Monday, March 30, 2015

How to succeed in life

If you want to succeed in life, then you need to avoid people who are failures.  You need to avoid hanging around people who have negative attitudes.  You need to avoid people who incessantly complain about their work.  Because these people will never succeed.  They will never be better than what they are today.  

If you want to succeed you need to talk to people who have succeeded.  Any person who has succeeded will tell you this.  If you hang around negative people, people who are not happy with their jobs, then that is the attitude that you will pick up.  So if you want to succeed, hang around happy and successful people.  

That's not just something I'm making up, it's true.  If you hang around the failures, you're just going to become negative, and you are going to lose hope, and you are going to become apathetic about your job.  Once apathy sets in, chances of you moving up the ladder will probably be thrown out the door.  

Once you become apathetic and sit around the RT Cave complaining about this or that, or complaining about this person or that person, then you are going to trapped where you are right now.  If you want to succeed, if you want to move up the ladder, for instance, you will have to get away from these people.  You will want to rise above them.  

Don't hang around people who tell you you can't succeed because they didn't, because then you won't succeed.  You don't want to hang around people who are bitter.  Find the successes and learn from them.

If you want to be a writer like I am, you used to have to be ambitious and try to get some newspaper or magazine to like your writing.  One day I was sitting around trying to figure out how I could become a writer, and my wife introduced me to the Blogosphere.  I started writing.  At first I wrote to no one, as I has no audience.  Then people started discovering my blog, and they realized that I had something interesting to say.  
Then one day I received an email from a producer.  She said, "I love your blog.  I love the way you write in a pithy manner, and how you describe your profession accurately, and how you write about asthma.  I love how you write about smart people and stupid people.  I think you are a great writer, and I want you to write for me."  

I responded to this email, and now I have been successfully writing about asthma and COPD since 2008 for healthcentral.com.  I love doing this.  To me, it's not work: it's fun.  I have succeeded.  You can too.  But you will have to take advantage of opportunities, and you'll have to stay away from the complainers, or at least not listen to them. 

I'm not even saying you can't complain, because Lord knows I do.  I'm honest about my job.  However, I talk about it in a generic way, without blasting any person.  I might honestly discuss a situation that isn't going well,  and I might even disagree with doctors and bosses, but never at the expense of respect.  

People do things for a reason.  Doctors order useless breathing treatments because that's what they were taught, and telling them they are "idiots" will not solve anything.  Many doctors even admit that they order 'useless" treatments because they have to in order to get patients admitted.  

You might look at me and say, "You are a small town respiratory therapist and you have a couple blogs, but you are not successful."  To that I say, "It depends how you define success.  I define success by how satisfied I am, and I'm very satisfied." 

Saturday, March 28, 2015

225 - 200 B.C. Dogmatism is challenged

Even while the dogmatic school of medicine (rational medicine) was being formed at the school of Cos by Hippocratic writers, so too was forming the emperical school of medicine at the school of Cnidos, about 20 miles away. (1, page 29)

In other words: "By the side of dogmatic philosophies Skepticism slowly arose," said Norman Maccoll in 1868.  (6, page 10, 18-19).

What is skepticism?  It is a branch of ancient Greek philosophy thought to have been created by Pyrrho.  Who was he?

Pyrrho lived lived 360-270 B.C., and was among the first of the skeptics, or philosophers who doubted that all wisdom could be learned.  (Skeptic comes from the ancient Greek term "skepsis," which, according to Meriam-Webster, means examination or doubt).

He is often considered as the father of skepticism. His followers were called Pyrrhoneans.  His philosophy was called Pyrrhonism, his school called the Pyrrhonean School. (6, page 13)

However, as was normal for the ancient world, many believe ideas contributed to him arose prior to his lifetime and were merely attributed to him later on.  (6, page 13)

Of his disciples or pupils, Maccoll said the one most important to historians of philosophy was Timon, who lived from 320-230 B.C.  While Pyrrho is known to have written only one poem addressed to Alexander, Timon wrote voluminously. Therefore, it "was through him that Pyrrho's doctrine became first generally known." (6, page 27, 28, 30)

