute a
  great deal. They would be much more critical than the
  present generation who can spend a whole session on
  nothing but the malabsorption tests, talking about
  nothing else but malabsorption.

       I really think that they exhaust themselves and the
  subjects unnecessarilly. Much too much laboratory work,
  much too little clinical work, and much too little em­
  phasis on the clinical sides of medicine.

       This is what is happening in medicine. My son is a
  physician up in Buffalo. He goes to the research meetings
  in Atlantic City every year, the so-called "Young Turks."
  He was down there and stopped in on the way back, and I
  said, "Show me your program," and he showed me his program
                                                               57




   which looked like a volume of the Encyclopedia
   Brittanica. I asked, "How many papers?" "About
   5000," he said. "Five thousand papers? How long
   were you down there?" "Three days," he said.   I
   asked, "How many did you hear?" "Not many, but al­
   together there were 5000 papers. There were meetings
   in every hotel." I said, "Are these all published?"
   "Oh, no. Maybe 2000 are." "What happens to the other
   3000?" He shook his shoulders and said "I don't know.
   Maybe in the waste basket." So of the 5000 papers,
   each represents a research effort and each probably is
   endowed by the National Institutes of Health, and you
   realize what a fortune is going into research, you can
   imagine the amount of waste, -- the waste of money and
   the waste of time. I am only cqnversant with medicine
   but when you think of the amount of money which goes
   into research in the industrial world, the pharmaceu­
   tical world, and other branches, you can see what an
   enormous amount of money is spent.

        As I told you the other day, the research founda­
   tions at Mount Sinai alone have made public in the
   last 6 years the use of a million dollars, and I am
   sure it doesn't begin to cover the amount of research
   which is endowed at that hospital. If you multiply
   this by the several thousand hospitals and teaching
   institutions throughout the country, you can see what
   this amounts to.

BOYLE: What do you think is going to happen? Do you
   think that the pendulum will swing back away from so
   much research?

CROHN: No, the world is getting more and more socialistic.
   I don't think it will swing back, because the prestige
   of medicine is in research -- full time appointments.
   Of course all departments are now "full time." I served
   at Mount Sinai Hospital for 61 years and never received
   a salary for any work that I ever did, nor did any of my
   confreres. Today each department is headed by a full­
   time man with salaries of 35,000 dollars a year upward.
   Most of them receive their appointments on the basis of
   research and outstanding achievements in some particular
   small field and this is the way the hospitals are run.
   I was an intern for~ years. At the end of this time,
   I received the magnificant emolument of $SO and a small
   black bag containing a blood pressure apparatus, a ther­
   mometer, and a stethescope. Today, the interns and
   residents start with $2500. Within a year or two it's up
   to $3500 or $4200, depending on whether he is married and
                                                                58




   has children. So are we to doubt who's paying for all
   this huge expense of medicine, this increase of the
   cost of medicine that goes on year after year until
   it exceeds in the rapidity of its increase any of the
   branches of industry throughout the United States.
   Who's paying for it all? Blue Cross, Blue Shield,
   Medicare, Medicaid, the State, and Federal government,
   and I think this trend will go on to the detriment of
   the clinical side of medicine. These full-time men!
   I recall one head of the Department of Medicine who
   received his appointment on the basis of a very
   creditable piece of research; he was rarely seen on
   the wards. He rarely came down to the wards to examine
   a case. He sat up in his cubicle, on the Pavillion
   on the roof, and directed the research from there.
   That was his concept of being Head of Medicine -- how
   much research could be produced and how much could be
   published. That was his interest, quite different than
   Osler and Libman.  I made rounds twice with Osler.

BOYLE:   Oh, really?   That must have been an experience.

CROHN: It was quite an experience. I can remember even
   to this day that tall, austere-looking, very pleasant
   man. He was making rounds on the invitation of Libman,
   and I remember till this day the bed in the ward in
   which he examined the abdomen. It was a question of
   an intra-abdominal carcinoma, and he felt for the spleen.
   I remember his turnin:9 around and saying, "You can .feel
   the spleen. There can not be any intra-abdominal car­
   cinoma. You can rule it out if the spleen edge is pal­
   pable." I have often quoted that experience, and every­
   body questions it and says, "Is it true?" I think with
   one exception it has been true, and the exception was
   a case with thrombosis of the splenic vein. This was
   the type of thing that Osler could say that made him so
   brilliant, so pleasant, such a delightful man o.f culture.

