Ignoring endotoxin

In 1947, Paul Beeson showed that rabbits repeatedly injected with certain bacteria eventually become resistant to the bacteria's fever-provoking effects-a phenomenon known as endotoxin tolerance.

From Fahrenheit to cytokines: fever, inflammation and the kidney

People have used the words inflammation and fever for millennia, but the meaning of inflammation has gradually changed whereas that of fever has remained reasonably constant. Whereas inflammation originally referred to the combination of heat, redness, swelling and pain in a local area, it has gradually evolved to focus upon cellular and humoral processes that occur in tissues when external or internal agents cause damage to them. The classical manifestations are no longer obligatory. Diseases that affect internal organs such as the kidneys are nowadays commonly described as inflammatory despite entirely lacking those classical manifestations, but possessing evidence of cellular proliferation and/or involvement of factors such as cytokines. These conceptual changes have resulted from the application of progressively improved investigational techniques such as microscopy, thermometry, experimental pathology, and tissue culture. The consequence of them has been largely to extinguish the fire that previously epitomised inflammation.

The contribution of Rudolf Virchow to the concept of inflammation: what is still of importance?

At the beginning of the 19th century, medicine was based largely on speculative and philosophical concepts. The greatest merit of Rudolf Virchow was without doubt a way of thinking based on natural science. In place of the empirical chaos represented by the doctrines of humors and crasis, he created the new paradigm of cellular pathology. In the field of inflammation, he critically analyzed the meaning of the four key symptoms of inflammation (redness, swelling, heat and pain) and postulated that inflammation cannot be represented as a single process but rather constitutes various inflammatory processes. In addition he introduced the functio laesa , denoting the restricted function of inflamed tissues. In the pathogenesis of inflammation, Virchow highlighted the importance of the inflammatory stimulus. The irritatio is the starting point and the conditio sine qua non . Through his pathohistological investigations in experimental animals and in humans, inflammation was widely accepted as the central cause of atherosclerosis, until the end of the 19th century, and has been confirmed in recent decades. It was Virchow who first coined the term endarteriitis deformans . Likewise, he was also the first to hypothesize a link between microinflammation and subsequent cancer development. This hypothesis has recently been corroborated by numerous studies and may have therapeutic consequences. Virchow contributed to nearly all aspects of human pathology and championed the cause of social medicine.

Atherosclerosis research from past to present--on the track of two pathologists with opposing views, Carl von Rokitansky and Rudolf Virchow

It is now clear that inflammation plays a key role in atherogenesis. As a matter of fact, signs of inflammation of atherosclerotic plaques have been observed for centuries and also constituted the basis for a fierce controversy in the 19th century between the prominent Austrian pathologist Carl von Rokitansky and his German counterpart, Rudolf Virchow. While the former attributed a secondary role to these inflammatory arterial changes, Virchow considered them to be of primary importance. We had the unique opportunity to address this controversy by investigating atherosclerotic specimens from autopsies performed by Carl von Rokitansky up to 178 years ago. Twelve atherosclerotic arteries originally collected between the years 1827 to 1885 were selected from the Collection Rokitansky of the Federal Museum of Pathological Anatomy, Vienna Medical University. Using modern sophisticated immunohistochemical and immunofluorescence techniques, it was shown that various cellular intralesional components, as well as extracellular matrix proteins, were preserved in the historic atherosclerotic specimens. Most importantly, CD3 positive cells were abundant in early lesions, thus, rather supporting Virchows's view, that inflammation is an initiating factor in atherogenesis. Furthermore, we hope to have opened a new and intriguing possibility to study various pathological conditions using valuable historical specimens.

In memoriam of Rudolf virchow: a historical retrospective including aspects of inflammation, infection and neoplasia

Rudolf Ludwig Carl Virchow (1821-1902) studied medicine and received his academic degree 'Dr. med.' in 1843. In 1856 he was appointed as head of the institute of pathology at the University of Berlin. In 1859, he became a member of the Berlin town council and later additionally a member of the Prussian and the German parliament. With his probably most important publication 'Cellularpathologie' he introduced pathology to a cellular rationale. This was the major basis for his research in oncology. Virchow further studied aspects of inflammation, despite only few links to tumor pathology were drawn. The few links from infection and inflammation to tumor pathology have almost been forgotten or ignored and have never been evaluated and discussed sufficiently. Virchow recognized that inflammation is a pre-disposing factor for tumor genesis. Furthermore, infectious diseases such as syphilis and tuberculosis had elements of a 'tumor process' and were therefore often difficult or impossible to separate from a 'genuine' tumor process, which was recognized by him. He further tried to explain tumor dissemination by an 'infectious' process. Additionally, there were ideas for a coherent explanation of tumor etiology in form of a common bacterial pathogen ('Krebsbacillus').

Infection, inflammation, height, and longevity

Using historical data from cohorts born before the 20th century in four northern European countries, we show that increasing longevity and declining mortality in the elderly occurred among the same birth cohorts that experienced a reduction in mortality at younger ages. Concurrently, these cohorts also experienced increasing adult height. We hypothesize that both the decline in old-age mortality and the increase in height were promoted by the reduced burden of infections and inflammation. Thus, early growth and cardiovascular diseases of old age may share infectious and inflammatory causes rooted in the external environment.