Maccoll wrote that it was Timon who said that a philosopher should ask the following questions:
  1. How are things constituted?  Our conclusions should not come from our opinions or senses because answers derived from them are neither true nor false.  Answers must be derived from empirical evidence. (6, page 21, 22)
  2. In what relation should we stand to them?  We cannot form opinions on things that are beyond our knowledge.  In other words, "We cannot distinguish the false from the true, for both to the senses and the reason all things are alike: they possess no criterion of truth: we must not hazard those decided judgments, in which the dogmatist indulges: we must incline neither to the right hand nor to the left: we must remain unmoved." (6, page 21, 22)
  3. What will result to us from our relation to them? "What effect on our happiness will our attitude to Things have ? This attitude has already been determined to be suspension of judgment. If therefore we are to make a rule of abstaining from all judgments, our happiness must be dependent on this abstinence, and consist in regarding everything external with undisturbed tranquillity of mind; for there is no certainty with regard to what is external, and, where there is no certainty, there can be no happiness. The soul must retire upon itself, looking upon all outside itself as indifferent, and striving to become neither the slave nor the mistress of circumstances, but separate from, and independent of, them." (6, page 21, 23)
Of this third question, Maccoll said: 
The answer to the third question shows the aim of Pyrrho's doubt: like all his contemporaries he searched for a summum bonum: he was not a sceptic in the modern sense of the word : he doubted because doubt appeared to give him the most secure promise of happiness. (6, page 24)
Of the three questions, Maccoll said:
They relate of course to the old points: " Is knowledge absolutely relative ? Is there any objective truth ? Can we have any knowledge of Things as they are in themselves ?" (6, page 31)
The quest of Pyrrhonism was to find the summum bonum, or the highest good. In this regard, Pyrrhoneans were considered eudaemonistic (eudaemonism), which, according to Merriam-Webster, was a theory that the highest goal is happiness and personal well being. (6, pages 8-9,24)

Skepticism died out after the death of Timon, only to be re-established by later philosophers.  (6, page 69)

However, it was from the skeptics, or Pyrrhoneans, that arose the empirical school.  It was the empirics who would ultimately counter dogmatism.  

Empiricism arose through the wisdom of the following triad:  (1, page 29) (3, page 68)(4, page 91)
  • Herophilus:  He lived 325-280 B.C., and came up with many of the theories followed by the the empirical school of medicine
  • Philinus: He was a pupil of Herophilus around 250 B.C., and started the empiric school of medicine
  • Serapion: He was successor of Philinus around 225 B.C., and supported empiricism
This Empirical School of Medicine was basically established to counter the "extravagances" of the Dogmatic School of Medicine at the School of Cos.  (3, page 69)

A common saying of the empiracist was:
"It is not the cause but the cure of disease that concerns us; not how we digest, but what is digestible." (5, page xiii)
The major differences between these schools were as follows:  (1, page 29)(3, page 69) (4, page 68-9)

Dogmatists/ Rationalists/ Hippocratic
Dogmatic School of Medicine
Empiricists/ Emperics
Empirical School of Medicine
Supported ideas of the physician Hippocrates
Supported ideas of the philosopher Pyrrho
Were in search for causes of disease
Were not concerned with causes.  A person was ill is all they needed to know
Speculated on possible causes and remedies
Did not speculate
Created theories to explain causes and why a remedy will work.  Generally, diseases were caused by the body as a whole.
Did not create theories to explain anything.  If something was unknown, it was left at that
Cures were based on the theory postulated. 
Cures were based on experience.  If something worked in the past, it will work today.  Medicine not based on experience could injure
They had few remedies, many of which were harsh, such as bleeding, purging, and vomiting
They had many remedies, and they were generally friendlier than dogmatist remedies and probably worked better
They believed anatomy was important to understand the physiology of disease
They despised anatomy and physiology. 

