The possible effects of iron loss from bloodletting on mortality from pneumonia in the nineteenth century.

OBJECTIVE: To estimate iron losses and disease severity following 19th century bloodletting in patients with pneumonia. STUDY DESIGN AND SETTING: Benefits of bloodletting in pneumonia patients were contested during the 19th century. Although large blood volumes during infection were removed there was no systematic data collection assessing efficacy and knowledge of iron composition of blood was rudimentary. This observational analysis of historical data quantifies iron losses in pneumonia cases in relation to disease severity. RESULTS: Based on one detailed case series average blood volume removed for survivors was 830 mL (range 114-2272 mL), and mean recovery times were shorter in patients bled within 2 days of illness (P < 0.001). Average iron removed was 446 mg with phlebotomy done ≤2 days of illness presentation and 347 mg after >2 days of illness (P = 0.012). Across several European hospitals average case fatality in pneumonia patients receiving phlebotomy was higher than in those treated without phlebotomy (19.9% vs. 12.8%, OR 1.55, 95% CI 1.38-1.74, P < 0.001). CONCLUSION: Variable efficacy for bloodletting could at least in part be explained by altered iron status.

No SARS-CoV-2 detection in the German CAPNETZ cohort of community acquired pneumonia before COVID-19 peak in March 2020.

PURPOSE: The first SARS-CoV-2 cases in Europe were reported in January 2020. Recently, concern arose on unrecognized infections before this date. For a better understanding of the pandemic, we retrospectively analyzed patient samples for SARS-CoV-2 from the prospective CAPNETZ study cohort. METHODS: We used nasopharyngeal swab samples from a cohort of well characterized patients with community acquired pneumonia of the CAPNETZ study group, recruited from different geographic regions across Germany, Austria, the Netherlands, and Switzerland between 02nd December 2019 and 28th April 2020. Multiplex real-time RT-PCR for a broad range of respiratory pathogens and SARS-CoV-2 real-time RT-PCR were performed on all samples. RESULTS: In our cohort, respiratory pathogens other than SARS-CoV-2 were detected in 21.5% (42/195) of patients with rhinovirus as the most frequently detected pathogen. The detection rate increased to 29.7% (58/195) when SARS-CoV-2 was included. No SARS-CoV-2 positive sample was detected before end of March 2020. CONCLUSIONS: Respiratory viral pathogens accounted for a considerable number of positive results but no SARS-CoV-2 case was identified before the end of March 2020.

Hippocratic concepts of acute and urgent respiratory diseases still relevant to contemporary medical thinking and practice: a scoping review.

BACKGROUND: The collected works of Hippocrates were searched for concepts on the diagnosis, prognosis, and treatment of acute and urgent respiratory diseases, with the objective to trace their origins in the Hippocratic Collection. METHODS: A scoping review was performed to map out key concepts of acute and severe respiratory diseases in the entire Hippocratic Collection. The digital library Thesaurus Lingua Graeca (TLG) was researched for references in the entire Hippocratic Collection regarding the epidemiology, pathophysiology, prognosis, diagnosis and treatment of acute respiratory diseases; then, the relevant texts were studied in their English translation by the Loeb Classical Library. RESULTS: Hippocratic physicians followed principles of treatment for pneumonia and pleurisy, still relevant, such as hydration, expectoration, analgesia and prompt mobilisation. Other approaches, including the inhalation of "vapours through tubes" in angina, can be considered as forerunners of modern medical practice. Thoracic empyema was diagnosed by shaking the patient and direct chest auscultation after "applying your ear to his sides". In case of an emergency from upper airway obstruction, urgent insertion of primitive airway equipment, such as a small pharyngeal tube, was applied. CONCLUSIONS: The main Hippocratic concepts on four still common acute and urgent respiratory diseases -pneumonia, pleurisy, thoracic empyema and upper airway obstruction- were identified and most of them were found to be in agreement with contemporary medical thinking and practice.

The Origin of the Idea That Herpes Labialis Is of Prognostic Importance in Bacterial Meningitis.

