Wednesday, January 20, 2016

1600-1800: Physicians study pneumonia

After Hippocrates defined pneumonia in 400 B.C., little more was learned about this disease and its treatment.  The same was true of the Middle Ages, where the only discussion about it was by physicians living among the Eastern world.

Maimonides, a Jew living among Arabs, was a physician whose medical ideas were greatly appreciated.  He mentioned pneumonia, and said:
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."
This was the most accurate description of the disease up to this time, and the first to be remotely similar to the modern description of the disease.

Scottish physician and asthmatic William Cullen described pneumonia as either inflammation of the "viscera of the thorax or the membrane lining that cavity." (2, page 3)

 In 1792, Dr. Jean P. Frank mentioned that pneumonia "must be studied under the common name pleuro-pneumonia."(2, page 3)

While one cannot deny that historic accounts and descriptions of epidemics were accurate, the descriptions of the way people died were often eerily similar to what doctors of today would diagnose as pneumonia.    

So while people suffering from the Black Plague, for example, may actually have been infested and diagnosed with the plague, many may have had their immune systems so wiped out that it was easy for pneumonia to set in.  (2, page 4-5)

This may explain monk descriptions as cough, bloody spitting, diarrhea and vomiting and fever, catarrh, difficulty breathing, pain in the side, weakness, delirium and quite often death. (2, page 4-5)

Pneumonia symptoms were also described during influenza outbreaks, which suggest that the flu weakened the immune response to the point where pneumonia set it.

Such an outbreak occurred in 1762, 1775, 1782 and again in 1837.

The death of the garrison of Philisbourg, in 1688,  was attributed to exposure to a "cold north wind... and camp life." (2, page 6)

Bleeding continued to be a common treatment for pneumonia.  Autopsies results on the garrison of Philsbourg ,and others afflicted with the disease,  described the lungs as "actively inflamed and hepatised, and in many parts purulent, the chest and pericardium filled with bloody serum and polypi in the right auricle of the heart." (2, page 6)

Hermann Boerhaave  published Aphorisms in 1709 and described that lobar pneumonia should be recognized as a separate disease from other infections of the lungs.  (6, page 3)

Giovanni Battista Morgagni recognized that pneumonia caused a solidification in a lobe of the lungs and referred to it as lobar pneumonia. (8, page 193)

John Huxham (1692-1768)
John Huxham, an English physician who wrote an "Essay on Fevers" in 1755, studied the writings of Hippocrates, Celsus and Aureatus, and, based on his own observations of diseases, came up with remedies for the various medical conditions.

One thing of significance regarding Huxham is he was in ardent opposition to what he referred to as quack medical therapy.

For the treatment of pneumonia he developed a procedure called the "Huxham tincture."  It was a medicinal drink that was recommended by physicians for many years.

Matthew Ballie spent quality time performing post mortem studies, and he described many diseases of the lungs.  In 1793 he described the inflamed parts of the lungs (pneumonia) as being covered by a solid mass similar to a liver, and he referred to it as "hepatisation."  (8, page 193)

So we can see that, even heading into the 19th century, little changes had occurred regarding the description and treatment for pneumonia.

  1. "Leading Cause of Death, 1900-1998,"
  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,"
  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
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