Serapion was the most outspoken of the empirics, and "he wrote with great vengeance  (1, page 29), as he said:
"What is the use of  knowing the shape and position of the brain and liver, or whether there are such things as brains or livers at all."  (4, page 68)
Another common saying of the empirics was:
"It is not the cause, but the cure of diseases that concerns us; not how we digest, but what is digestible." (4, page 68)
Galen wrote about Serpion the empirist in his Outline of Empericism: (2, page 161)
Of the ancients, however, Hippocrates, Erasistratus, and Herophilus have stated nothing about the treatment suffering from the disease (i.e. lethargy).  But Serapion the Empericist, in Book 1 of his treaties Against the Haireseis, gave some instructions (about this) which are, however, too obscure to be reported here.
Serapion thus became an experimentalists.  He experimented to see what drugs worked best for said disease.  He recorded and made conclusions based on his own observations and experiments, as opposed to coming to speculative conclusions.  (1, page 30)

As described by Edward Withington:
"In short, they (empiricists) reduced the whole art and science of medicine to a system of therapeutics.  A person is ill, that is, he has certain unpleasant feelings or symptoms; surely the first thing to do is to find something which will remove them, and the whole duty of the physician is to discover what particular treatment, and especially what drugs, will get rid of particular sets of symptoms."  (3, page 68-9)
The way to do this is based on the "tripartite foundation" (1, page 30) of the following three methods:  (3, page 69)
  1. Experience:  His own experience and observations
  2. History:  Learning from the experience and observation of his contemporaries and  predisessors
  3. Analogy:  Drawing conclusions based on similar situations to find remedies for new and strange cases
 And thus was formed the Empirical school of medicine.

The empirics were essential to this time because they created an important alternative to the dogmatists, some of whom (see Erasistratus) performed autopsies on live convicted criminals to see what organs did during life.  Hopefully, as some reports suggest, many such victims were given a large dose of morphine before the procedure.  Yet still it was considered inhumane and irrational by the empiricist, and reasonably so.

While the dogmatists based their remedies on speculation, the empiricists used only remedies that were shown by experience to work. This was a viable alternative to the extreme remedies of bleeding and purging used by many dogmatists.  The empiricist also added quite an array of new remedies, including opium and sulpher.

The dogmatists became known as rationalists due to their desire to rationalize diseases and their remedies.  They believed "everything must have a sufficient reason for its existence," Empirics believed what can be observed by experience is known, and what is not known is not to be speculated upon.

References
  1. Meryon, Edward, "History of Medicine: comprising a narrative of its progress from the earliest ages to the present and of the delusions incidental to its advance from empericism to the dignity of a science," volume I, London, 1861,
  2. Eijk, Philip J., editor, "Ancient Histories of Medicine: essays in medical doxography and histeriography in classical antiquity," 1999, Boston,
  3. Withington, "Medical History from it's Earliest Times: a popular history of the healing art," 1894, London, The Scientific Press
  4. Watson, John, "Medical Profession in Ancient Times: an anniversary discourse delivered before the New York Accademy of Medicine November 7, 1855," 1856, New York, Baker and Godwin
  5. Brock, John, "Galen on the natural faculties," 1916, London, New York, William Heinemann, G.P. Putnam's Sons
  6. Maccoll, Norman, "The Greek Skeptics from Pyrrho to Sextus: An Essay which obtained the Hare Prize in the Year 1868," 1868, London and Cambridge, Macmillan and Co.
  7. "Ancient Greek Skepticism," Internet Encyclopedia of Philosophy, http://www.iep.utm.edu/skepanci/, accessed 6/20/14
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Friday, March 27, 2015

331 B.C- 619 A.D..: The School of Alexandria

Figure 1 --Alexander the Great had a vision of creating
a great city, and compiling all the science and wisdom of
the world in one place.  He died before he was 32, thus
not living to see his dream come true. 
The evolution of medicine was slow moving through most of history.  One of the reasons for this was that it was illegal to touch a human corpse except in preparing it for burial or cremation.  This was one of the main reasons Galen's ignorant explanations of the human body were worshiped as the medical Bible for over a thousand years after his death.  This created a roadblock for learning about diseases like asthma and allergies.

This roadblock made it so it was nearly impossible for there to be any major advancements in medicine.  If someone learned something about the human body by dissecting, it was usually done by stealing a corpse from a graveyard, or from a prison, and performed illegally.  And the information learned was kept secret from a monarchy that might kill you, or at least throw you in prison, for learning something that opposed the view of the establishment. So even if something was learned, it was probably never published.  And if it was published, it was so posthumously. 

