[On the formation of Russian pulmonology: the development of the doctrine of lung diseases (first half of the 20th century)]

The articles on the history of Russian pulmonology presented in the historical, medical and therapeutic literature contain materials for this history, but their authors did not solve the problem of its consistent presentation, highlighting the stages of formation and founders. The authors of this study critically reviewed the literary and archival primary sources, for the first time proposed the identification of three stages in the development of Russian pulmonology and indicated eight of its founders at these stages. The abundance of material did not allow us to present it in one article. This article is devoted to the 1st stage of the history of pulmonology - the formation of the doctrine of lung diseases. The second (development of pulmonology as an independent scientific direction in internal diseases) and the third (organizational design of pulmonology as a new independent clinical scientific and educational discipline and medical specialty, i.e. its institutionalization) stages will be discussed in the next articles.

Childhood rare lung disease in the 21st century: "-omics" technology advances accelerating discovery

Childhood rare lung diseases comprise a large number of heterogeneous respiratory disorders that are individually rare but are collectively associated with substantial morbidity, mortality, and healthcare resource utilization. Although the genetic mechanisms for several of these disorders have been elucidated, the pathogenesis mechanisms for others remain poorly understood and treatment options remain limited. Childhood rare lung diseases are enriched for genetic etiologies; identification of the disease mechanisms underlying these rare disorders can inform the biology of normal human lung development and has implications for the treatment of more common respiratory diseases in children and adults. Advances in "-omics" technology, such as genomic sequencing, clinical phenotyping, biomarker discovery, genome editing, in vitro and model organism disease modeling, single-cell analyses, cellular imaging, and high-throughput drug screening have enabled significant progress for diagnosis and treatment of rare childhood lung diseases. The most striking example of this progress has been realized for patients with cystic fibrosis for whom effective, personalized therapies based on CFTR genotype are now available. In this chapter, we focus on recent technology advances in childhood rare lung diseases, acknowledge persistent challenges, and identify promising new technologies that will impact not only biological discovery, but also improve diagnosis, therapies, and survival for children with these rare disorders.

NIOSH's Respiratory Health Division: 50 years of science and service

The year 2017 marked the 50th anniversary of NIOSH's Respiratory Health Division (RHD). RHD began in 1967 as the Appalachian Laboratory for Occupational Respiratory Diseases (ALFORD), with a focus on coal workers' pneumoconiosis. ALFORD became part of NIOSH in 1971 and added activities to address work-related respiratory disease more generally. Health hazard evaluations played an important role in understanding novel respiratory hazards such as nylon flock, diacetyl, and indium-tin oxide. Epidemiologic and laboratory studies addressed many respiratory hazards, including coal mine dust, silica, asbestos, cotton dust, beryllium, diesel exhaust, and dampness and mold. Surveillance activities tracked the burden of diseases and enhanced the quality of spirometry and chest radiography used to screen workers. RHD's efforts to improve scientific understanding, inform strategies for prevention, and disseminate knowledge remain important now and for the future.

American pediatric society's 2017 John Howland award acceptance lecture: a tale of two toxicants: childhood exposure to lead and tobacco

This article summarizes the presentation of the 2017 Howland Award to Michael Weitzman, MD, at the Annual Pediatric Academic Society Meetings. It summarizes the remarkable advances in understanding the effects and pathways of exposure of the two most common and pernicious of our nation's child environmental exposures, namely lead and tobacco. It also summarizes the profound effect of the translation of these findings into prudent and effective clinical and public health policies such that exposure to both has dramatically decreased over the past 40 years due to the tenacious activities of pediatricians, other child-related professionals, government agencies at all levels, and the American Academy of Pediatrics. Research and clinical activities, although essential, were not sufficient to produce these successes, but required extensive mentoring to produce a generation of academic pediatricians capable of conducting the requisite research, and extensive advocacy by pediatricians and others to overcome the formidable inertia and outright opposition to efforts to protect our children from these exposures. Moreover, the article highlights that both of these environmental exposures have roots in social and environmental injustice and neither is solved, and that there is no safe level of exposure to either of these toxicants.

"English Disease": Historical Notes on Rickets, the Bone-Lung Link and Child Neglect Issues

Nutritional or classical rickets (here labeled as "rickets") is a worldwide disease involving mostly infants and young children having inadequate sunlight exposure, often associated with a low dietary intake of Vitamin D. Rickets targets all layers of society independently of economic status with historical information spanning more than two millennia. Vitamin D is critical for the absorption of calcium and prevention of rickets in children as well as osteomalacia in adults. The initial and misleading paradigm of the 19th and 20th centuries that rickets may have been the consequence of infection has been, indeed, reversed following the identification of the Vitamin D molecule's important role in the function of the immune system. Although traditionally considered limited to osteopathology, Vitamin D deficiency is now known to be linked to infection, inflammation, and carcinogenesis. In this review, we consider the key historical (Whistler, pre-Whistler and post-Whistler descriptors) and social facts around rickets; highlight the osteo-pathological features of rickets and the pathology of the upper and lower respiratory tract, stressing the fact that lungs remain the main secondary organ affected by Vitamin D deficiency; and emphasize the public health role in identifying the cases of child neglect or abuse based on the evaluation of the costochondral region.