OBJECTIVE: The aim of the work was to study the origin of the idea that herpes labialis (HL) in patients with pneumonia and meningitis was believed to be of prognostic importance. BACKGROUND: HL is caused by a primary infection or reactivation of herpes simplex type I. In the past, it has been related to pneumonia and meningitis; moreover, HL was believed to be of prognostic importance. METHODS: A selection of 19th- and 20th-century textbooks and referred articles was consulted. The relation between meningitis and herpes, type of meningitis, and attributed diagnostic and prognostic importance were studied. In addition, the HL-pneumonia association was studied. RESULTS: The Strasbourg physician Charles-Polydore Forget was the first to describe the HL-meningitis association in 1843. Tourdes (1843), Drasche (1859), and Salomon (1864) attributed a favorable prognostic importance to the HL-meningitis relation. In a comprehensive monograph (1866), August Hirsch, although confirming the association, denied the prognostic importance through critical analysis of the data. Few authors attributed a diagnostic importance to the occurrence of HL, suggesting meningococcal meningitis. CONCLUSIONS: The HL-meningitis relation, but not the prognostic importance, has been mentioned in most neurological textbooks since then. In contrast to meningitis, in which a prognostic attribution of HL was only a short-lived 19th-century idea, the favorable prognostic importance of HL in pneumonia continued to be described until the 1950s. A possible protective effect of herpesviruses has been found in recent years. One could speculate that the disappearance of the prognostic HL-pneumonia relation could be related to the introduction of antibiotics in the late 1940s.

Osler Centenary Papers: Management of pleural infection: Osler's final illness and recent advances.

Sir William Osler's great work and achievements are extensively documented. Less well known is his prolonged battle with postinfluenza pneumonia, lung abscess and pleural infection that eventually led to his demise. At the age of 70, he was a victim of the global Spanish influenza epidemic, and subsequently developed pneumonia. In the era before antibiotics, he received supportive care and opium for symptom control. The infection extended to the pleura and he required repeated thoracentesis which failed to halt his deterioration. He proceeded to open surgical drainage involving rib resection. Unfortunately, he died shortly after the operation from massive pleuropulmonary haemorrhage. In this article, we review the events leading up to Osler's death and contrast his care 100 years ago with contemporary state-of-the-art management in pleural infection.

Risk of pneumonia among residents living near goat and poultry farms during 2014-2016.

In the Netherlands, an association was found between the prevalence of pneumonia and living near goat and poultry farms in 2007-2013. This association then led to regulatory decisions to restrict the building of new goat farms and to reduce emissions of poultry farms. Confirmation of these results, however, is required because the period of previous analyses overlapped a Q-fever epidemic in 2007-2010. To confirm the association, we performed a population-based study during 2014-2016 based on general practitioner (GP) data. Electronic medical records of 90,183 persons were used to analyze the association between pneumonia and the population living in the proximity (within 500-2000 m distance) of goat and poultry farms. Data were analyzed with three types of logistic regression (with and without GP practice as a random intercept and with stratified analyses per GP practice) and a kernel model to discern the influence of different statistical methods on the outcomes. In all regression analyses involving adults, a statistically significant association between pneumonia and residence within 500 meters of goat farms was found (odds ratio [OR] range over all analyses types: 1.33-1.60), with a decreasing OR for increasing distances. In kernel analyses (including all ages), a population-attributable risk between 6.0 and 7.8% was found for a distance of 2000 meters in 2014-2016. The associations were consistent across all years and robust for mutual adjustment for proximity to other animals and for several other sensitivity analyses. However, associations with proximity to poultry farms are not supported by the present study. As the causes of the elevated pneumonia incidence in persons living close to goat farms remain unknown, further research into potential mechanisms is required for adequate prevention.

Nursing in Pneumonia.

: Editor's note: From its first issue in 1900 through to the present day, AJN has unparalleled archives detailing nurses' work and lives over more than a century. These articles not only chronicle nursing's growth as a profession within the context of the events of the day, but they also reveal prevailing societal attitudes about women, health care, and human rights. Today's nursing school curricula rarely include nursing's history, but it's a history worth knowing. To this end, From the AJN Archives highlights articles selected to fit today's topics and times.In the September 1903 issue of AJN, Jessie E. Catton of Boston City Hospital writes about the nursing care of pneumonia. Many early AJN authors were national figures, and Catton was no exception: she later became secretary of the National League for Nursing Education, a forerunner of the National League for Nursing.Catton notes that in pneumonia, "if no complications occur nursing is considered rather more important than treatment." She goes on to discuss key principles in caring for someone with pneumonia: "absolute rest in bed" to prevent exhaustion; "perfect cleanliness… warmth, light covering, and… fresh air"; careful positioning in bed; and proper treatment of high fever, where "the external use of cold is preferred by many physicians rather than large doses of antipyretic drugs." To read the full article, go to http://links.lww.com/AJN/A129.In this month's issue, Chastity Warren and colleagues describe their project to prevent pneumonia via the use of standardized oral protocols for high-risk patients in "A Nurse-Driven Oral Care Protocol to Reduce Hospital-Acquired Pneumonia."

Sir Winston Churchill: treatment for pneumonia in 1943 and 1944.