Thankfully, however, there were a few places scattered around the world where it was legal to perform autopsies.  It was at these places where physicians would flock to obtain medical knowledge, and patients would flock to get the best treatment.  Among the first such place was the great city of Alexandria in Egypt. (1)

Alexander the Great is considered one of the greatest military leaders of all time.  Born in 356 B.C. in Macedonia, a city just north of Greece (Macedonia was not a city-state like Athens and Sparta).  He spent his childhood watching his father, Phillip II, build Greece into a great military power, winning battle after battle. (1)

When he was 13 Aristotle was hired to be his personal tutor.  Like other Greeks, he learned about science, medicine, and philosophy.  (1) Aristotle taught him to read and speak Greek, and taught him to respect philosophy the way the Greeks did.  He loved Greece, it's gods, it's history, and he dreamed of teaching it's culture to people all over the world. (2)

Figure 2 -- A rendering of Ancient Alexandria.  The lighthouse
you see depicted here was one of the seven wonders of the
ancient world.  This was one of the most beautiful cities ever.
His father, Phillip, conquered most of the Greek city-states, and when his father died, Alexander went on to conquer many nations, including Egypt.  As he did in other places he conquered, he championed Greek culture. 

As noted by historian John Watson:  "The rapid extension of Grecian arms under Alexander the Great, lead to the diffusion of taste and learning among the surrounding nations.  Pergamus and the new capital of Egypt (Alexandria), became points of scientific attraction second only to Athens; and with the spread of general knowledge, the study of medicine extended to these cities."  (4, page 74)

The Asclepion of Pergamus was surrounded with architecturally amazing structures that "were occupied as places of public instruction and scientific intercourse. Here the orators, sophists, and philosophers of the city held their daily conferences, and sometimes amused themselves in expounding to the sick the vaticinations of the priests. As a school of medicine, the Asclepion of Pergamus enjoyed a long continued celebrity." (4, page 74)

Alexander died in 323 B.C. of a mysterious illness in the palace of Nebuchadrezzar II of Babylon.  He was only one month shy of his 32nd birthday.  At this time the Egyptian portion of Alexander's empire was given to Ptolomy Soter (367-282 B.C.), the brother of Alexander. 

Figure 3 -- The library of Alexandria was one of the largest libraries
in the ancient world.  Physicians came from all over the world
to study here.  Unfortunately it was destroyed by barbarians.
Can you just imagine if this was never destroyed?  Perhaps medical
knowledge would have been advanced faster, and there would be
better asthma and allergy knowledge today, and maybe even better
medicine, or a cure.  If I could go back in time, I'd want to go to the
City of Alexandria during its glory days and peruse ancient writings
Like Alexander, Ptolomy loved arts and sciences, and he formed the great library of Alexandria, and he placed Aristotle in charge of it.  (3, page 33) The flow of knowledge through this city was so abundant its great library "rendered Alexandria the great repository of science and wisdom." Some estimate that by the reign of Ptolomy Philadelphus (36-29 B.C.) the library had accumulated a collection "about two hundred thousand rolls of papyrus, equal to about ten thousand of our modern printed volumes." (4, page 79)
Ptolomy also started Museum of College of Philosophy, or the school of Alexandria, in 331 B.C., which was described best by John Watson in 1856:
It's chief apartment was a lecture room and place of general concourse.  Around the main building, on the outside, was a covered walk or portico.  And connected with it was an Exhedra, in which the philosophers sometimes sat in the open air... This noble institution was originally designed to serve in part as a school for the training of  youth in the higher walks of learning, and in part as a retreat within which men of genius and acquirements, free from the necessary and providing for their daily wants, might have leisure and opportunity, each in his own way, for extending the domain of science, or for increasing the enjoyments of improving the condition of their fellow beings. (4, pages 77-8)
Figure 4 -- Ptolomy
By the time of Ptolomy Philadelphus, the school "had already risen to the highest rank among the Greek schools. (4, page 79)

One of the main reasons for this was that for the first time in the ancient world, dissection was legal in Alexandria.  This was significant, because religion made even touching a human corpse illegal in Ancient Egypt, Greece and Rome.  Now, for the first time in history, the human body could be studied, and it was.  In this way Aristotle was able to describe the insides of the human body by actual dissection. (3, page 33)  