[Lung diseases and miscellaneous pathologies in the novels of François Mauriac and Pierre Benoit]

Two modern novelists of the 20th century native from the Landes, François Mauriac (1885-1970) and Pierre Benoit (1886-1962), were eager to locate a part of their novels in the French South-West. Beyond the silence and the torrid warmth of this "sand desert populated by pine trees", each of them make live, suffer and die their sick heroes from diseases treated with therapies of that time with the risk of voluntary or not drug misuse : tuberculosis, cardiac insufficiency, angina pectoris, puerperal and typhoid fevers and other diseases.

[On the cause of F. M. Dostoevsky's death]

Opinions of F. M. Dostoevsky's death as resulting from "...throat bleeding..." associated with bronchopulmonary pathology differ and have no solid basis. In order to clarify mechanisms behind fatal "...throat bleeding...", we systematized the data pertaining to possible pathology and undertook retrospective differential diagnostic analysis of the case history taking account of the patient's description of his health conditions, notes made by the writer after counseling with doctors, and observations of his relatives. Main attention was given to lung diseases that could possibly provoke "... throat bleeding..." In contrast to the generally accepted view we failed to obtain convincing evidence that this condition was responsible for the lethal outcome. New versions of the cause and mechanism of F. M. Dostoevsky's death are proposed, but none of them has yet been definitely proved.

[Health promotion from the 20th to the 21th century. The Valais Ligue for fighting tuberculosis--a visionary model started in 1951]

At the beginning of the twentieth century, tuberculosis was really a plague. Many people had been mobilised to successfully fight against this infectious disease. Valais, a Swiss alpine canton developped then an original concept of health promotion by involving all the health partners including a specialised hospital under the auspices of the local Health Departement. Such a model named then Ligue pulmonaire contre la tuberculose, celebrates his 60th anniversary. Its present name is Valais Health Promotion, i.e., a proactive health network very unique in Switzerland. It assumes many tasks of public health in clinical as well as in preventive medicine. These two components strongly facilitate the insertion of this organisation into the reality of this population to fulfil many challenging tasks with efficacy.

[Development of the stethoscope from Laennec to Cammann]

A history of Stethoscope from Laennec to Camman through Piorry, Nauche, Louis, Landouzy (father), Commins, Williams, Stokes, Billing and Depaul.

His majesty's subjects: from laboratory to human experiment in pneumatic chemistry

Experiments in pneumatic chemistry paved the way for medical innovation in the last quarter of the eighteenth century. Thomas Beddoes and James Watt were instrumental in the spread of the use of new gas chemistry in pneumatic therapy, but they were far from alone. There was no shortage of experimental subjects, as the practice was quickly taken up by medics throughout Britain.

Molecular epidemiology of tuberculosis in England, 1998

SETTING

England.

OBJECTIVE

To investigate the proportion of tuberculosis (TB) cases attributable to recent transmission and factors associated with clustering.

DESIGN

Demographic, clinical and microbiological surveillance data were collated from all new culture-confirmed cases in 1998. Using insertion sequence (IS) 6110 restriction fragment length polymorphism (RFLP) typing, strains were classified as clustered (identical patterns) or unique and risk factors were determined using multivariable logistic regression.

RESULTS

RFLP patterns were available for 2265 of 3713 (61%) cases: 1808 had >or=5 IS6110 copies, while 372 cases were in 152 clusters, giving an estimated proportion due to recent transmission of 12.2%.Pulmonary disease (aOR 1.6; 95%CI 1.1-2.2), previous treatment (aOR 3.7; 2.2-6.5) and homelessness (aOR 5.5; 1.2-24.1) were independent risk factors for clustering. Fourteen per cent of patients of Indian subcontinent origin were clustered compared with 27% of white patients. Many clusters spanned ethnic groups (45%) and geographical regions (47%).

CONCLUSION

The calculated proportion of TB cases due to recent transmission is low.Adjusting for missed cases and study duration, it increases to 27.6%. Many cases may arise from reactivation or acquisition outside England. Transmission within England accounted for approximately one in four cases and occurred over wide geographic areas, between ethnic groups and among the homeless. Molecular epidemiology can inform local and national public health action.