Indigenous practices among Palestinians for healing eye diseases and inflammations

This paper briefly describes the state health services in general, and eye care in particular for Palestinian Arabs under the British Mandate (1917-1948). The paper will also discuss the environmental and cultural origins of the prevalence of eye diseases among Palestinian Arabs. The second part of the research describes in detail indigenous practices of traditional medicine for healing trachoma and other eye diseases, inflammation that were prevalent in Mandatory Palestine.

From inflammation to sickness: historical perspective

The concept of the four cardinal signs of acute inflammation comes from antiquity as rubor et tumor cum calore et dolore, (redness and swelling with heat and pain) extended later by functio laesa (loss of function). The contemporary understanding of this process we owe to 19th-century milestone discoveries by Rudolph Virchow, Julius Cohnheim and Elie Metchnikoff. In the 20th century, the development of potent technological tools allowed the rapid expansion of knowledge of the cells and mediators of inflammatory processes, as well as the molecular mechanisms of their interactions. It turned out that some mediators of inflammation have both local and distant targets, among them the liver (responding by the production of several acute phase reactants) and neurohormonal centers. In the last decades it has become clear that the immune system shares mediators and their receptors with the neurohormonal system of the body; thus, they form a common homeostatic entity. Such an integrative view, introduced by J. Edwin Blalock, when combined with Hans Selye's concept of stress, led to the contemporary understanding of sickness behavior, defined by Robert Dantzer as a highly organized strategy of the organism to fight infections and to respond to other environmental stressors.

Role of leukocytes and endothelial cells in the development of angiogenesis in inflammation and wound healing

The basic signs and symptoms of inflammation and wound healing have been appreciated for thousands of years. However, the specific cells involved and their roles in this complex environment are still being elucidated today. In 1926, the origin of the phagocytic mononuclear ameboid wandering cell (macrophage) had not been determined. One popular theory was that the cells were differentiated from the endothelial cells of the nearby blood vessels, whereas others believed that the cells came from the peripheral blood or resting wandering cells. The purpose of this article is to review the seminal article published by Lang regarding this topic nearly 75 years ago. In addition, this article will review what is now known with regard to the role of the macrophage and endothelial cells in the development of angiogenesis, which is arguably the most critical component of successful inflammatory process or wound healing.

Role of endothelium in the production of polyblasts (mononuclear wandering cells) in inflammation. 1926

Reproduced from Archives of Pathology & Laboratory Medicine. 1926;1:41–63, with permission from the American Medical Association.Also see page 67 for a current review of the subject matter discussed in this manuscript.

Of blood, inflammation and gunshot wounds: the history of the control of sepsis

Galen (AD 129-199) propounded the notion that all wounds healed by second intention and the concept of laudable pus became unshakeable for almost 15 centuries. But William of Saliceto (AD ca 1210-1280) held quite firmly that pus formation was bad for both wound and patient and proclaimed that wounds should heal by first intention. The first rational theory of the nature of infection was by Fracastoro (1478-1553), a physician of Verona who regarded infection as being due to the passage of minute bodies from one person to another. But it was not until the work of Pasteur (1822-1895) that bacteriology took a significant leap forward. The association between bacteria and infection was slow to be accepted. The work of Semmelweis (1818-1865) is notable for his association between bacterial infection and puerperal fever. Lister (1827-1912) began the modern movement to control infection with his pioneering work in antiseptic surgery. Other contributions came from von Bergman (1836-1907; steam sterilization of instruments) and Halstead (1852-1922; rubber gloves for surgeons). The aseptic system has changed very little since then except for the innovations of Sir John Charnley (1911-1982; the laminar flow enclosure). The development of safe antibacterial drugs has been confined to the 20th century. This was led by Domagk (1895-1964; sulfonamides) and was followed by Sir Alexander Fleming (1881-1955), Sir Howard Walter Florey (1898-1968) and Sir Ernest Boris Chain (1906-1979; penicillin) and Selman Waksman (1888-1973; actinomycin).

Historical perspectives on laminitis

This article attempts to provide a historical perspective regarding equine laminitis. It is designed to cover, as completely as possible, the historical record of, and the research advances made, in regards to acute and chronic laminitis. With respect to the historical record, the names given to this disease, the postulated etiologies, and the various treatment protocols are discussed. This article demonstrates the historical longevity of this disease and establishes a background for the current understanding of the disease's pathologic mechanisms and treatments.

[Diseases of the pericardium in Avenzoar's Kitab al-Taysir (c.1095-1162)]

Avenzoar has been credited as the author of the first description of inflammation of the pericardium in medical historical literature. Our study shows that although Avenzoar authored a study of diseases of the pericardium with emphasis on pathologies, his epistemological framework was similar to that used by Galen and Avicenna, authors who constituted the source of knowledge for Islamic medicine. We show that the approach used by Avenzoar appears to derive from the absence of anatomical and physiological information, and from a detailed description of the indications and treatments, which distinguish his work from earlier writings.