BOYLE: To talk of research once more, do you think that
   the trouble in gastroenterology is too much basic re­
   search to the exclusion of clinical research, or just
   too much research that is not good research?

CROHN: There is so much basic research, but at the same
   time I recognize that if you don't have masses of basic
   research you may miss some very important discoveries.
   Something unexpected may materialize. Many years ago,
   when I took the trouble to go up to General Electric in
   Schenectady to see what their research laboratories looked
   like, I went through these massive research laboratories
                                                                59




and said to the director, "What do you get out of
this? Does it pay?" He said, "Doctor, if one man is
able to devise a slightly better insulator for our copper
wires that we have at the present time, no matter how small
the advantage is it will pay for all the research." In
medicine, we have the example of Fleming who made the
original observation of the effect of penicillin mold but
paid very little attention to it, and of Florey who during
the war saw the possibility of adopting penicillin to the
infection of wounds and discovered that he could mass­
produce penicillin. From all the research that went on,
just the single instance of finding penicillin mold made
it worthwhile. Perhaps ninety percent of the research
through the years in this area were not directly productive ,
but just that one idea justified the efforts.

     Still, there is such an unnecessary tremendous expen­
diture of money for research. At Mount Sinai it amounts
to almost a million dollars a year from the federal
government. At Columbia P. & S. it is said that if the
United States Government ever withdrew its research money,
most of the laboratories at P. & S. would close down, and
this is true all over the United States. The United States
Government and pharmaceutical firms are practically
supporting all the country's laboratory research. Now this
is good if they produce something, but everybody knows
what a large percentage of research is wasted.and repetitive
and gets nowhere.
    BIBLIOGRAPHY OF
BURRILL B. CROHN, M.D.
                                                             61




                    BIBLIOGRAPHY OF
                BURRILL B. CROHN, M.D.



 1.    Meyer, L.B., Crohn, B.B. Acute glanders. J.A.M.A.
       ~O: 1593-1595, 1908.
 2.    Crohn, B.B. Blood cultures in human glanders. Am.
       J. Med. Sc. 138: 1-11, 1909.
 3.   Crohn, B.B. Experience with duodenal and stool
       ferments in health and disease. 8th Int. Cong. Appl.
      Chem. 19: 73, 1910.
 4.   Heiman-;--H., Bookman, s., Crohn, B.B. Studies in
      metabolism of amaurotic family idiocy. Am. J. Dis.
      Child • .!.Q.: 234-245, 1912.
 5.   Crohn, B.B. The diagnosis of the functional activity
       of the pancreatic gland by means of ferment analyses
       of the duodenal contents and of the stools. Am. J.
      Med. Sc. 115: 393, 1913.
 6.   Crohn, B.S:- Periodic explosive toxemias. N.Y. Med.
       J. 1, (Jan.17) 1914.
 7.   Crohn, B.B., Epstein, A.A. The stimulating influence
       of serum on pancreatic amylase. -J. Biol. Chem • .!.z::
       317-324, 1914.
 8.   Crohn, B.B. New growths involving the terminal bile
      and pancreatic ducts; their early recognition by means
       of duodenal count analysis. Am. J. Med. Sc • .!i!!= 839,
       1914.
 9.   Crohn, B.B. Studies in pancreatic diseases. Arch. Int.
      Med. ,!1: 581-607, 1915.
10.   Crohn, B.B. Rat-bite fever. Arch. Int. Med. 15: 1014-
      1039, 1915.
11.   Crohn, B.B. Bulimia. Med. Clin. N. Amer. 629-638,
       1915.
12.   Wilensky, A.O., Crohn, B.B. Studies in the physiology
      and pathology of the stomach after gastro-enterostomy.
      Am. J. Med. Sc . .l21,: 809-824, 1917.
13.   Crohn, B.B., Wilensky, A.O. Studies in the variations
      of the tonus of the gastric musculature in health and
      disease. Arch. Int. Med. 20: 145, 1917.
14.   Crohn, B.B., Reiss, J. St~ies in fractional estima~
      -tions of stomach contents. Am. J. Med. Sc. 154: 857-
      873, 1917.
15.   Crohn, B.B. Clinical conditions characterized by ob­
      structive jaundice. Med. Clin. N. Amer. 245-299, 1918.
16.   Crohn, B.B. Studies in fractional estimations of
      stomach contests. II. Effects of antacid medication on
      gastric acidity and secretion. Am. J. Med. Sc. 155:
      801-819, 1918.
                                                                 62




