Medical treatment of ulcerative colitis.

Medical treatment of ulcerative colitis in the period 1934-1949 sorely tested the patience and optimism of both patient and doctor. Some principles remain as important today as they were then, a diet generous in protein and calories, mineral and iron replacement, and blood transfusion. Other aspects sound unfamiliar such as prolonged bed rest and a strict low-residue diet. Two advances around 1950 promised new hope and Avery Jones, with his unerring instinct for progress, marked them both. In 1950, the first encouraging results were described of treatment with the newly available hormones, cortisone and corticotrophin. Around the same time, Bryan Brooke was perfecting his new technique for construction of an ileostomy by manually everting the mucosa to bring it into apposition with skin. Physicians and surgeons long frustrated by their relative ineffectiveness in treatment sensed success and joined forces with enthusiasm. Avery Jones invited his surgical colleagues at the Central Middlesex Hospital to treat colitis in medical wards. Conversely, in 1950, the surgeons at St Mark's Hospital invited him to join them as Consulting Gastroenterologist and introduce new medical treatments there. The advent of corticosteroids came at just the time when the concept of the controlled therapeutic trial was gaining force. By 1952, there were many anecdotal reports of improvement in colitis with cortisone and corticotrophin but, to quote Truelove and Witts (1954), 'in none ... was there a formal trial in which some patients received therapy and some did not'. To remedy this uncertainty, these two had begun in 1952 a double-blind trial of cortisone against a dummy tablet 'to decide the issue'. They invited Avery Jones and Richard Doll, among others, to collaborate and the result was a classic of medical literature (Truelove and Witts, 1955) which proved the efficacy of cortisone beyond all doubt. Stimulated by this success, the same team, slightly enlarged, went on to compare the effectiveness of cortisone and corticotrophin in acute disease and to test the possible use of cortisone in prolonging remission (Truelove and Witts, 1959). Since many patients with colitis can be treated outside hospital, Avery Jones started a special clinic at St Mark's Hospital for their care from which the results of a series of controlled therapeutic trials in out-patients have been reported. The following account of current treatment in colitis is based on such trials performed at various centres and on knowledge gained by close collaboration with surgical colleagues. Avery Jones, by his initiative and leadership, has greatly affected the treatment of colitis. Many sufferers have cause individually to be grateful for his concern and care; as a group they can thank him for his contribution to knowledge about treatment of their disease.