The school was also a place for public lectures and readings, which were very important in Alexandria, as in all ancient civilizations.  This was because books were expensive and few could read.  Great minds would orally educate about the common wisdom of the day, and readers, or orators, would "familiarize" people with the writings of Homer and other great authors of the day. (4, page 82) Watson explained:
Among the Greeks this had been the common mode of enlightening the people, of amusing them, and of molding their opinion.  Most of the poetry, and much of the written history of the nation, were prepared for public recitation.
Placed in charge of medicine at the school were Erasistratus and Herophilus.

Erasistratus (304-250 B.C.) was from the Isle of Chios, and was the grandson of Aristotle.  He was the founder of the school of anatomy at the school of Alexandria, performing many autopsies.  Herophilus (335-280 B.C.) was a native of Chalcedon and was educated at the school of Cos. He also performed many autopsies at the school. (4, page 85

Figure 5 -- Aristotle
Along with Aristotle, they both made stunning observations from their inspections of the internals of the human body, and postulated various hypothesis based on these observations.  For instance, Erasistratus discovered that the trachea was a passageway for air (pneuma) to the lungs, and he discovered veins and arteries both originate from the heart.  Only he, like Aristotle,  believed the arteries were filled with air not blood, and hence the name 'arteries.'  And the passage of pneuma from the veins to arteries was the cause of disease(3, page 35-6, 4, page 86))

He disregarded the four humors of Hippocrates and the four elements of Empedocles, and instead postulated that fevers were caused by inflammation.  He was not a believer in purgatives and most medicine, and instead preferred a good diet and gymnastics.  Some believe he was the first to recommend exercise as a means to stay healthy and for healing.  (4, page 86)

Herophilus was among the "first of the Hippocratic school to distinguish himself as an atomist."  He was the first to use the pulse as an "index of varying conditions of health and disease."(4, page 84)

He properly attributed the pulsations of the arteries to the heart. 


Figure 6 -- Herophilus
Of interest is that Herophilus was charged with opening "the bodies of living criminals, to discover the secret springs of life."  (3, page 35)

Unlike Erasistratus, he was a believer in the hypothesis that imbalances of the four humors cause most diseases.  (4, page 85)

He revered Hippocrates to the point that "when obliged to contradict him he always avoided mentioning his name."   Also, unlike his counterpart, he placed a "high value on drugs, which he called, 'the hands of the gods,' and used them in great variety.  (5, page 62-3)

Erasistratus was an empiracist.  Herophilus was a rationalist. In this way, "the same rivalry which existed in Greece between Cos and Cnidos arose also between Alexandria and Pergamus, in which later place Galen was born, and Aesculapius was held in great respect as one of its most celebrated divinities."  (3, page 36-37)

Regardless, anyone who wanted to be a physician in the ancient world was eager to learn at the school of medicine in Alexandria, as "to have studied medicine at Alexandria, was everywhere considered a passport to the confidence and patronage of the public."  (4, page 92)

The school continued "its celebrity as a seat of learning and as a school of medicine, until it was taken by Saracens in 638 of the Christian era."  (3, page 36)

Figure 7 -- 1532 woodcut showing Herophilus (L) and Erasistratus (R)
Alexandria would fall in 619 A.D., and that ended whatever medical wisdom came out of it.  Many of it's wonders were destroyed by barbarians, including it amazing library.  As the library went up in flames, so to did all medical wisdom except for random scrolls scattered here and there.  (6, page 150-2) (7, page 28)

Until the  School of Salerno was established in the 10th century, there were no known autopsies performed, and medicine was left in limbo, or what historians like to refer to as the dark ages of medicine.  (6, page 150-2) (7, page 28)