17.    Crohn, B.B. Studies in fractional estimations of
        stomach contents. III. Effect of hydrochloric acid
        therapy on the acid titer of stomach during digestion.
       Am. J. Med. Sc. 156: 656-665, 1918.
18.    Crohn, B.B. Early abdominal symptoms of myocardial
        insuffienciency. Med. Clin. N. Amer. 4: 289, 1920.
19.    Crohn, B.B., Reiss, J. Effects of restricted (so­
       called ulcer) diets on gastric secretion and motility.
       Am. J. Med. Sc. ill: 70, 1920.
20.    Crohn, B.B. eisturbances of metabolism accompanying
       pancreatic diseases. Med. Clin. N. Amer. 657-691,
        1921.
21.    Crohn, B.B. The existence of gastric ulcer with
        tabes dorsalis. J.A.M.A. 77: 2023-2029, 1921.
22.    Crohn, B.B., Reiss, J. Alimentary hypersecretion.
       Am. J. Med. Sc. 161: 43, 1921.
23.    Crohn, B.B., Reiss, J., Radin, M.J. Experiences with
        lyon test (magnesium sulfate lavage of duodenum.)
       J.A.M.A. 76: 1567, 1921.
24.    Crohn, B.B. Tabetic crises and associated gastric
       ulcer, Med. Clin. N. Amer. 1161-1171, 1922.
25.    Crohn, B.B., Auster, L.S. Studies in physiology of
       the gallbladder. Am. J. Med. Sc. 164: 345-360, 1922.
26.    Crohn, B.B. Conservative treatment of hour-glass
       stomach. Med. Clin. N. Amer • .§_: 175-185, 1924.
27.    Crohn, B.B., Rosenberg, H. The medical treatment of
       chronic ulcerative colitis (non-specifi~) J.A.M.A •
       .§1: 326-331, 1924.
28.    Crohn, B.B., Weiskopf, s., Aschner, P.W. The life
       cycle of peptic ulcer. Arch. Int. Med. 1i= 405-425,
       1925.
29.    Crohn, B.B., Rosenberg, H. The sigmoidoscopic pic­
       ture of chronic ulcerative colitis (non-specific).
       Am. J. Med. Sc. 170: 220, 1925.
30.    Crohn, B.B. Ocular lesions complicating ulcerative
       colitis. Am. J. Med. Sc. 169: 260-267, l925.
31.    Crohn, B.B., Weiskopf, s., Aschner, P.W. The healing
       of gastric ulcers. Arch. Int. Med. 37: 217-224, 1926.
32.   ·crohn, B.B., et al. Syphilis of the-;1lG>mach. N.Y.
       St. J. Med. 26: 540-541, 1926.
33.    Crohn, B.B., Einhorn, M. Follow-up of 100 cases of
       gastroduod~nal ulcer tr~ated by medical means. Am. J.
      Med, Se. 172: 691•703, 1926.
34.   Crohn, B.B. Affectations of the stomach. W.B. Saunders
      Co. 902 p~ Philadelphia, 1927.
35.   Crohn, B.B. Nonspecific ulcerative colitis. Tr. Sect.
      Gastro-Enterol. & Proct., AMA 136-147, 1927.
36.   Crohn, B.B. Case of congenital hypertrophic pyloric
      stenosis in adult life. Tr. Am. Gastro-Enterol. Ass.
      30: 69-74, 1928.
                                                            63




