Tuesday, May 19, 2015

1920-1980: Pneumonia is finally tackled

For most of mankind, deadly diseases like influenza and tuberculosis were the main focus of the medical profession.  It was only when these diseases were tackled were physicians able to focus on other diseases, like pneumonia.

In 1928, Sir Alexander Fleming observed that colonies of the Bacterium Staphylococcus that he was growing in a colony were dissolving.  He later discovered the plates had been infested by a blue-green mold, and he determined it was this mold that was responsible for the bacteria dissolving.  He later grew the mold in its pure form and discovered that it killed many different kinds of bacteria. (5)

The mold he used was Peiciillium notatum.  The importance of this discovery was not known until 1939 when Howard Florey and Ernst Chain isolated the active ingredient and developed a powdered form of it.  (5)

Several Eurpean and American scientists worked together to work on a therapeutic medicine that could be used to treat bacterial infections.

By 1941 they had succeeded, and penicillin studies were performed.  In 1944 antibiotics were made available to treat allied soldiers wounded on the battlefield.

Incidence of pneumonia started to decline in 1937 due to improved medicine. So oxygen therapy, coupled with penicillin, helped decrease the rate of pneumonia deaths.  Yet cases of pneumonia continued to be prevalent.

For example, operations weren't commonly performed in hospitals until the 1950s when effective aneasthetics and breathing machines were made available. These were exciting times among the medical profession, as for the first time in history physicians were able to hone in their surgical skills to the benefit of mankind.

This excitement was stymied somewhat during the 1960s and 1970s when physicians started observing a high incidence of post operative pneumonia, particularly among abdominal surgeries, and despite the use of antibiotics.

Similar observations were made among patients taking large amoungs of sedatives and narcotics.

It was quickly realized that further research needed to be done to determine the cause, and therefore a means of preventing these patients from developing pneumonia.

Studies soon concluded that humans were naturally inclined to action, that when a person was restricted to bed, this resulted in ill health.

That people naturally sigh 3-4 times in an hour in order to exercise the lungs and clear secretions, in an effort to keep the lungs sterile.  Sedatives, and painful surgeries, resulted in patients not taking deep breaths, and this resulted in an increase in the risk for developing pneumonia.

Preventative measures were then established, which mainly included having patients roll over, sit up, stand, and walk as soon as possible after surgery, even if the patients have to push themselves to the pain threshold.

Various devices were then invented with the intent of preventing alveoli from collapsing, and pneumonia from developing.  One device was a blowby device that encouraged patients to blow balls into jars.  Another device was called in incentive spirometer, which encouraged people to inhale and cough.

Morbidity and mortality for post operative pneumonia steadily declined.

Pneumonia in general declined when a pneumonia vaccine hit the market in 1977, and again when a pneumonia vaccine for children hit the market in 2000.

Thanks to all these innovations pneumonia is not the sixths leading cause of death, as opposed to the leading cause of death in the 1930s.

It's true that pneuomonia will continue to inflict people with diminished immune systems, such as the elderly and sick.  Yet with a growing plethera of medical knowledge, physicians have been able to greatly reduce the incidence of this disease, and in the process, prevent many deaths from the malady.

  1. "Leading Cause of Death, 1900-1998," http://www.cdc.gov/nchs/data/dvs/lead1900_98.pdf
  2. Sturges, Octavius, "The Natural History and Relations of Pneumonia," London, 1876
  3. "History of Pneumonia," The British Medical Journal,  Jan. 19, 1952, pages 156-158
  4. Schmitt, Steven K., "Oral Therapy for Pneumonia:  Who, When, and With What?" editorial, Journal of Clinical Outcomes Management,  March, 1999, vol 6, No 3, pages 48-50
  5. Bellis, Mary, "The History of Penicillin," http://inventors.about.com/od/pstartinventions/a/Penicillin.htm
  6. Marrie, Thomas J, "Community Acquired Pneumonia," 2001, New York, chapter one by Jock Murray, "The Captain of Men and Death: The History of Pneumonia."
  7. Auld, A.G., "The Pathological Histology of Bronchial Affections," The Lancet, Aug. 6, 1892, page 312
  8. Allbutt, Clifford, ed, A System of Medicine, 1909, Toronto, chapter on "Lobar Pneumonia,"  by P.H. Pye-Smith, pages 191-205
  9. Addison, Thomas, "A Collection of the published works of Thomas Addison," 1868, 
  10. Auld, A.G., "Fibroid Pneumonia," The Lancet,  June 13, 1891, page 1308-1310
  11. "Nikolai Fedorovich Gamaleia, The Free Dictionary by Farlex, http://encyclopedia2.thefreedictionary.com/Nikolai+Fedorovich+Gamaleia
  12. Osler, William, "The Principles and Practice of Medicine," 1898, 3rd ed., New York
  13. *Photo compliments of sciencephotolibrary.com
  14. "Plutarch," britannica.com, http://www.britannica.com/EBchecked/topic/465201/Plutarch, accessed 7/20/14
  15. Laennec, Rene, "Mediate Auscultation," translated by John Forbes, Notes by professor Andral, 4th edition, 1838, New York, Samuel S. and William Wood, pages 84-87 for bronchitis treatment, and 175-177 for emphysema treatment
  16. Andras, author of the notes in the book, "Mediate Auscultation, by Rene Laennec," ibid
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