References:
  1. "Alexander the Great Alexander of Macedon Biography: King of Macedonia and Conqueror of the Persian," historyofmacedonia.org, http://www.historyofmacedonia.org/AncientMacedonia/AlexandertheGreat.html
  2. "Alexander the Great: Ancient Greece for kids," mrdonn.org, http://greece.mrdonn.org/alexander.html
  3. Meryon, Edward, "History of Medicine: comprising a narrative of its progress from the earliest ages to the present and of the delusions incidental to its advance from empericism to the dignity of a science," volume I, London, 1861,
  4. Watson, John, "The medical profession in ancient times," 1856, Baker and Godwin, New York
  5. Withington, Edward Theodore, "Medical history from the earliest times,"
  6. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, Philadelphia, W.B. Saunders Company
  7. The John Hopkins Hospital bulleton," (volume XV 1904), "From the epoch of the Alexandria School (300 B.C.)"
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Thursday, March 26, 2015

400 B.C.: Hippocrates alludes to heart failure

I wanted to make a note here that Hippocrates had no way of knowing about heart failure, or any other diseases of the heart.  So, when the heart caused dyspnea, this would simply be diagnosed as asthma.

However, Hippocrates, and other Greek physicians, did recognize and diagnose as diseases some of the symptoms of heart failure, such as angina (chest pain), dropsy (swelling of the feet and ankles, and hydropsy (fluid in the lungs) and anascara (generalized edema).

In his book "On the Different Parts of Man, Hippocrates said:
Angina arises from blood arrested in the vessels of the neck. (1, page 243)
Here he must have recognized that many people who present with chest pain also have bulging carotid arteries, or the arteries on either side of the neck.   He would have no way of associating this with heart failure.

He continued:
We must bleed in the arm and purge, to divert downward the humours that cause the disease. (1, page 243)
In his book "On Internal Affections," described dropsy, which was the diagnosis when fluid was observed inside the tissue, and he referred to a condition where the fluid caused swelling of various tissues of the body, such as in the feet and ankles, as anascara.

In his book "Predictions and Prognostics," he said that dropsy, like phthisis and epilepsy, are difficult to cure when congenital.  He said: (1, page 129)
For the cure of dropsy, sound viscera and adequate strength, with good digestion, are very essential; good breathing, freedom from pain, equable temperature of the whole body, no emaciation of the limbs, but rather a fulness, although the absence of both is best, with natural softness and size, and the belly soft to the touch. There should be neither cough, thirst, nor dry tongue, whether after sleep, or at other times, as often is the case. The appetite should be good, and after eating no uneasiness. Purgatives should operate promptly, and at other times the stools should be soft and figured. The urine should correspond with the regimen, and with the changes of wines. Labour should be readily supported without feeling fatigued. Such is the best state for an hydropic person, to give the expectation of recovery. In proportion as it deviates therefrom are our hopes to be less sanguine; but they must entirely cease when the reverse of what is above stated is the actual condition; or only be maintained according to the existing state of things.
It is much to be feared that dropsy will succeed large discharges of blood from the stomach and bowels; when connected with fever it will be of a brief character, and few recover. A prediction to this effect may be safely made to the friends of the patient. Large oedematous swellings, disappearing, and recurring again, are more readily cured than in the preceding case. (1, page 129)
Interestingly, he also said:
They are (the symptoms), however  very deceptive, inducing the patient to dismiss his physician, and thus dying without assistance. (1, page 129)
Dropsy of the lung, or fluid in the lung, was treated similar to hydrothorax, with an incision of the chest between ribs to drain fluid from the lung.  (1, page 261)

So he recognized the fact that people suffering from this ailment often did not recognize the symptoms and seek medical attention until it was too late.  This is a common predicament of modern medicine as well.

In "Rationale of Food in Acute Disease: Book IV," he recommends pleurisy, angina and dropsy all be treated with cantharides and other acrids. The patient must also pay close attention to diet, and vomit three times a day for a month. (1, page 221)

In "Semeiotics III: On the Difference of Pulses," Galen said that Hippocrates was the first to use the term "palpitate" as when feeling for a pulse, and "palpitations," as when feeling an abnormal, or rapid beating of the heart. (1, page 602)

The medical profession would not even begin to understand the heart and heart diseases, such as angina and heart failure, until after great minds like Vesalius and Harvey made their great discoveries in the 16th and 17th centuries.

