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[[Image:Hippocrates.jpg|thumb|180px|[[Hippocrates]], the ancient Greek physician known as the "father of medicine."]]
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{{Pneumonia}}
{{Pneumonia}}


'''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh@perfuse.org]
{{CMG}}; {{AE}} {{HQ}}, {{SSK}}, [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh13579@gmail.com]
==Overview==
==Overview==
Sir [[William Osler]], known as "the father of modern medicine," appreciated the morbidity and mortality of pneumonia, describing it as the "captain of the men of death" in 1918. However, several key developments in the 1900s improved the outcome for those with pneumonia. With the advent of [[penicillin]] and other antibiotics, modern surgical techniques, and intensive care in the twentieth century, mortality from pneumonia dropped precipitously in the developed world. Vaccination of infants against ''[[Haemophilus influenzae]]'' type b began in 1988 and led to a dramatic decline in cases shortly thereafter.<ref name=adams>Adams WG, Deaver KA, Cochi SL, et al. Decline of childhood Haemophilus influenzae type b (Hib) disease in the Hib vaccine era.''JAMA''1993;269:221-6. PMID 8417239</ref> Vaccination against ''Streptococcus pneumoniae'' in adults began in 1977 and in children began in 2000, resulting in a similar decline.<ref name=whit>Whitney CG, Farley MM, Hadler J, et al. Decline in invasive pneumococcal disease after the introduction of pneumococcal protein-polysaccharide conjugate vaccine.'' New Engl J Med''. 2003;348:1737–1746. PMID 12724479</ref>
The pneumonia syndrome has been recognized since ancient times. It was initially described by [[Hippocrates]] who recorded his observations of its symptoms and complications. Edwin Klebs was the first to identify bacteria in the lungs of patients who died from pneumonia in 1875. This discovery was soon-after substantiated by the works of Carl Friedländer and Albert Fränkel who were the first to identify ''[[Streptococcus pneumoniae]]'' as a causative agent. The introduction of the [[Gram staining|gram stain]] subsequently led to the discovery of other causative organisms. Despite being an important cause of [[Mortality rate|mortality]] before the late twentieth century, the advent of [[Antibiotic|antibiotics]], modern surgical techniques, and [[vaccination]] drastically lowered the [[morbidity]] and [[Mortality rate|mortality]] of pneumonia with the turn of the century.
 
==Historical Perspective==
==Historical Perspective==
The symptoms of pneumonia were described by [[Hippocrates]] (c. 460 BC–380 BC) as:
===Discovery===
{{cquote|
*Pneumonia was first discovered by [[Hippocrates]].
Peripneumonia, and pleuritic affections, are to be thus observed: If the fever be acute, and if there be pains on either side, or in both, and if expiration be if cough be present, and the sputa expectorated be of a blond or livid color, or likewise thin, frothy, and florid, or having any other character different from the common... When pneumonia is at its height, the case is beyond remedy if he is not purged, and it is bad if he has dyspnoea, and urine that is thin and acrid, and if sweats come out about the neck and head, for such sweats are bad, as proceeding from the suffocation, rales, and the violence of the disease which is obtaining the upper hand.''}}
*In 1817, Dr. Simpson of United Kingdom was the first to report a case of pneumonia treated with blood letting.<ref name="pmid29257545">{{cite journal| author=| title=Case ofPneumonia, Where the Extent to Which Blood-Letting May Be Successfully Carried Is Fully Exemplified. | journal=Med Chir J Rev | year= 1817 | volume= 4 | issue= 24 | pages= 460-463 | pmid=29257545 | doi= | pmc=5570882 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29257545  }} </ref>
<br>
*In 1842, Dr. Edward Newfold of United Kingdom was the first to report a case of [[Typhoid fever|typhoid]] pneumonia.<ref name="pmid21373079">{{cite journal| author=Newbold E| title=Case of Typhoid Pneumonia. | journal=Prov Med J Retrosp Med Sci | year= 1842 | volume= 4 | issue= 84 | pages= 87 | pmid=21373079 | doi= | pmc=2489819 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21373079  }} </ref>
However, Hippocrates himself referred to pneumonia as a disease "named by the ancients." He also reported the results of surgical drainage of empyemas. Maimonides (1138–1204 AD) observed "The basic symptoms which occur in pneumonia and which are never lacking are as follows: acute fever, sticking [pleuritic] pain in the side, short rapid breaths, serrated pulse and cough."<ref name=maimo>Maimonides, ''Fusul Musa'' ("''Pirkei Moshe''").</ref> This clinical description is quite similar to those found in modern textbooks, and it reflected the extent of medical knowledge through the Middle Ages into the 19th century.
*In 1875, Dr. Edwin Klebs was the first to discover the association between [[bacteria]] and the development of pneumonia.
<br><br>
Bacteria were first seen in the airways of individuals who died from pneumonia by [[Edwin Klebs]] in 1875.<ref name=klebs>Klebs E. Beiträge zur Kenntniss der pathogenen Schistomyceten. VII Die Monadinen. ''Arch. exptl. Pathol. Parmakol.'' 1875 Dec 10;4(5/6):40–488.</ref> Initial work identifying the two common bacterial causes ''Streptococcus pneumoniae'' and ''Klebsiella pneumoniae'' was performed by [[Carl Friedländer]]<ref name=fried>Friedländer C. Über die Schizomyceten bei der acuten fibrösen Pneumonie.'' Virchow's Arch pathol. Anat. u. Physiol.'' 1882 Feb 4;87(2):319–324.</ref> and Albert Fränkel (1848-1916)<ref name=fraenkel>Fraenkel A. Über die genuine Pneumonie, Verhandlungen des Congress für innere Medicin. ''Dritter Congress''. 1884 April 21;3:17–31.</ref> in 1882 and 1884, respectively. Friedländer's initial work introduced the [[Gram staining|Gram stain]], a fundamental laboratory test still used to identify and categorize bacteria. Christian Gram's paper describing the procedure in 1884 helped differentiate the two different bacteria and showed that pneumonia could be caused by more than one microorganism.<ref name=gram>Gram C. Über die isolierte Färbung der Schizomyceten in Schnitt- und Trocken-präparaten.'' Fortschr. Med''. 1884 March 15;2(6):185–189.</ref>
<br><br>
===Early classification schemes===


