Friday, April 15, 2016

1784: Emphysema is further defined

Charles Badham (1813-1884)
After the term emphysema was coined in 1679 the quest was on to learn more about this disease. Perhaps some best knowledge was gained from an unexpected source in Dr. Samuel Johnson, although not until he was dead, and his autopsy was performed

In 1721 F. Ruysh provided the first detailed description of emphysema coupled with pictures in his book "Observations anatomica-chirirgicae."  (1, page 85)

In 1764, W.Watson described a case of emphysema in "On account of what happened upon opening the body of an asthmatic person."  He was quoted in "Physiologic Basis of Respiratory Disease" as saying:  (1 page 85)
"The lungs were enormously distended with air... this air was extravasate and had burst through the extremities of the bronchi and vesicular substance...  In a word the lung was truly emphysematous.  In several parts this had formed large bladders... The air getting loose in the substance in the lungs cannot be parted with expiration; it subsequently is retained there and the space it occupies prevents as much of the external air being received into the lungs as its own quantity.(1 page 85)(13, pages 145-147)
Watson also described the diseased condition of the heart.
The figure of the human heart is that of a cone, divided through its axis; but in this case, the heart's figure was altered, and was more compressed than usual; and its ventricles distended with grumous blood. Every other part of the body was in its natural state. (13, page 145)
He added:
From this examination we find that in this instance respiration was greatly disturbed... The varices of the pulmonary vein not only retarded the blood in its passage to the left auricle of the heart, but, occupying a much larger space in the lungs than they naturally should, they left less room for the minute ramifications of the bronchia to extend themselves and consequently a less quantity of air was taken in at every inspiration than was necessary for the ordinary purposes of life...  But the disorder of the lungs from the varices was made infinitely worse by the emphysema. For by the extravasated air possessing so large a portion of the lungs, and which the patient could by no means part with in expiration, very little room was left for fresh air in inspiration; the lungs, from the emphysema, and from the diseased state of the pulmonary vein, filling almost the whole cavity of the thorax. (13, pages 145-146)
He said that in life the man was seized with a troublesome cough, and shortness of breath with minimal exertion.  He said there was no cure for the man because there was "no method of discharging the extravasated air from the lungs." (13, page 146)

Dr. Samuel Johnson (1709-1784)
By 1784 Dr. Samuel Johnson was well known for his medical skills,  and he also well known for his breathing trouble. He was thought to have suffered from asthma since birth, and later he was determined to have died of fibrosis of the lungs.  (6)

At any other time in history this information would have gone down as a fact and that would have been the end of it.  However, Dr. Johnson was born into a time when the medical community was searching for answers about diseases, and so, before he died he gave permission for his lungs to be preserved and studied for science.  (6)

Dr. James Arthur Wilson was only 19 when he performed the autopsy on Dr. Johnson, and he described the following:
"On opening into the cavity of the chest, the chest did not collapse as they usually do when the air is admitted, but remained distended, as they had lost the power of contraction; the air cells on the surface of the lungs were also very much enlarged... the heart was exceedingly large and strong."
Based on this autopsy report, later physicians, upon examining it, determined that Dr. Johnson did not die of asthma, nor fibrosis, but of a disease that was barely known at the time: emphysema. He was also found to have suffered from cor pulmonale, which would have been the result of his heard working so hard for many years to pump blood through his stiff lungs. (6)

Matthew Ballie was a prominent British physician who inherited his father's anatomy school in 1783. Throughout his career he studied the bodies of diseased patients, including some specimens handed down to him, such as the lungs of Dr. Samuel Johnson.

Matthew Ballie (1761-1823)
In 1799 and 1807, Ballie  described emphysema with detailed pictures.  He described the condition as "enlarged air spaces" in the lungs, and lungs that did not collapse.

He published a book in 1793, "The Morbid Anatomy of Some of the Most Important Parts of the Human Body." It's believed to be the first book on pathology.

He described the lungs of emphysema patients, which included the following description of Dr. Johnson's lungs:
"The lungs are sometimes, though I believe rarely, formed into pretty large cells to resemble the lungs of an amphibious animal. Of this I have seen three instances. It is not improbable that this accumulation (of air) may break down two or three contiguous cells into one, thereby, form a cell of very large size." (5, page 2)
In 1814 British Physician Charles Badham became the first to use the term "bronchitis" to denote "inflammatory changes in the mucous membrane." (9?)

Bronchitis would soon "supercede" the term chronic catahrr when referring to chronic inflammation of the respiratory tract that resulted in a chronic cough and the spitting up of yellow or otherwise colorful phlegm.   (9)

In 1819 a French physician would invent a device called the stethoscope that would forever change the landscape of medicine, allowing for a more precise means of diagnosing pulmonary diseases in life, as opposed to waiting for an autopsy to take place.  The inventor would be Dr. Rene Laennec.

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.
  5. Thurlbeck, Wright, "Thurlbeck's Chronic Airflow Obstruction," 1999, Canada, pages 1-6
  6. Reich, Jerome M, "Convulsion of the lung: an historical analysis of the cause of Dr. Johnson's fatal emphysema," Journal of the Royal Society of Medicine, Vol. 87, December, 1984, page
  7. Laennec, Rene, "Treaties of the diseases of the chest," 1821
  8. Stokes, William, "The Diagnosis and Treatment of Diseases of the Chest," 1837, Dublin
  9. Gee, Samuel, "Bronchitis, Pulmonary Emphysema and Asthma, " The Lancet, March 18, 1899, page 51
  10. Klotz, Oskar, Wm. Charles White, ed., "Papers on the Influence of Smoke on Health,"  Bulletin #9, 1914, page 36
  11. Christie, Ronald V, "Emphysema of the Lungs: Part IIBritish Medical Journal, Jan. 29, 1944, page 143-146
  12. Cleveland, Geo. Henry, "The Clinical Review: AJournal of Practical Medicine and Surgery," Vol. VIII, April-Sept. 1898, Chicago.
  13. Wilson, W., "An account on what appeared on opening the body of an asthmatic person," The Philosophical Transactions of the Royal Society of London, from their commencement, in 1665, to the year 1800, abridged with biographical illustrations by Charles Hutton, George Shaw, Richard Pearson, Volume XII, 1809, London, Printed by and for C. and R. Baldwin, pages 145-147
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