Pneumonia historical perspective
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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Philip Marcus, M.D., M.P.H.[2]
Historical Perspective
The symptoms of pneumonia were described by Hippocrates (c. 460 BC–380 BC):
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.
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."[1] 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.
Bacteria were first seen in the airways of individuals who died from pneumonia by Edwin Klebs in 1875.[2] Initial work identifying the two common bacterial causes Streptococcus pneumoniae and Klebsiella pneumoniae was performed by Carl Friedländer[3] and Albert Fränkel (1848-1916)[4] in 1882 and 1884, respectively. Friedländer's initial work introduced the 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.[5]
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.[6] Vaccination against Streptococcus pneumoniae in adults began in 1977 and in children began in 2000, resulting in a similar decline.[7]
References
- ↑ Maimonides, Fusul Musa ("Pirkei Moshe").
- ↑ Klebs E. Beiträge zur Kenntniss der pathogenen Schistomyceten. VII Die Monadinen. Arch. exptl. Pathol. Parmakol. 1875 Dec 10;4(5/6):40–488.
- ↑ Friedländer C. Über die Schizomyceten bei der acuten fibrösen Pneumonie. Virchow's Arch pathol. Anat. u. Physiol. 1882 Feb 4;87(2):319–324.
- ↑ Fraenkel A. Über die genuine Pneumonie, Verhandlungen des Congress für innere Medicin. Dritter Congress. 1884 April 21;3:17–31.
- ↑ Gram C. Über die isolierte Färbung der Schizomyceten in Schnitt- und Trocken-präparaten. Fortschr. Med. 1884 March 15;2(6):185–189.
- ↑ Adams WG, Deaver KA, Cochi SL, et al. Decline of childhood Haemophilus influenzae type b (Hib) disease in the Hib vaccine era.JAMA1993;269:221-6. PMID 8417239
- ↑ 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