[Family practice in a rural environment in the west of France (1908-1920): chronicle of mortality]

This paper reports about a manuscript from Doctor Pelletier who accounted the causes of death rate in a village of the Vendée: pneumopathy, typhoid, diarrhoea linked to unhealthiness provoked by stagnant waters.

[Ninety years of the antituberculosis mission of the Topolsica Hospital (1919-2009)]

The beginnings of the hospital reach back to the discovery of a thermal spring in the sixteenth century, which became a public bath and eventually a spa in 1838. In 1919, the government of the Kingdom of Serbs, Croats, and Slovenes purchased the premises and converted the spa into a tuberculosis sanatorium. The institution prospered rapidly and began to expand. During its heyday, it included around thirty buildings with 300 hospital beds. In addition to climatic and dietary therapy, surgical treatment was also practiced and, following the discovery of antibiotics, tuberculosis was largely contained by the mid 1960s. The leading physicians who fought against tuberculosis were Otto Haus, Karel Lusicky, Vaso Savić, Mirko Karlin, and Josip Otahal. The post-tuberculosis period was characterised by a search for a new mission; new connections were formed with the hospital in Celje (in 1970) and the Velenje health centre (in 1976). Since 1993, the institution has operated as an independent pulmonary and internal medicine hospital in the Salek Valley.

Stanisław Kuczborski (1912-2004): pulmonologist and phtysiatrist

Stanisław Kuczborski was born in Lódź on January 31, 1912. In 1937, he got his medical degree at the Medical Department of the Warsaw University. Afterwards, he was employed in a sanitarium in Otwock near Warsaw. As a physician, he was a pulmonary and phtysiatric consultant. After Second World War, Kuczborski performed many managerial duties in Lódź. In the 1950s, he was Deputy Director of the Tuberculosis Institute in Warsaw. He held foreign (Denmark, France) scientific internships and was a member of the International Union against Tuberculosis and Lung Disease in Paris. In Poland, he received an honorary membership of the Polish Phtysiatry and Pneumonology Association. Kuczborski published 70 works. He died in Lódź on August 23, 2004.

Marian Zierski (1906-1998): world-famous Polish phtysiatrist

Marian Zierski was born in Lviv on May 1, 1906. He studied medicine at the Jan Kazimierz University in Lviv and the Charles University in Prague, where he received his medical degree. Before and during Second World War (until 1942) he worked in Lviv and then he moved to Warsaw. He experienced the tragedy of the Warsaw Uprising (1944) and the total destruction of the city. After the war he settled in Lódź. He held numerous managerial posts in medical care institutions in Lódź. There he also established a tuberculosis outpatient clinic for students. At the same time, Zierski carried out phtysiatric research publishing numerous works (approx. 300) and participating in conventions and scientific conferences both in the country and abroad. Apart from many awards and offices, Prof. Marian Zierski was a holder of an honorary doctorate of universities in Great Britain, Brazil, Germany, France, the USA and Hungary.

[Machado, Moix and Montalbán: smoke gets in your lives]

The writers Antonio Machado (pulmonary chronic disease), Terenci Moix (emphysema) and Manuel Vázquez Montalbán (acute myocardial infarction) died of the complications derived from their inveterate habit-forming tobacco. They were aware of the prejudices that a such addiction was causing and tried, in some moment, to leave it. In addition, the testimonies of their contemporary or their same writings offered dramatic samples of this struggle. Nevertheless, they relapsed and tobacco caused them a premature death before 65 years. With a panoramic of 60 years among the last two authors and Machado, a brief historical perspective is offered on the acquisition of scientific knowledge that changed the attitudes towards tobacco during this period of time.

Thoracoscopy: Origins Revisited

The ways in which thoracoscopy has evolved wonderfully illustrate how a diagnostic and therapeutic technique can transcend a particular medical or surgical subspecialty. In this review, an in-depth history is provided to enable readers to better understand the nature of minimally invasive endoscopic pleural imaging techniques.