This paper reviews Churchill's illnesses in February 1943 and August/September 1944 when he developed pneumonia; on the first occasion this followed a cold and sore throat. Churchill was managed at home by Sir Charles Wilson (later Lord Moran) with the assistance of two nurses and the expert advice of Dr Geoffrey Marshall, Brigadier Lionel Whitby and Colonel Robert Drew. A sulphonamide (sulphathiazole on the first occasion) was prescribed for both illnesses. Churchill recovered, and despite his illnesses continued to direct the affairs of State from his bed. On the second occasion, Churchill's illness was not made public.

In Carthage ruins: the illness of Sir Winston Churchill at Carthage, December 1943.

This paper reviews Churchill's illness in Carthage in December 1943. It was characterised by fever that lasted 6 days, left lower lobe pneumonia and two episodes of atrial fibrillation. He was managed in a private villa by Lord Moran, his personal physician, with the assistance of two nurses and the expert advice of colleagues. Sulphadiazine and digitalis leaf were prescribed and Churchill recovered. It is remarkable that, despite the severity of his illness, he continued to direct the affairs of State from his bed.

[Mortality from respiratory diseases in the provinces of Apulia Region (Southern Italy) from 1933 to 2010]. / La mortalità per patologie respiratorie nelle province pugliesi dal 1933 al 2010.

OBIETTIVI: valutare l'andamento temporale della mortalità per patologie respiratorie nelle province pugliesi utilizzando dati omogenei per fonte e metodologia di calcolo. DISEGNO: analisi ecologica storica degli andamenti temporali di mortalità per tumori e patologie dell'apparato respiratorio nelle province pugliesi, in Puglia e nelle ripartizioni geografiche italiane dal 1933 al 2010. SETTING E PARTECIPANTI: i dati di mortalità e le popolazioni residenti sono di fonte Istat. Sono state esaminate tutte le cause di decesso, il tumore della laringe, il tumore del polmone, l'insieme dei tumori respiratori, la bronchite, la polmonite e la broncopolmonite considerate congiuntamente, e l'insieme delle patologie respiratorie. Le analisi sono disaggregate per sesso dal 1969. PRINCIPALI MISURE DI OUTCOME: rapporti standardizzati di mortalità (SMR%) in riferimento all'Italia, con intervalli di confidenza al 95%, e tassi di mortalità standardizzati col metodo diretto (TSD ) in riferimento alla popolazione standard europea. RISULTATI: dal 1933 al 2010, i TSD per tumori respiratori e per bronchiti diminuiscono in tutte le aree analizzate. Tuttavia, nelle province di Taranto, Brindisi e Lecce, l'SMR% per tumori respiratori, inferiore al riferimento nazionale fino agli anni Sessanta, si allinea (a Brindisi) e supera (a Lecce e Taranto) il riferimento negli anni successivi. Nelle province di Foggia e Bari il numero dei decessi per tumore del polmone è costantemente inferiore all'atteso. CONCLUSIONI: la ricostruzione storica e l'analisi dei trend temporali di mortalità dal 1933 al 2010 mostrano alcune criticità sanitarie in periodi specifici. L'elaborazione dei dati di mortalità per un arco temporale di circa 80 anni ha messo in evidenza la maggiore rilevanza di queste criticità con l'avvio dello sviluppo industriale.

Trends in Pneumonia Mortality Rates and Hospitalizations by Organism, United States, 2002-2011(1).

Because the epidemiology of pneumonia is changing, we performed an updated, population-based analysis of hospitalization and case-fatality rates for pneumonia patients in the United States. From 2002 to 2011, hospitalization rates decreased significantly for pneumonia caused by pneumococcus and Haemophilus influenzae but increased significantly for Pseudomonas spp., Staphylococcus aureus, and influenza virus.

Evolución etimológica y análisis de la definición de las neumonías recurrentes en niños / Etymological evolution and analysis of the definition of the recurrent pneumonias in children

Fundamento: El término neumonía recurrente en niños ha tenido variaciones en cuanto al enfoque dado a su definición y son varias las frases utilizadas para hacer referencia a esos procesos; sin embargo, no se han encontrado evidencias de obras donde se integren la evolución y el análisis etimológico de la definición de neumonías recurrentes en niños. Objetivo: Profundizar en el conocimiento sobre la evolución etimológica de la definición de afecciones pulmonares recurrentes; así como, analizar desafíos que tiene la comunidad científica ante elementos cuestionables de esa definición. Desarrollo: Se realizó una investigación bibliográfica y analítica, que permitió identificar los cambios evolutivos de la definición de afecciones pulmonares recurrentes en el niño y se analizaron desafíos que la comunidad científica tiene ante elementos cuestionables de esa definición. Conclusiones: El origen de la definición de neumonías recurrentes es reciente comparado con la historia de la medicina, sin embargo, en su evolución pasó de ser utilizada como una valoración temporal de la afección a una valoración más completa e inclusiva de los pacientes con esas afecciones. No obstante, aún hay algunos elementos teóricos que pueden ser perfectibles en la definición, para que su significado sea más sistémico e integral.