Pneumonias can be classified in several ways. Pathologists originally classified them according to the [[anatomy|anatomic]] changes that were found in the lungs during [[autopsy|autopsies]]. As more became known about the microorganisms causing pneumonia, a [[microbiology|microbiologic]] classification arose, and with the advent of [[x-ray]]s, a [[radiology|radiological]] classification. Another important system of classification is the combined clinical classification, which combines factors such as age, risk factors for certain microorganisms, the presence of underlying lung disease and underlying systemic disease, and whether the person has recently been hospitalized.
==Landmark Events in the Development of Treatment Strategies==
Initial descriptions of pneumonia focused on the anatomic or [[pathology|pathologic]] appearance of the lung, either by direct inspection at [[autopsy]] or by its appearance under a [[microscope]]. A ''lobar'' pneumonia is an infection that only involves a single lobe, or section, of a [[lung]]. Lobar pneumonia is often due to ''[[Streptococcus pneumoniae]]''. ''Multilobar'' pneumonia involves more than one lobe, and it often causes a more severe illness.''Interstitial'' pneumonia involves the areas in between the alveoli, and it may be called "interstitial pneumonitis." It is more likely to be caused by viruses or by atypical bacteria. The discovery of x-rays made it possible to determine the anatomic type of pneumonia without direct examination of the lungs at autopsy and led to the development of a [[radiology|radiological]] classification. Early investigators distinguished between typical lobar pneumonia and atypical (e.g. Chlamydophila) or viral pneumonia using the location, distribution, and appearance of the opacities they saw on chest x-rays. Certain x-ray findings can be used to help predict the course of illness, although it is not possible to clearly determine the microbiologic cause of a pneumonia with x-rays alone.
*In 1902, Dr. Wright discovered the [[pneumococcal]] [[vaccine]] as a preventative treatment of pneumonia.<ref name="pmid20764553">{{cite journal| author=Harris AB| title=Observations on the Therapeutic Value of the Pneumococcus Vaccine in the Treatment of Pneumonia and some of its Complications. | journal=Br Med J | year= 1909 | volume= 1 | issue= 2530 | pages= 1530-5 | pmid=20764553 | doi= | pmc=2320626 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20764553  }} </ref>


==References==
==References==
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Infectious disease]]
[[Category:Pneumonia|Pneumonia]]
[[Category:Pneumonia|Pneumonia]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
{{WH}}
{{WS}}

Latest revision as of 23:45, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2], Serge Korjian M.D., Priyamvada Singh, M.D. [3]

Overview

The pneumonia syndrome has been recognized since ancient times. It was initially described by Hippocrates who recorded his observations of its symptoms and complications. Edwin Klebs was the first to identify bacteria in the lungs of patients who died from pneumonia in 1875. This discovery was soon-after substantiated by the works of Carl Friedländer and Albert Fränkel who were the first to identify Streptococcus pneumoniae as a causative agent. The introduction of the gram stain subsequently led to the discovery of other causative organisms. Despite being an important cause of mortality before the late twentieth century, the advent of antibiotics, modern surgical techniques, and vaccination drastically lowered the morbidity and mortality of pneumonia with the turn of the century.

Historical Perspective

Discovery

  • Pneumonia was first discovered by Hippocrates.
  • In 1817, Dr. Simpson of United Kingdom was the first to report a case of pneumonia treated with blood letting.[1]
  • In 1842, Dr. Edward Newfold of United Kingdom was the first to report a case of typhoid pneumonia.[2]
  • In 1875, Dr. Edwin Klebs was the first to discover the association between bacteria and the development of pneumonia.

Landmark Events in the Development of Treatment Strategies

References

  1. ↑ "Case ofPneumonia, Where the Extent to Which Blood-Letting May Be Successfully Carried Is Fully Exemplified". Med Chir J Rev. 4 (24): 460–463. 1817. PMC 5570882. PMID 29257545.
  2. ↑ Newbold E (1842). "Case of Typhoid Pneumonia". Prov Med J Retrosp Med Sci. 4 (84): 87. PMC 2489819. PMID 21373079.
  3. ↑ Harris AB (1909). "Observations on the Therapeutic Value of the Pneumococcus Vaccine in the Treatment of Pneumonia and some of its Complications". Br Med J. 1 (2530): 1530–5. PMC 2320626. PMID 20764553.

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