Anatomy of a serial killer: Differential diagnosis of tuberculosis based on rib lesions of adult individuals from the Coimbra identified skeletal collection, Portugal

The role of new bone formation on visceral surfaces of ribs in the diagnosis of tuberculosis (TB) in past human populations has been explored by many researchers, using both skeletal remains with known causes of death and archaeological samples. This study focuses, firstly, on adult skeletons from the Coimbra Identified Skeletal Collection in Portugal and investigates the skeletal manifestations of individuals known to have died from TB; secondly, this study focuses on the role of rib lesions in the diagnostic criteria for TB. One hundred and fifty-seven males and 106 females aged between 22-87 years were examined; causes of death were assigned as pulmonary TB, extrapulmonary TB, and pulmonary non-TB; a control group, extrapulmonary non-TB, was selected from the remaining individuals. Of individuals with rib lesions, 85.7% (69/81) had pulmonary or extrapulmonary TB as an assigned cause of death, while 17.8% (16/90) of individuals with rib lesions had a non-TB cause of death. Rib lesions were significantly more common in individuals who had died from TB, although the lesions cannot be considered pathognomonic for TB. In individuals dying from pulmonary TB, ribs in the central part of the rib cage were most affected, at their vertebral ends. The lower part of the rib cage may be a marker for peritoneal TB, and "coral-like" new bone formation on ribs may be an indicator of neoplastic disease. Further work on rib involvement in TB in clinical contexts, and the study of further documented skeletal collections, are recommended.

Dead space: Simplicity to complexity

This essay looks at the historical significance of an APS classic paper that is freely available online:

Fowler WS. Lung function studies. II. The respiratory dead space. Am J Physiol 154: 405-416, 1948. ( http://ajplegacy.physiology.org/cgi/reprint/154/3/405 ).

History of aerosol therapy: liquid nebulization to MDIs to DPIs

Inhaled therapies have been used since ancient times and may have had their origins with the smoking of datura preparations in India 4,000 years ago. In the late 18th and in the 19th century, earthenware inhalers were popular for the inhalation of air drawn through infusions of plants and other ingredients. Atomizers and nebulizers were developed in the mid-1800s in France and were thought to be an outgrowth of the perfume industry as well as a response to the fashion of inhaling thermal waters at spas. Around the turn of the 20th century, combustible powders and cigarettes containing stramonium were popular for asthma and other lung complaints. Following the discovery of the utility of epinephrine for treating asthma, hand-bulb nebulizers were developed, as well as early compressor nebulizers. The marketing of the first pressurized metered-dose inhaler for epinephrine and isoproterenol, by Riker Laboratories in 1956, was a milestone in the development of inhaled drugs. There have been remarkable advances in the technology of devices and formulations for inhaled drugs in the past 50 years. These have been influenced greatly by scientific developments in several areas: theoretical modeling and indirect measures of lung deposition, particle sizing techniques and in vitro deposition studies, scintigraphic deposition studies, pharmacokinetics and pharmacodynamics, and the 1987 Montreal Protocol, which banned chlorofluorocarbon propellants. We are now in an era of rapid technologic progress in inhaled drug delivery and applications of aerosol science, with the use of the aerosolized route for drugs for systemic therapy and for gene replacement therapy, use of aerosolized antimicrobials and immunosuppressants, and interest in specific targeting of inhaled drugs.

[Treatment of pulmonary diseases from the 20th to the 21st century]

In the 21st century, the treatment of pulmonary diseases will undergo fundamental change. The treatment of patients in general and of pulmonary diseases in particular will transcend the vertical and fragmented approach based on analytical and reductionistic disease concepts to emphasize holistic care given by an interdisciplinary team. Extended life expectancies, understandably ones that represent significant progress in 20th century medicine, will lead to considerably higher costs in the healthcare system and to a redistribution of therapeutic resources. Healthcare centers will form that are better equipped to handle the true needs of the patients and provide better continuity of care. Likewise, this nascent century will bring forth one irreversible sociological change, namely the better informed and better educated patient who, by demanding access to medical information in order to profit from modern technological advances, will become an active partner of the healthcare professionals. The Swiss Lung League, which is celebrating its 100th anniversary this year, has been able to tackle the real pulmonological challenges of the 20th century by taking on a pioneering role in the fight against tuberculosis, smoking and setting benchmarks by providing patients with sophisticated respiratory technology like mechanical home ventilation. Unlike other medical disciplines, it recognized early on the importance of working within a healthcare network. Its strength derives from a synergy of the cantonal leagues' medical and social commitment and the Pulmonological Society's scientific support. Indeed, this trend can be observed all over Europe and the USA. This partnership is self-perpetuating and has adapted its own mentalities and structures to scientific progress and the changing needs of pulmonary patients.

[Research in pneumology since 100 years]

Pulmonology during the last century has early on benefited from outstanding morphologic, anatomic and physiologic descriptions which have allowed the comprehension of pulmonary mechanic and gas exchanges. On these bases invasive and non-invasive ventilations have been initiated. With the discovery of antibiotics and antituberculosis treatments, the mortality related to infections diseases has markedly decreased in the young ages in countries having access to them. Biotechnology should soon improve the treatment not only of vascular but also interstitial diseases. Surgery remains the cornerstone for the treatment of limited cancer. Lung transplantation and lately thromboendarterectomy are becoming of more widespread usage.