References:
  1. Hippocrates, Claudius Galen, writers,  John Redman Coxe, translator, "Hippocrates, the Writings of Hippocrates and Galen," 1846, http://oll.libertyfund.org/titles/1988, accessed 7/6/14, also see the book online at Google books, Philadelphia, Lindsay and Blakiston
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Wednesday, March 25, 2015

400 B.C.: Hippocrates describes pneumothorax

While he didn't understand it nor its cause, Hippocrates described a condition that we now refer to as pleural effusion and he referred to as hydrothorax.  It's a condition where fluid builds up in the pleural cavity.

As a remedy, he described the procedure of paracentesis, which involved creating an incision above the third false rib, and inserting a tube into the opening. He then used a trocar.  A Trocar, according to dictionary.com, is a sharp pointed instrument enclosed in a cannula that was used for withdrawing fluid from the cavity. (1, page 282)

This procedure was very similar to the procedure physicians would perform today for the same ailment. The main difference is that modern physicians would know about aseptic technique and would be better capable of controlling pain.

References:
  1. Hippocrates, Claudius Galen, writers,  John Redman Coxe, translator, "Hippocrates, the Writings of Hippocrates and Galen," 1846, http://oll.libertyfund.org/titles/1988, accessed 7/6/14, also see the book online at Google books, Philadelphia, Lindsay and Blakiston
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Tuesday, March 24, 2015

1920-1980: Pneumonia is finally tackled

For most of mankind, deadly diseases like influenza and tuberculosis were the main focus of the medical profession.  It was only when these diseases were tackled were physicians able to focus on other diseases, like pneumonia.

In 1928, Sir Alexander Fleming observed that colonies of the Bacterium Staphylococcus that he was growing in a colony were dissolving.  He later discovered the plates had been infested by a blue-green mold, and he determined it was this mold that was responsible for the bacteria dissolving.  He later grew the mold in its pure form and discovered that it killed many different kinds of bacteria. (5)

The mold he used was Peiciillium notatum.  The importance of this discovery was not known until 1939 when Howard Florey and Ernst Chain isolated the active ingredient and developed a powdered form of it.  (5)

Several Eurpean and American scientists worked together to work on a therapeutic medicine that could be used to treat bacterial infections.

By 1941 they had succeeded, and penicillin studies were performed.  In 1944 antibiotics were made available to treat allied soldiers wounded on the battlefield.

Incidence of pneumonia started to decline in 1937 due to improved medicine. So oxygen therapy, coupled with penicillin, helped decrease the rate of pneumonia deaths.  Yet cases of pneumonia continued to be prevalent.

For example, operations weren't commonly performed in hospitals until the 1950s when effective aneasthetics and breathing machines were made available. These were exciting times among the medical profession, as for the first time in history physicians were able to hone in their surgical skills to the benefit of mankind.

This excitement was stymied somewhat during the 1960s and 1970s when physicians started observing a high incidence of post operative pneumonia, particularly among abdominal surgeries, and despite the use of antibiotics.

Similar observations were made among patients taking large amoungs of sedatives and narcotics.

It was quickly realized that further research needed to be done to determine the cause, and therefore a means of preventing these patients from developing pneumonia.

Studies soon concluded that humans were naturally inclined to action, that when a person was restricted to bed, this resulted in ill health.

That people naturally sigh 3-4 times in an hour in order to exercise the lungs and clear secretions, in an effort to keep the lungs sterile.  Sedatives, and painful surgeries, resulted in patients not taking deep breaths, and this resulted in an increase in the risk for developing pneumonia.

Preventative measures were then established, which mainly included having patients roll over, sit up, stand, and walk as soon as possible after surgery, even if the patients have to push themselves to the pain threshold.

Various devices were then invented with the intent of preventing alveoli from collapsing, and pneumonia from developing.  One device was a blowby device that encouraged patients to blow balls into jars.  Another device was called in incentive spirometer, which encouraged people to inhale and cough.

Morbidity and mortality for post operative pneumonia steadily declined.

Pneumonia in general declined when a pneumonia vaccine hit the market in 1977, and again when a pneumonia vaccine for children hit the market in 2000.

Thanks to all these innovations pneumonia is not the sixths leading cause of death, as opposed to the leading cause of death in the 1930s.

