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Tuesday, March 24, 2015

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. 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.

  1. "Leading Cause of Death, 1900-1998,"
  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,"
  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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