37.   Crohn, B.B. Congenital pyloric stenosis in adult
      life. J.A.M.A. 90: 197-199, 1928.
38.   Crohn, B.B. Hernia diafragmatica post-traumatica.
      Vida nueva ~: 131-143, 1928
39.   Crohn, B.B. The clinical use of a colloidal aluminum
      hydroxide as a gastric antacid. J. Lab. Clin. Med.
      14: 610-614, 1929.
40.   Crohn, B.B. Pain sensibility: a variable human
      factor. Am. J. Surg. 7: 474-479, 1929.
41.   Crohn, B.B., SchwartZlllan, G. Positive blood cultures
      in nonspecific ulcerative colitis. J. Lab. Clin. Med.
      14: 722-726, 1929.
42.   Crohn, B.B., Schwartzman, G. Positive blood culture
      in nonspecific ulcerative colitis. Tr. Am. Gastro­
      Enterol. A. 31: 326-331, 1930.
43.   Crohn, B.B. Psychoneuroses affecting gastrointestinal
      tract. Bull. N.Y. Acad. Med.~: 155-178, 1930.
44.   Crohn, B.B. Pain sensibility: a variable human factor.
      Tr. Am. Gastro-Enterol. A. 32: 729-753, 1930.
45.   Crohn, B.B., Ginzburg, L., Oppenheimer, G.D. Regional
      ileitis: a pathologic and clinical entity. J.A.M.A.
      99: 1323-1328, 1932.
46.   Crohn, B.B. Gastro-duodenal ulcer and pain sensibility;
      course of ulcer complications as affected by pain in­
      sensitivities. Libman Anniv. Vols.!_: 337-343, 1932.
47.   Crohn, B.B., Gerendasy, J. Traumatic ulcer of the
      duodenum and stomach. J.A.M.A. 100: 1653-1658, 1933.
48.   Crohn, B.B. Broadening concept of regional ileitis.
      Am. J. Dig. Dis. 1: 97-99, 1934.
49.   Crohn, B.B. Functional and nervous disorders of the
      stomach and alimentary tract. Amer. J. Dig. pis. 1:
      773-777, 1935.
50.   Klein, E., Aschner, P~W., Crohn, B.B. End-results of
      partial gastrectomy for primary gastric and duodenal
      ulcers; studies in pre- and post-operative gastric
      secretion. Tr. Am. Gastro-Enterol. A. 36: 197-205,
      1933.
51.   Crohn, B.B., Rosenak, B.D. Exhibition of books shown
      at Graduate Fortnight illustrating progress of gastro­
      enterology. Oct. 22 - Nov. 2, 1934. Bull. N.Y. Acad.
      Med. Q: 74-97, 1935.
52.   Crohn, B.B. Psychic effect of abdominal trauma. Med.
      Clin. N. Amer. 19: 837-845, 1935.
53.   Crohn, B.B., Rosenak, B.D. Follow-up of ulcerative co­
      litis (nonspecific). Am. J. Dig. Dis.~: 343-346, 1935.
54.   Crohn, B.B., Rosenak, B.D. A combined form of ileitis
      and colitis. J.A.M.A • .!.Q.2: 1-7, 1936.
55.   Crohn, B.B. The prognosis in regional ileitis. Amer.
      J. Dig. Dis. l= 736-739, 1936.
                                                             64




~6.    Crohn, B.B., Rosenak, B.D. Traumas resulting from
       sigmoid manipulation. Am. J. Dig. Dis. 2: 678-682,
       1936.
57.    Crohn, B.B. Gastro-duodenal ulcer; etiology; treat­
       ment and end results of treat~ent. J. Connecticut
       Med. Soc. 1: 92-101, 1936.
58.    Berg, A.A., Crohn, B.B. Lymphangiectatic envelope
       of small intestine causing chronic membranous obstruction.
       J. Mt. Sinai Hosp. 4: 203-209, 1937.
59.    Crohn, B.B. Berg, A.A. Right-sided (regional) colitis.
       J.A.M.A. fil: 32-38, 1938.
60.    Crohn, B.B. Gastroduodenal ulcer: etiology, treatment
       and end results. New Eng. J. Med. 218: 148-156, 1938.
61.   Crohn, B.B. Non-specific granulomatous lesions in and
       about ileocecal region. J. Med. !2,: 84-87, 1938.
62.   Crohn, B.B., Schwartzman, G. Ulcer recurrences attri­
       buted to upper respiratory tract infection: possible
       illustration of Schwartzman phenomenon. Am. J. Dig.
       Dis. 4: 705-707, 1938.
63.    Penner, A., Crohn, B.B. Perianal fistulae as a com­
       plication of regional ileitis. Ann. Surg. 108: 867-
       873, 1938.
64.   Crohn, B.B. Regional ileitis and ileocolitis. Encycl.
      Med. (Piersol) 29-36, 1938.
65.   Crohn, B.B. Regional ileitis. Surg., Gynec. Obst.
       68: 314-321, 1938.
66.   Crohn, B.B., Lerner, H.H. Gross hemorrhage as a
      complication of peptic ulcers. Amer. J. Dig. Dis •
      .2,: 15-22, 1939.
67.   Crohn, B.B. Chronic gastritis: clinical aspects. Bull.
      N.Y. Acad. Med. 15: 392-405, 1939.
68.   Crohn, B.B. Regional ileitis. Am. J. Surg • .12_: 74-78,
       1939.
69.   Crohn, B.B., Yarnis, H. Anatomical position of ileum in
      health and disease. Radial. 33: 325-330, 1939.
70.   Crohn, B.B. Recurrences in peptic ulcer. Lahey Birthday.
      pp. 203-204, 1940.
71.   Crohn, B.B., Yarnis, H. Primary ileocecal tuberculosis.
      N.Y. State J. Med • .1Q_: 158-166, 1940.
72.   Crohn, B.B. Peptic ulcer in wartime. Am J. Dig. Dis.
      ~: 359, 1941.
73.   Yunich, A.M., Crohn, B.B. Atypical regional ileitis:
      roentgenological limitations. Am. J. Dig. Dis.~: 185-
      188, 1941.
74.   Crohn, B.B., Yunich, A.M. Ileojejunitis. Ann. Surg.
      ill= 371-380, 1941.
75.   Crohn, B.B. Achbrhydria: its ultimate significance.
      Ass. Life Insur. Med. Dir. Amer.~: 74-88, 1942.
                                                            65




