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LUNG DISEASES: PNEUMONIA
Pneumonia is the accepted name for pneumonitis, or inflammation of the lungs. Every textbook article starts by telling us that Hippocrates was familiar with it. Yet from his day until the last decade or so little was added to our knowledge of it except a lot of technical details of interest only to trained students of disease. As a matter of fact, I have just read the latest, highly esteemed textbook of medicine and also Sir William Osier’s Practice of Medicine, written a half century ago; that is, I have read their articles on pneumonia. In my estimation Osier had far the better story except that he was just too early for X-ray examinations, and as for treatment, he could say only this: “Pneumonia is a self-limited disease which can neither be aborted nor cut short by any known means at our command.”
John Bunyan, in his Pilgrim’s Progress, spoke of consumption as “Captain of the Men of Death,” and over two centuries later Osier decided that pneumonia then merited the name. It was a little difficult to say just how important it was as a fatal scourge, for many a long drawn-out chronic disease was finally mercifully ended by an acute attack of pneumonia, when the patient had become too weak to aerate the lungs and keep them healthy. For this reason Osier called it “The Friend of the Aged.”
It is agreed that pneumonia is caused by infective organisms, of which the most common is the pneumococcus, but numerous others are found guilty at times and some of them are especially wicked. In the great, widespread influenza epidemic towards the end of World War I, people were dying like flies, often it would seem, of streptococcus pneumonia. Nowadays we hear much of a particularly miserable virus pneumonia.
The pneumococcus is not a scarce organism; it can be found in many places in the body, especially in the nose and throat secretions, but it does not at all follow that the patient is sick. It would seem that the germ lurks about, and when it finds conditions just to its liking, it seizes the victim. Neither does it follow that the patient has to be weak, puny, or ailing to succumb. Husky young athletes, apparently in the pink of condition, may be struck down. Cold has always been regarded as a cause but Montreal is a very cold city in winter and Osier reported that in January, the coldest month of the year, there was a comparatively low death rate from pneumonia. In the late winter and early spring of 1917 a thousand wounded might be admitted to our big hospital in a night. I wore all the clothes that I could pile on me and felt congealed. Yet the wounded boys were not very warmly clad, particularly the Scotch with their bare thighs, and they had been exposed to cold and wet for long, long periods. If cold and exposure were great factors in pneumonia, there should have been epidemics then, but there were none.
There was one aspect of the pneumonia of the old days that was a great source of elation to the physician and family and yet it was also at times a frustration to the former. This was the spectacular “crisis.” Many diseases, typhoid for instance, get well very slowly and gradually. Not so with the characteristic recovery of pneumonia. The patient might appear desperately sick, with high fever and prostration. Then, usually in five to twelve hours, but often in an hour, the fever would drop many degrees, the respiration return almost to normal, the pulse would slow, and the patient would pass from a state of extreme hazard and distress to one of safety and comfort. There was a belief among physicians that these crises occurred on the odd days, as the third, fifth, or seventh.
Now why should there have been any frustration about such a delightful phenomenon? The best physicians have always been chary about using the word “cure.” As they knew that there was no good treatment for pneumonia, they relied only on good care. My friend, Dr. Frank Fulton, as he was making morning rounds with the intern, was shown a man, exceedingly sick with pneumonia. He studied him carefully and then resignedly remarked, “Well, the best thing we can do for him is to put him to bed with a good nurse.” But in the minds of many people there is always a cure. The question is where to find it. A family may be told by a kind neighbor of a similar case miraculously cured by a cultist. The family, in desperation, might then dismiss the doctor and call in the wonder worker. If the crisis occurred a day or so later, could that family ever be convinced that the sick man did not owe his life to their wisdom in switching? They could not.
All that, however, is ancient medical history. The sulfa drugs came along in the 1930′s and made life hard for a lot of pathogenic bacteria. That is what we call those which attack our health. (The others, most of which are trying to help us, are called saprophytic.) Then came Armageddon, just before the Second World War, and penicillin has made pneumonia a weak warrior. Do not think, though, that it is completely out of the picture. The forces of evil never give up the battle and organisms other than the pneumococcus are still bitterly attacking the lungs.
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