Friday, July 15, 2016

1819: Laennec defines pneumonia

By the year 1819, when Rene Laennec invented the stethoscope, little had changed regarding pneumonia since it was described by Hippocrates.  Treatment was also unchanged, as many physicians still recommended bleeding as a general treatment.

In his 1819 book, Mediate Auscultation, Laennec used his stethoscope to distinguish pneumonia from other pulmonary diseases.  He said that first it had to be separated from pleurisy, as calling it peripneumony as added to "confounded" descriptions of it. (1, page 512)

However Laennec continues to use the terom peripnumony.  He described three types of peripneumony. (1, pages 512-516)
  1. Pneumonia complicated with slight pleurisy: It can be accurately diagnosed by crepitous rhonchus (fine inspiratory crackles) being heard over the part of the lung affected, which is usually the "roots of the lungs"
  2. Pleurisy complicated with slight pneumonia: Crepitous rhonchus only at the roots of the lungs and the large bronchi
  3. Pleuro-pneumonia: Pleurisy with severe pneumonia (1, pages 512-516)
The following are the recommended options: (1, pages 504-508)
  1. Venesection, either general or local (to reduce congestion)
  2. Cupping
  3. No food for a few days
  4. Getting out of bed several hours a day
  5. Tartar emetic in large doses
  6. Antimonials as an emetic
  7. Kermes as an emetic
  8. Mercury to treat inflammation 
  9. Hot wine, brandy, and aromatics to treat fever
  10. Blisters to the affected side to treat chronic pleuropneumony
  11. Purgatives and diuretics, particularly when dropsy or hydrothorax occurs
  12. Acetate of potass
  13. Extract of squills
  14. Watery infusion of digitalis
  15. Nitre as a diuretic (1, pages 504-508)
Which of the above remedies is used, and the dosage, depends on the stage of the disease, and what comorbidities exist with it: does it present with a fever? Is it aucte or chornic? 

Pleurisy and pneumonia were pretty much treated the same, basically because they both present with inflammation.

  1. 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
  2. Andras, author of the notes in the book, "Mediate Auscultation, by Rene Laennec," ibid
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