76.    Crohn, B.B., Drosd, R. Halitosis. J.A.M.A. 117:
       2242-2245, 1941.
77.    Drosd, R., Crohn, B.B. Halitosis, true and false.
      Am. J. Dig. Dis. 9: 79-81, 1942.
78.    Crohn, B.B. Halitosis in relation to oral diagnosis.
       Am. J. Orthodont. {Oral Surg. Sect.)~: 109-110,
       1942.
79.    Crohn, B.B. Chronic diarrheas. Mississippi Doctor
       20: 10-13, 1942.
80.   Crohn, B.B. Historical exhibit, commemorating ninetieth
       anniversary of founding of Mount Sinai Hospital. J. Mt.
       Sinai Hosp. 9: 184-206, 1942.
81.   Crohn, B.B. The neurogenic production of duodenal ulcer~
      Am. J. Dig. Dis. 2_: 358, 1942.
82.   Crohn, B.B., Drosd, R. The coated tongue. Gastroenter­
       ology 1_: 34-43, 1943.
83.   Crohn, B.B. Understand your ulcer, a manual for the
       ulcer patient. l 9iR'· Sheridan House, N. Y., 1943.
                      1


84.   Crohn, B.B. The clinical use of succinyl sulfathiazole,
       (Sulfasuxidine). Gastroenterology 1_: 140-146, 1943.
85.   Crohn, B.B. Left pelvic masses. J. Mount Sinai Hosp •
      .!.Q: 238-240, 1943.
86.   Crohn, B.B. The early diagnosis of carcinoma of the
      colon. N.Y. State J. Med. ,i1: 1719-1743, 1943.
87.   Crohn, B.B. Israel Moses, Surgeon. J. Mount Sinai
      Hosp. 10: 512-521, 1944.
88.   Crohn,B.B. Nutrition in Dig. Dis. (book chapter #28)
      pp. 557-576, 1944.
89.   Crohn, B.B. Benign diseases of the small intestine.
      Gastroenterology 2: 385-394, 1944.
90.   Crohn, B.B. Newer advances in our knowledge of gastritis.
      J. Mt. Sinai Hosp. 11: 75-82, 1944.
91.   Garlock, J.H., Crohn, B.B. An appraisal of the results
      of surgery in treatment of regional ileitis. J.A.M.A.
      _!E: 205-208, 1945.
92.   Crohn, B.B. Gastro-enterology at the Mount Sinai
      Hospital. J. Mt. Sinai Hosp. 12: 129-136, 1945.
93.   Crohn, B.B. The use of sulfonamides in ileitis. Gastro­
      enterology _i: 11-13, 1945.
94.   Crohn, B.B. Inflammatory diseases of the small intestine.
      J. Omaha Mid-West. Clin. Soc.z:    77, 1949.
95.   Crohn, B.B. Digestive ulcers, their significance and
      prognosis. Ass. Life Insur. Med. Dir. Amer. (1946) 30:
      177-194, 1947.
96.   Crohn, B.B., Rouse, M.O., Smith, H.W. The relationship
      of trauma to the perforation of peptic ulcer. Gastro­
      enterology 7: 456-463, 1947.
97.   Crohn, B.B.- Peptic ulcer as a psychosomatic disease.
      Surg. Clin. N. Amer. 309-314, Apxil, 1947.
                                                                66