Background: The term recurrent pneumonia in children has had variations according to the focus given to its definition. There are several phrases which are used to refer to those processes; however, evidences of scientific texts in which the evolution and the etymological analysis of the definition of recurrent pneumonias in children were integrated, were not found. Objective: To deepen on the etymological evolution knowledge of the definition of recurrent lung affections; as well as, to analyze challenges the scientific community has faced in front of questionable elements of this definition. Development: A bibliographical and analytic investigation was carried out to fulfill the objectives stated in terms of identification and analysis. Conclusions: The origin of the definition of recurrent pneumonias is recently compared with the history of medicine, however, in its evolution it passed from being used as a temporary evaluation of the affection to a more complete and inclusive evaluation of patients with those affections. Nevertheless, some theoretical elements can still be perfectible in the definition, in order to make its meaning more systemic and integral.

Evolución etimológica y análisis de la definición de las neumonías recurrentes en niños / Etymological evolution and analysis of the definition of the recurrent pneumonias in children

El término neumonía recurrente en niños ha tenido variaciones en cuanto al enfoque dado a su definición y son varias las frases utilizadas para hacer referencia a esos procesos; sin embargo, no se han encontrado evidencias de obras donde se integren la evolución y el análisis etimológico de la definición de neumonías recurrentes en niños. Objetivo: Profundizar en el conocimiento sobre la evolución etimológica de la definición de afecciones pulmonares recurrentes; así como, analizar desafíos que tiene la comunidad científica ante elementos cuestionables de esa definición. Desarrollo: Se realizó una investigación bibliográfica y analítica, que permitió identificar los cambios evolutivos de la definición de afecciones pulmonares recurrentes en el niño y se analizaron desafíos que la comunidad científica tiene ante elementos cuestionables de esa definición. Conclusiones: El origen de la definición de neumonías recurrentes es reciente comparado con la historia de la medicina, sin embargo, en su evolución pasó de ser utilizada como una valoración temporal de la afección a una valoración más completa e inclusiva de los pacientes con esas afecciones. No obstante, aún hay algunos elementos teóricos que pueden ser perfectibles en la definición, para que su significado sea más sistémico e integral(AU)

The term recurrent pneumonia in children has had variations according to the focus given to its definition. There are several phrases which are used to refer to those processes; however, evidences of scientific texts in which the evolution and the etymological analysis of the definition of recurrent pneumonias in children were integrated, were not found. Objective: To deepen on the etymological evolution knowledge of the definition of recurrent lung affections; as well as, to analyze challenges the scientific community has faced in front of questionable elements of this definition. Development: A bibliographical and analytic investigation was carried out to fulfill the objectives stated in terms of identification and analysis. Conclusions: The origin of the definition of recurrent pneumonias is recently compared with the history of medicine, however, in its evolution it passed from being used as a temporary evaluation of the affection to a more complete and inclusive evaluation of patients with those affections. Nevertheless, some theoretical elements can still be perfectible in the definition, in order to make its meaning more systemic and integral(AU)

The first wave of the 1918 influenza pandemic among soldiers of the Canadian expeditionary force.

OBJECTIVES: This article evaluates the evidence for the presence of the first, mild wave of the 1918 influenza pandemic among soldiers in the Canadian Expeditionary Force (CEF). METHODS: Death records for soldiers in the CEF who died in Canada in 1917 and 1918 were extracted from the Commonwealth War Graves Commission and record-linked to the Canada War Graves Registers, Circumstances of Casualty database. Monthly mortality rates from pneumonia and influenza (P&I) were compared with mortality rates from all other causes for 1917 and 1918, and by region for 1918. RESULTS: The herald wave of influenza was present among CEF soldiers in 1918. P&I mortality was significantly higher in March and April 1918 than during the same period in 1917. P&I mortality rates varied across the country and were significantly higher among soldiers who died in the Maritime region of Canada. In March, Maritime P&I mortality was significantly higher than its counterpart in the West; in April it was significantly higher than P&I mortality in both the Central and Western regions. CONCLUSIONS: The CEF findings suggest that local, geographic heterogeneity characterized the first wave of the 1918 influenza pandemic in Canada and illustrate the ways in which well-established, historical patterns of cross-border social contact with the United States, coupled with the special conditions created by warfare, disproportionately funnelled influenza into particular regions. Identification of the mild first wave among soldiers in the CEF calls for more research on the civilian experience of both waves of influenza in Canada.