Respiratory Infections: Diagnosis and Management [antikvár]

Foreword to the First Edition: Pneumonia: Past, Present, and Future Róbert G. Petersdorf Departments of Medicine and Health Sciences, School of Medicine, University of Califomia, San Diego, La Jolla, California 92093 In the first volume of the second edition of the Osler-McCrae textbook. Modern Medicine (4), published in 1913, the third longest chapter, nearly 45,000 words in length, was devoted to the topic of lobar pneumonia. Among all the infections, it was surpassed in importance in the text only by typhoid fever and tuberculosis: this despite the fact that much of the information on etiology was lacking or incorrect; the bacteriology of the pneumococcus was incomplete; little was known about the pathogenesis and immunology of the infection; and, of course, there was no treatment. That is not to say that everything written about pneumonia 70 years ago was incorrect or has become obsolete. On the contrary, the presence of pneumococci as part of the oral and respiratory flóra in many apparently healthy individuals was well known, but why the organisms set up infection in somé people and not in others was not. To my knowledge, this question has not yet been answered. Of course, the pathology of pneumococcal pneumonia was well described; many of the complications had been delineated, and descriptions of the clinical manifestations contained the kind of elegant detail that has since had to be sacrificed to the economy essential in textbook writing. The description of the chili is a case in point: Generally a well-marked rigor is promptly followed by a rapid rise in temperature, cough, pain and dyspnoea. The chili is often severe, lasting from one to several hours, the patient feeling very cold, shaking from head to foot with teeth chattering, cyanosed lips and icy extremities. Whereas there is no question that today's textbooks of medicine provide much more factual information in a fraction of the space (the ninth edition of Harrison's chapter on lobar pneumonia is closer to 6,000 words in length), they alsó lack the clinical detail of their pedagogic forebears. Of course, the pneumococcus and the infection it causes has been the subject of much important investigation, somé of which has turnéd out to have biological application far beyond pneumonia. But the single most significant event that revolutionized the field was the discovery of penicillin. There is no aspect of pneumonia that has not béén subject to the profound impact of this drug. The etiology, ecology, pathogenesis, manifestations, and clinical course and outcome of pneumococcal infection all have undergone marked change, most of which can be attributed in one way or another to penicillin.