 98.   Crohn, B.B., Garlock, J.H., Yarnis, H. Right-sided
       (regional) colitis. J.A.M.A. lli= 334-338, 1947.
 99.   Crohn, B.B. The relationship of trauma to the
       diseases of the gastro-intestinal tract. Gastro­
       enterology B: 735-742, 1947.
100.   Crohn, B.B.7 Yarnis, H. Continuous fever of in­
       testinal origin. Ann. Int. Med. 26: 858-862, 1947.
101.   Crohn, B.B. The treatment of non:Specific ulcer­
       ative colitis. Med. Ann. District Columbia 16:
       492-493, 1947.
102.   Crohn, B.B. Marriage and maternity, as affected by
       diarrheal diseases. J. Mt. Sinai Hosp. 1±= 265-268,
       1947.
103.   Crohn, B.B. Dr. John L. Kantor. Gastroenterology
       9: 796-798, 1947.
104.   Crohn, B.B. Algunos conceptos sabre el problema
       de la ulcera gastrica y duodenal. Arch. aigent.
       en£erm. ap. digest. nut.~: 238-255, 1947.
105.   Crohn, B.B., Marshak, R.H., Galinsky, D. Repeated
       gastro-duodenal hemorrhages without the discoverable
       explanation. Gastroenterology 10: 120-128, 1948.
106.   Crohn, B.B. Enteritis regional-:- Prensa Medica
       Argentina~: 1801-1803, 1948.
107.   Crohn, B.B. Regional ileitis.   (Book chapter) 731-
       734, 1949.
108.   Crohn, B.B. Regional ileitis. 229p., Grune & Stratton,
       N.Y., 1949.
109.   Crohn, B.B. Regional ileitis. Enferm. ap. digest.
       nut. 22: 238-255, 1949.
110.   Crohn-;-B.B. Ileo-jejunitis. N.Y. State J. Med • .12_:
       1808-1811, 1949.
111.   Crohn, B.B. Differential diagnosis of ulcerative
       colitis. Rev! Gastroenterol., ~: 463-467, 1949.
112.   Crohn, B.B. Dr. Manfred Kraemer. Gastroenterology £:
       1012-1013, 1949.
113.   Crohn, B.B. Regional ileitis. In Tice's Practice or
       Medicine. W.F. Pryor Co., Inc., Hagerstown, Md. z.:
       1949.
114.   Crohn, B.B. Ileitis, regional. In Current Therapy.
       pp. 207-209, 1950.
115.   Crohn, B.B. Ileftis regional. Jornada Pan Amer. de
       Gastroent. 23: 11, 1950.
116.   Crohn, B.B.-The treatment of massive hemorrhage of
       peptic ulcer origin. U. West. Ontario Med. J. ~:
       98, 1950.
117.   Crohn, B.B. Gastroenterology as a surgical specialty
       at The Mount Sinai Hospital. J. Mt. Sinai Hosp. g:
       843-847, 1951.
118.   Crohn, B.B., Yarnis, H. Present trends in the treat­
       ment of ulcerative colitis. N.Y. State J. Med. 51:
       2129-2135, 1951.
                                                                 67




