by Edward Borton
The COVID-19 pandemic has been a painful reminder of how important lung health is. But there are many other threats to this very vital organ. Numerous lung diseases have plagued the human race throughout history, and doctors have been working tirelessly to find effective means of beating them — a battle that continues to the present day.
While many diseases cause symptoms in the lung, several of them attack this organ directly. “Pneumonia” is not a single disease, but rather a generic term for inflammatory conditions affecting the lungs. Pneumonias affect hundreds of millions of people each year, and are the leading causes of mortality among both children and elderly individuals, with an estimated 4 million deaths every year [1].
An old enemy
Pneumonia has existed for thousands of years, with Hippocrates himself describing the symptoms during the fifth to fourth centuries BCE [2]. Knowledge of the disease likely dates back even further, as Hippocrates himself considered it to be ‘named by the ancients’. The name appears to be derived from the Greek word pneúmōn, meaning ‘lung’ In common usage, most forms of pneumonia are caused by infection.
Maimonides’ (12th century) stated ‘The basic symptoms that occur in pneumonia and that are never lacking are as follows: acute fever, sticking pleuritic pain in the side, short rapid breaths, serrated pulse, and cough.’ This is mirrored by many modern textbooks even today.
It was not until the late 1880s that the link between bacteria and pneumonia was established. This concept was prompted by Edwin Klebs in 1875, who first observed the bacteria in patients dying from the disease (the bacterial genus Klebsiella is named after him) [3]. Viral pneumonia was not discovered until 1938, by Hobart Reimann [4].
Four types of Pneumonia
Pneumonia has a wide etiological spectrum — including a large variety of bacteria, viruses, fungi [5] which cause alveoli (air sacs) in one or both lungs to become inflamed and fill with fluid or pus, resulting in restricted breathing ability. The choice of treatment is largely determined by the nature of the infecting organism — and will include one or more antibiotics, antiviral drugs, or antifungal agents.
A number of clinical “clues” may help the doctor decide which pathogen is involved in a given case of pneumonia. For instance, Mycoplasma pneumoniae infection is most frequently observed in patients below the age of 30 and is often accompanied by a bullous otitis media and a ‘hacking’ cough. Pneumocystis pneumonia, on the other hand, is characterized by dyspnea and hypoxia — and is usually encountered in severely immunosuppressed patients.
GIDEON chronicles the epidemiology of pneumoniae caused by bacteria such as Streptococcus pneumoniae, Klebsiella pneumoniae, Chlamydia, Mycoplasma pneumoniae, and fungi, such as Cryptococcus neoformans and Pneumocystis jirovecii.
Historical treatments
An extensive array of therapeutic options have evolved for the treatment of pneumonia. Hippocrates pioneered thoracic drainage, leaving tubes in place for up to two weeks [6]; while in medieval times we might have encountered the occasional bloodletting. As crude as those methods may seem, the treatments of the early 20th century were far from elegant, though somewhat more comfortable.
Electronic inhalers such as the one shown below have now been consigned to the history books and museums. While the design of inhalers improved considerably during the last 100 years, their function has changed little.
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References:
[1] “Pneumonia”, Who.int, 2020. [Online]. Available: https://www.who.int/news-room/fact-sheets/detail/pneumonia.
[2] R. Feigin, Textbook Of Pediatric Infectious Diseases, 5th ed. Philadelphia: Saunders, 2004, p. 299.
[3] I. Gerard and K. Root, “Pneumonia”, Library.leeds.ac.uk, 2017. [Online]. Available: Pneumonia | Special Collections | Library | University of Leeds.
[4] F. Wagner and J. Hodges, Thomas Jefferson University: Tradition and Heritage. Philadelphia, Pa.: Jefferson Digital Commons, 1989, p. 253.
[5] “Pneumonia”, John Hopkins Medicine, 2020. [Online]. Available: https://www.hopkinsmedicine.org/health/conditions-and-diseases/pneumonia.
[6] S. Walcott-Sapp and M. Sukumar, “A History of Thoracic Drainage: From Ancient Greeks to Wound Sucking Drummers to Digital Monitoring”, Ctsnet.org, 2015. [Online]. Available: https://www.ctsnet.org/article/history-thoracic-drainage-ancient-greeks-wound-sucking-drummers-digital-monitoring.
