Historical Notions of Chest Diseases

he recent bicentennial phantasmagoria has raised awareness in matters historical for most of us. For physicians who are willing to indulge themselves by pursuing some facet of the story of our profession, such enhancement has happy results, results that can range from the mere acquisition of information, through feelings of humility at being reminded how competent and fine were so many of our predecessors, to the genuine inspiration that comes occasionally from exposure to an historical figure with whom one can feel a special affinity. One difficulty in reading about our own history is the increasing rarity of the original books. Many are rare enough to be difficult to find, except in the largest libraries. This problem is being met by several companies dedicated to reprinting, usually by photographic facsimile, single volumes and whole collections of rare books. Perhaps representative of the latter more ambitious type of endeavor is the collection, Medicine and Society in America. This was published between 1972 and 1976 by the Arno Press (New York), in 47 volumes under the advisory editorship of Charles Rosenberg of the University of Pennsylvania. Examining a few books in this series, selected more or less at random, may be of interest to readers of Chest. We are reminded, for example, in Blanton’s1 Medicine in Virginia in the Seventeenth Century, that in the first few years at Jamestown, Va, 1100 of the 1700 immigrants died. From our perspective now, it is difficult to be sure what caused most of the deaths. But some descriptions of epidemics clearly point to the ravaging effect of such respiratory infections as influenza, pneumonia, and pleurisy. In 1688, influenza produced a great mortality in Virginia. Bleeding (often massive) was a standard of therapy. Not surprisingly, in Virginia tobacco was considered healthful; some physicians believed that it would “heal gout and the ague, neutralize the effects of drunkenness and remove weariness and hunger.”(”111) Massachusetts was perhaps no healthier a place to live than was Virginia. In the early to middle 18th century, recurrent epidemics of malignant sore throat (almost certainly diphtheria) were devastating and all too common. Four accounts are collected in the volume, Disease and Society in Provincial Massachusetts: Collected Accounts, 1736 1939.2 Children were disastrously susceptible; in one year, 984 deaths were recorded in the larger towns of New Hampshire. Of these, 82 percent were children younger than ten years of age, and 95 percent were under 20 years. One family lost eight children between Nov 5 and Nov 28, 1736. Climate, of course, had a prodigious effect on our ancestors and their health. Fortunately, an invaluable compilation of data was made in 1792 by William Currie3 of Philadelphia. He notes that one physician recorded that at noon on Jan 29, 1786, the outdoor temperature was 46#{176}F,while that “in house” was 44#{176}F.In April, Currie3 recorded “Pertussis, epidemical amongst children... . Bad Coughs brought on by the long continuation of damp and raw weather, a number of which terminated in Phthisis; some other Pulmonic affections Of 139 deaths in 1786 in Salem, Mass, 20 were blamed on consumption, 13 on “hooping cough,” four on inflammation in the thorax, and one on angina pectons. The last is a surprising diagnosis, recorded less than 20 years after Heberden’s original description, and in a time when communication of medical information was anything but instantaneous. Although we know relatively little of folk beliefs and instructions in the distant past, some records have been preserved. One of these is the intriguing Catechism of Health: For the Use of Schools, and for Domestic Instruction, prepared by B. C. Faust, M.D.,4 in 1794. A single example must suffice to give the tone of this slim book, prepared in the form of questions by a wise interlocutor and answers by an