Wednesday, January 20, 2016

1679: The term emphysema is coined

Theophile Bonet (1620-1689)
The 42-year-old Alaskan woman sat by the crackling fire 1,600 years before the birth of Christ.  She was severely winded after just a short walk with the children. Her chest heaved up and down, occasionally interrupted by a dry, hacking, painful cough.

"I can no longer do  this," she decided, working hard to stop the tears.  The children stood around her silent and concerned.  These episodes were happening more frequently now, so often that she could barely stand it.  "I'm fine," she said.  It was a lie.

Looking into our prism we can see the woman obviously suffered from Cronic Obstructive Pulmonary Disease (COPD), although back then the disease she suffered from was poorly understood. In Alaska there may have been no treatment at all other than rest.

We know she probably acquired the disease gradually over time as she continued to inhale smoke from the same fires she used to cook food for the children and their parents.  We know she probably died slowly from lack of oxygen.

Nearly 1,600 years later, a Greek physician named Hippocrates described asthma for the medical community, describing it as dyspnea, or shortness of breath.  He was not aware of different causes of dyspnea, so they were all included under his umbrella term asthma.

Yet somewhere, tucked nicely under this umbrella, were patients who had inhaled some microscopic substances, perhaps a chemical, that caused changes of some airway tissue and destruction of others.  The end result were diseases we now refer to as chronic bronchitis and emphysema, and that we lump under the umbrella term chronic obstructive pulmonary disease.

It would be another 2,000 years before emphysema would be described around 1650 A.D.  The 17th century was well known as a time when physicians were performing autopsies in order to match symptoms observed in life with changes that occurred within the body.

Emphysema became a term that would be used to describe lungs that were larger than normal due to the fact they held abnormal amounts of air.  The term would come from the Greek term physe, which means "to blow into."  They did not, however, understand why the lungs had extra air blown into them, so this resulted in much speculation.

So it was in the year 1679  that a Swiss physician named Theophile Bonet performed over 3,000 autopsies on patients he followed, and was among the first to describe emphysema as a medical condition of "voluminous lungs" in his book Sepulchretum. (2) (3) (4)

Giovanni Morgagni (1682-1771) wrote how he respected the works of Bonet, and he himself described 19 cases of "turgid" lungs in his classic work "On the seats and causes of disease." (3)

About 200 years after the death of Morgagni, the mummy of a 1,600 year old woman was discovered in Alaska. The woman was found to have evidence of emphysema, and this may be the oldest reported case of COPD.  (1, page 85).

References:
  1. Qutayba Hamid, Joanne Shannon, James Martin, "Physiologic Basis of Respiratory Disease," 2005, Montreal, page 85-99
  2. Bhatia, K. Sujata, "Biomaterials for Clinical Application," 2010, London, page 100
  3. Petty, Thomas L, "The History of COPD,"Int. J. Chron. Obstruct. Pulmon. Dis., 2006, March; 1(1): 3-14
  4. Crellin, J. M.D., "Selected Items from the history of pathology," Am J Pathol. 1980 January; 98(1): 212.
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