1820-1930: Pneumonia, the new "captain of the men and death

Thomas Addison (1793-1860

For most of human existence tuberculosis was known as the deadliest disease.  It was such a deadly disease by the 17th century, that John Bunyan (1628-1688), the famous author of "Pilgrim's Progress" referred to it as "the captain of men and death."  It wouldn't be until the early 20th century that tuberculosis would take a back seat to pneumonia.

While pneumonia has been present since the beginning of mankind, and the medical profession has been aware of it since the 5th century, little new information was learned about it.  It really wasn't until the end of the 19th century that physicians started to get a grasp on this disease.

Dr. Thomas Addison, a physician to Guy's Hospital in London,  was the first to write about pneumonia not being a disease that affected just the "interstices" of the lungs but the "air vessicles" themselves. (8, page 193)

Carl von  Rokitansky, a German physician, was the first to describe lobar pneumonia. (10, page 1308)

He said:

The red inflammatory product becomes gray and compact and indurated.  The air cells contract over the granulations, coalesce with them round their circumference, and become obliterated, their tissue being changed into a fibro-cellular structure, in which, from the similarity of their organization, the granulations are most probably also merged. (10, page 1308)

Various physicians described a pneumococcus associated with patients with lobar pneumonia.  (8,page 197)

Carl von Rokitansky (1804-1878)

In 1880 Sternberg found it in the saliva, and in 1881 Louis Pasteur discovered the same. (8, page 197)

In 1882 Ernst victor von Leyden and Gunther drew fluid from hepatized lungs of living pneumonia patients and discovered pneumococci in this fluid. (8, page 197)

Yet in all of these cases, the significance of the discovery went unnoticed.  (8, page 197)

It wasn't until 1875 that Edwin Klebs associated pneumonia with the bacteria, describing an "oval coccus" that he obtained from cases of lobar pneumonia. (8, page 197)(?)

A few years later Karl Friedlander and Hans Christian Gram started working together in the morgue of a hospital in Berlin and added to Klebs work by identifying the specific types of bacteria associated with pneumonia.

In 1882 Friedlander isolated streptococcus Pneunomiae in the sputum of a patient inflicted with pneumonia, and in 1884 Gram isolated Klebsiella Pneumoniae in the sputum of a patient  inflicted with pneumonia.

The procedure that Gram described when writing of his discovery was later called the gram stain.  It's a technique where a small sample of the sputum is stained, and this causes the cell walls of the bacteria to turn a certain color so the bacteria can be clearly identified. 

This technique is still used in labs to this day.  Yet while Gram simply used the technique to identify bacteria in sputum samples, it's used today to distinguish between different types of bacteria.

In 1888 Nikolia Fedorovich Gamaleia was working in Pasteur's lab when he inoculated sheep and dog with pneumococcus and this caused lobar pneumonia in these animals.

This experiment proved that pneumococcus was the cause of lobar pneumonia.  Gamaleia is also credited in 1888 as discovering bacteriolysins that destroy bacteria.  (11)

He also worked with pasteur to improve the process of inoculation.

By 1891, interstitial changes may occur in acute lobar pneumonia and this may result in fibroid pneumonia (fibrosis of the lungs), and this will be chronic.  (10, page 1309)

In 1896 French student Ernest Duchesne discovered penicillin, yet the significance of his discovery went unknown, and the discovery was left hanging.

William Henry Osler, in the early editions of his book, "The Principles and Practice of Medicine," mentioned using oxygen for emphysema and asthma, and by 1898, or the third edition, he finally recommended oxygen for pneumonia.

However, while he mentions oxygen as an option, he rarely prescribed it for his patients.

He wrote:

It is doubtful whether the inhalation of oxygen in pneumonia is really beneficial. Personally, when called in consultation in a case, if I see the oxygen cylinder at the bedside I feel the prognosis to be extremely grave. It does sometimes seem to give transitory relief and to diminish the cyanosis. It is harmless, its exhibition is very simple, and the process need not be all that disturbing to the patient. The gas may be allowed to flow gently from the nozzle directly under the nostrils of the patient, or it may be administered every alternate 15 minutes through a mask. (12)

In 1901, in his popular medical textbook "The Principles and Practice of Medicine," Dr. Osler referred to pneumonia as the new captain of men and death. He wrote:

The most widespread and fatal of all infectious diseases, pneumonia, is now the "Captain of the Men and Death," to use the phrase applied by John Bunyon to consumption." 

 By 1918 pneumonia became the leading cause of death, overtaking tuberculosis. In describing the new leading cause of death, Osler burrowed from Bunyan, describing pneumonia as "captain of men and death. (4)

References:

References:

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
17. Reynolds, Arthur, R., "Pneumonia: The New Captain of the Men and Death," February 28, 1903, Journal of the American Medical Association," XL(9):583-586, http://jamanetwork.com/journals/jama/article-abstract/854678, accessed 1/2/16

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