119.   Garlock, J.H., Crohn, B.B., Klein, S.H., Yarnis, H.
       An appraisal of the long-term results of surgical
        treatment of regional ileitis. Gastroenterology 19:
       414-423, 1951.                                    -
120.   Marshak, R.H., Priedman, A.I., Wolf, B.S., Crohn, B.B.
       Roentgen findings in ileo-jejunitis. Gastroenterology
       .!2.= 383-413, 1951.
121.   Crohn, B.B., Janowitz, H.D. The modern treatment of
       massive hemorrhage of peptic ulcer origin. Gastro­
        enterology 19: 605-619, 1951.
122.   Crohn, B.B.-Dr. Albert A. Berg (1872-1950). Gastro­
        enterology 18: 145-146, 1951.
123.   Janowitz, H.D., Crohn, B.B. Hyperinsulinism and
       duodenal ulcer; a rare clinical combination. Gastro­
        enterology 17: 578-580, 1951.
124.   Crohn, B.B.-Presentation of Julius Friedenwald Medal
        to Dr. Walter C. Alvarez. Gastroenterology 19: 148-
       151, 1951.
125.   Crohn, B.B., Turner, D.A. Porcine ileitis. Gastro­
       enterology Feb., 1952.
126.   Crohn, B.B., Ginzburg, L., Oppenheimer, G.D. Regional
       ileitis; pathologic and clinical entity. Am. J. Med.
       13: 583-590, 1952 (reprint, 1932.)
127.   Crohn, B.B. Need for aggressive therapy in massive
       upper gastrointestinal hemorrhage. J.A.M.A. ffi: 625-
       629, 1953.
128.   Crohn, B.B. Milton Harris Redish, M.D. 1911-1952.
       Gastroenterology 23: 676, 1953.
129.   Crohn, B.B. Regional enteritis. Maryland Med. J. 3:
       537-546, 1954.
130.   Crohn, B.B., Janowitz, H.D. Reflections on regional
       ileitis, 20 years later. J.A.M.A. lli= 1221-1225, 1954.
131.   Crohn, B.B. Joseph Felsen, 1892-1955. Gastroenterology
       29: 323, 1955.
132.   Crohn, B.B. Symposium on regional ileitis; early days
       of regional ileitis at Mount Sinai Hospital -- reminis­
       cences. J. Mt. Sinai Hosp. g: 143-146, 1955.
133.   Crohn, B.B. Regional ileitis. Med. Clin. N. Amer. iQ_:
       513-518, 1956.
134.   Crohn, B.B. Indications for ileostomy and colectomy in
       ulcerative colitis. N.Y. J. Med. 56: 860-863, 1956.
135.   Crohn, B.B. et·;a1. Ulcerative colitis and pregnancy.
       Gastroenterology 30: 391-403, 1956.
136.   Crohn, B.B. et al-.- Ulcerative colitis as affected by
       pregnancy. N.Y. J. Med. 56: 2651-2657, 1956.
137.   Crohn, B.B. Indications for surgical intervention in
       regional ileitis. A.M.A. Arch. Surg. 74: 305-311, 1957.
138.   Yarnis, H., Marshak, R.H., Crohn, B.B.-Ileocolitis.
       J.A.M.A. 164: 7-13, 1957.
139.   Amendela,F.H., Crohn, B.B., Reznikoff, P., Rousselot,
       L.M. Management of severe upper gastrointestinal hem­
       orrhage. Bull. N.Y. Acad. Med. 11: 405-427, 1957.
                                                                68




140.   Crohn, B.B. Life cycle of regional ileitis. Gastro­
       enterology li= 300-305, 1958.
141.   Crohn, B.B. Current status of therapy in regional
       ileitis. Gastroenterology 166: 1479-1480, 1958.
142.   Crohn, B.B., Engel, G.L., Flood, C.A., Garlock, J.H.
       Management of ulcerative colitis. Bull. N.Y. Acad.
       Med. 34: 366-386, 1958.
143.   Crohn-;-B.B. Life history of regional enteritis.
       Gastroenterologia 89: 352-358, 1958.
144.   Crohn, B.B. The first William Beaumont Lecture.
       Wisconsin Med. J. 58: 115-120, 1959.
145.   Crohn, B.B. Abraham L. Levin Memorial Lecture:    regional
       ileitis; ileojejunitis; combined ileocolitis. Am. J.
       Gastro. 31: 536-550, 1959.
146.   Crohn, B.B. Knud Blege Faber, 1862-1956. Gastroenterology
       37: 489, 1959.
147.   Crohn, B.B. Rectal complications of inflammatory disease
       of the small and large bowel. Dis. Colon Rectum l.= 99-
       102, 1960.
148.   Yarnis, H., Crohn, B.B. Segmental (ulcerative) colitis.
       Gastroenterology ~ : 721-728, 1960.
149.   Crohn, B.B. An historic note on ulcerative colitis.
       Gastroenterology £: 366-367, 1962.
150.   Crohn, B.B. Richard Lewisohn, 1975-1961. Gastroenterology
       43: 353, 1962.
151.   Crohn, ,B.B. Psychosomatic factors in ulcerative colitis
       in children. N.Y. J. Med.~: 1456-1457, 1963.
152.   Crohn, B.B. Carl Koller and cocaine. J. Mt. Sinai Hosp.
       11: 430-432, 1964.
153.   Crohn, B.B. Regional ileitis. Postgrad1 Med. 2.§_: 276-281,
       1965.
154.   Crohn, B.B. The pathology of acute regional ileitis.
       Am. J. Dig. Dis. 10: 565-572, 1965.
155.   Crohn, B.B. Acuteregional ileitis; clinical aspects and
       follow-up studies. N.Y. J. Med. 65: 641-644, 1965.
156.   Lust, G., Crohn, B.B., Hartman, J. Nonspecific granulo­
       matous disease involving duodenum, jejunum and ileum. Am.
       J. Gastro. 43: 40-48, 1965.
157.   Crohn, B.B.-In memoriam: John H. Garlock, 1896-1965.
       J. Mt. Sinai Hosp. 11= 361-364, 1966.
158.   Crohn,· B.B., Yarnis, H. Granulomatous colitis: an attempt
       at classification.   J. Mt. Sinai Hosp. ~3: 503-513, 1966,
159.   Crohn, B.B. Granulomatous diseases of the small and large
       bowel. A historical survey. Gastroenterology 52: 767-772,
       1967.                                        -
INDEX OF PERSONAL NAMES
                  INDEX OF PERSONAL NAMES