It's true that pneuomonia will continue to inflict people with diminished immune systems, such as the elderly and sick.  Yet with a growing plethera of medical knowledge, physicians have been able to greatly reduce the incidence of this disease, and in the process, prevent many deaths from the malady.

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
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400 B.C: Hippocrates defines pneumonia

Pneumonia is sometimes referred to as one of the oldest diseases known to mankind.  It would seem wise to presume that so long as a person, or a species, has lungs, that the possibility of them becoming infected, and inflamed, would always exist.  If this is true, then pneumonia must have been a common cause of death since the beginning of mankind.

During the rare opportunities that medicine men, or priest physicians, or later physicians, had to dissect a person who died of dyspnea or asthma, a whitish hue to the tissue of certain lobes, which may have been hardened, would have been observed.  They also would have observed colorful secretions in the airway.  In this way, it was easy for the first physicians to distinguish pneumonia from other diseases.  

Despite the disease going that far back, it wasn't described for the medical profession until Hippocrates wrote of it in 400 B.C.  However, we know that it was described long before him because he said it was "described by the ancients."

In attempting to distinguish between the two diseases, Hippocrates might try to shake the patient, a procedure called succussion.  This would allow the physician to hear the puss in the pleural cavity rattle.  He said any keen physician should be able to diagnose pleurisy by this method.

However, it must not have been that easy, as various Greek physicians, including Hippocrates himself, observed that it was difficult to differentiate between the two, and for this reason they were generally grouped together as peripneumonia, or peripneumony.  (8, page 192)

They knew pneumonia was inflammation in of one lobe of the lungs, and they knew pleurisy was inflammation in the pleural cavity.  Yet while pneumonia was accompanied by a fever and a pain in the chest, pleurisy was accompanied by a fever and a sharp pain in the side.

We now know that sometimes the two diseases appear independently of one another, although sometimes they appear together.  So its understandable that ancient physicians would have had trouble differentiating between the two, particularly lacking the ability to perform autopsies.

Of course, it was also quite common for both of these diseases to also be confused with asthma, which is our umbrella term for all causes of dyspnea other than pneumonia and phthisis.  So getting an accurate diagnosis was difficult regardless of the efforts of the physician.  (2, page 3)

Of peripneumony, Hippocrates wrote:
Peripneumonia, and pleuricic affections, are to be thus observed: If the fever be acute, and if there be pains on either side, or in both, and if expiration be if cough be present, and the sputa expectorated be of a blond or livid color, or likewise thin, frothy, and florid, or having any other character different from the common.
Dictionary.com describes pneumon as latin for lung or lung and pneuma as latin for lung.  So pneumonia refers to a condition of the lung.

Pleurisy was defined by the Ancient Greeks as inflammation of the pleural cavity, and they recognized symptoms of pleurisy and pneumonia as a sharp pain in the side.

The treatment of Hippocrates was generally the same for all diseases, and consisted of good hygiene, a good diet, rest, exercise, and plenty of sleep.  These were supposed to help nature be the remedy, or the means of returning the humours to homeostasis.

However, if those did not work, and depending on the stage of the disease of the illness, age of the patient, color of the sputum, and season of the year, any of the following may be the remedies.  (6)
  • Bleeding
  • If fever, the bowels were opened with clysters
  • If pain, hot water in a bottle or bladder, a sponge of hot water, or cataplasm of linseed was applied to the hypochondrium
  • Linctus containing galbanum and pine fruit in Attic Honey or...
  • Sothernwood in oxymel
  • Oppaponax (a bitter resin with a garlic taste) mixed in oxymel
  • Drink of ptisan made from huskey barley and mixed with oxymel
Hippocrates was well aware of when the disease was getting better or worse, as noted in the following passage.  (6)
"When pneumonia is at its height, the case is beyond remedy if he is not purged, and it is bad if he has dyspnoea, and urine that is thin and acrid, and if sweats come out about the neck and head, for such sweats are bad, as proceeding from the suffocation, rales, and the violence of the disease which is obtaining the upper hand, unless there be a copious evacuation of thick urine, and the sputa be concocted; when either of these comes on spontaneously, that will carry off the disease."
Hippocrates noted that death from pneumonia usually occurs on the seventh day.

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
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