Crime detective: towards the first description of inflammatory bowel diseases

Abstract

Background. The first scientific description of inflammatory bowel disease refers to the pathologoanatomic work of Samuel Wilkes. This sectional research is related to a real detective story, which had a great public response in Victorian England. The story focuses on the death of Isabella Banks, which happened with the occurrence of fast-flowing intestinal disease. The young woman had been suffering for several weeks and died mysteriously. During the investigation of the case, there was a supposition that there was poisoning, which could have been committed by the husband of the dead, a doctor Thomas Smethurst. The initial data of the investigation, based on authorities in the field of toxicology, confirmed this supposition, and at the first court hearings the doctor was found guilty. According to the results of the investigation, the doctor poisoned his wife with arsenic. Thomas Smethurst was given a death sentence. However, further investigation led to fundamental changes: the toxicological examination turned out to be misleading. The pathology report stated that in the large intestine, "the mucous membrane was ulcerated from edge to edge". There were ulcers of all sizes, most often the size of a "sixpence coin" and "mostly isolated, although some fused together”. In the blind intestine "there was inflammation of the most acute and intense character ... beneath it the exposed muscular membrane was visible... Another striking phenomenon on the inner surface of the intestine, besides desquamation and ulceration, was the effusion of blood, which was observed everywhere, but especially in the blind intestine". The doctor was acquitted, and the death of Isabella Banks was regarded as the manifestation of the disease.
Conclusion. Subsequently, this disease was related to inflammatory bowel diseases; for a long time it was regarded as the first description of ulcerative colitis, however, recently, a lot of experts have considered it as the first description of Crohn's disease. The real cause of Isabella Banks' death is still unclear, although the authors of the article suggest the possibility of the development of toxic megacolon.