                                                                      Page
Aaron, A. H.                                                     .    .32, 33
Aaron, Charles D.                                           ..        32
Alvarez, Walter c.                                                    39,43,53
Babkin, B. P.                  .                                      45
Bargen, J. A.                                                .        15,17,33,34,53
Bastedo, Walter                                     .                 28
aenedict, A. L.                                                       32
Berg, A. A.                                    .                 ..   7-8,15,26,27,
                                                                         28,29,42
Bevan, Aneurin                     ..                            .    52
Bockus, Henry .                                                       33,34,35,43,54
Boles, Mary                                                           38,39
Boles, Russell                                                        33,38,53
Brill, Nathan                                                         20
 Bryant, John                                                         53
Burge, H. w.                                                          40
Cannon, w. B.                                                         43,44
Carlson, A. J.                                                        44,45
Cave, Henry            .                                              29
Chace, Arthur                  .                                      26
Checkhov, Anton                                         .             22
Colp, Ralph                                                           27,28,29,40
Comfort, Mandred                                                      38
Cornell, Beaumont                                                     45
Crohn, B.B.
    Wife                               .                .             1
    Parents.                                                          3-5
    Son                                                               56-57
Daniels, George            .                            .             29
Dragstedt, Lester                                                     40
Einhorn, Max.                  .               ..                     11,20,24,54
Elsner, Henry .                                                       32
Eusterman, George                      .   .        .                 39,40
Fleming, Sir Alexander.                                               19
Fowler, George                                                        55
Friedenwald, Julius                    .                .             33
Garlock, John     .                                                   27,28,29
Geiss, Professor                                        .             6
Ginzberg, Leon                                                        15
von Haberer, Professor                                                7
Hurst, Sir Arthur                                                     38,39
Jo·nes, Allen A.                                                      32
Jones, Chester                                                        53
Jones, Clement                                                        53
Jordan, Sara                                                          33,37,43,53
Kast, Ludwig                                                          53
Kaufmann, Jacob •          ..      .                                  11,24
Killian, John                                                        29
Kirsner, Joseph                                                      13,45
Komara£, s. A.                                                       45
Lahey, Frank                                                         36,37,43,53
Lewisohn, Richard      .                        ...                  7 ,28
Libman, Emanuel                                                      6,11
Lockhardt-Mummery, H. E.                                             16
Lyon, B. B. v.                                                       35,38,53
McClellan, General G. H.                                             22
Manges, Morris                                                       11,25
Mayo, William J.                   ..                                11,41
Meltzer, s. J.                                                       24, 32, 35, 54
Metchnikoff, E.                             .                        48
Mills, Walter                                                        12
Morson, Basil                               .                        16
Moschcowitz, Eli                                                     15
Moses, Israel                       .       .                        21
Mower, Penfield                                                      34
Osler, w.            . ..                            .               58
Palmer, Walter                                   .                   45
Rafsky, Henry           .                   .            .           26
Rehfuss, Martin                                                      20,24
Roosevelt, Franklin D.                                           .   37
Shattuck, Howard .                                                   53
Simon, Charles                                       .               33
Smithies, Frank                                                      21,45,53
Solomon, Emanuel                                                     14
Stetten, DeWitt                .                                     24
Stewart, William .         .        ..                               25
Stockton, Charles G.                                                 33
Wangensteen, Owen.   •                          ..           .       40
Weingarten, Fred s.            .                 . .                 6
Wilensky, A. o.                         .   •    . •                 7 ,10