Would I Have Died? Pneumonia

Pneumonia Jacket, 1920-1940,001029001

My Mum is a born caregiver, and one of the ways in which her giving nature manifests itself is her desire to help the sick. Now she, unlike me, detested the sciences, so the post-secondary study of medicine was never exactly part of her plan. But despite a lack of official training, that woman can walk into a drugstore and within minutes select an over-the-counter product to cure what ails you based on the small-print dosages written on the sides of bottle. So when my Mum became seriously ill, to the point where any physical movement was more or less impossible, I felt lost. Even at 17-years-old, it had never occurred to me that there would come a time when my mother would no longer assume the role of the family caregiver, even in a case of her own illness. And what was this crippling disease? This may sound anti-climactic, but it was a bad case of pneumonia, a severe infection of both lungs which causes tissues damage and an increase of inflammatory fluids therein. These stressors can lead to significant respiratory distress, which can in turn lead to death. For eighteen days, my mother was immobile in bed, and for months afterward she continued to be unable to exert herself in the slightest. Of course, however difficult her illness might have been for our family, I am grateful that we live in a time when treatment is available and that we weren’t forced to deal with the much more difficult instance of her death, which might well have occurred just over 100 years ago.

Pneumonia is a historically feared phenomenon. Around 1200, the medieval philosopher Maimonides described the basic symptoms of pneumonia as “acute fever, sticking (pleuritic) pain in the side, short rapid breaths, serrated pulse and cough.” Even after Louis Pasteur’s Germ Theory began to inform the treatment of bacterial diseases such as pneumonia in 1861, the illness continued in its infamy as treacherous. In 1918, William Osler proclaimed that pneumonia is “the captain of the men of death.” Around the time of Pasteur’s discovery, Edwin Klebs discovered bacteria in the airways of those who had perished at the hand of pneumonia. In the 1880s, Carl Friedländer and Albert Fränkel identified two common bacterial causes of pneumonia: Streptococcus pneumoniae and Klebsiella pneumoniae. We now know that pneumonia can be caused by bacteria, a virus, or a fungus, although bacteria appear to be the more common perpetrators. And yet it seems that the commonality of pneumonia now continues, as the British Medical Journal reported  (as of 2011) that approximately six in every thousand Britons aged 18-39 will suffer from pneumonia each year, five to ten per cent of whom are not expected to survive. The numbers for the Unites States are even worse with a death rate sitting at 14%.

And yet, for all the fear-mongering surrounding pneumonia, the KGH Admissions and Death register for pneumonia/pleurisy claim that there were 44 patients admitted and 5 deaths between 1853 and 1859; and 98 admissions and 8 deaths between 1860 and 1866. However, it is vital to take note of the fact that there was an imposed maximum stay at KGH at the time, so many may have been sent home while still ill and died at home. It is entirely possible that the true killer behind pneumonia was not the disease itself, but the bronchial tissue scarring it left behind, which would have lessened a person’s overall respiratory health, and thus their overall health.

Interestingly enough, despite four courses of antibiotics, a simple business technicality gave the disease an extra two days to worsen her condition. The problem? The chest x-ray was performed on a Friday, and the analysis of the x-ray could not be completed until the following Monday. To be fair, though, I suspect that the lack of an x-ray would have led to a much worse outcome, as even medical texts from the turn of the century make clear the importance of an x-ray when pneumonia is involved. Before the discovery of x-rays in 1895 by Wilhelm Conrad Röntgen, a physician would have relied solely on the use of a stethoscope and, up until 1824, the stethoscope would have been monaural, and therefore less accurate than its dual-aural successor.

Monaural Stethoscope, 1860-1890,997002009

After two or so weeks of what began as a form of pneumonia developed into a case of pleurisy–a severe inflammation of the pleura, the two-ply membrane that both encloses the lungs and lines the chest cavity. In my mother’s estimation, 100 years ago she would have died of pneumonia long before the pleurisy took hold, but even if this were not the case, pleurisy, which causes excruciating and constant pain due to friction between the layers of the pleura, could well have brought death if left untreated. In the course of our discussion I reminded her that in the days before regulated dosages and contents of medicine, she may have had unlimited access to opium.

Might my mother have died of pneumonia over 100 years ago? It appears to be more likely than not. However, I have met few people as determined and hard-working as my mother, so perhaps, in her own manner of psychological self-care, she might have pushed through after all.

For more information (written in an extremely engaging fashion) on how pneumonia can kill a healthy adult even today, see the article “The Stupid Question: How Does a Relatively Healthy Person Die of Pneumonia?” by Mel Campbell for The Enthusiast.

Maddi McKay is the summer 2012 Curatorial Assistant at the Museum of Health Care.

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