In a postscript to his 1698 Treatise of the Asthma, John Floyer described bullous emphysema, together with hyperinflation and loss of lung elastic recoil, from his dissection of a broken winded mare. In his 1793 book on Morbid Anatomy, Matthew Baillie described the morphology of human emphysema with tissue destruction leading to airspace enlargement. There is good evidence that the lung used as an illustration in Baillie's book was that of Samuel Johnson, whose lungs, at autopsy, were found to be permanently distended and failed to collapse on opening the chest. René Laennec's classic Treatise on the Diseases of the Chest first appeared in 1819 and was expanded in a subsequent edition in 1826, the year of his death. In it, Laennec provided the first description of pulmonary emphysema, the destructive nature of the disease, and its association with chronic bronchitis. James Jackson, Jr., accumulated a series of cases of emphysema and noted that the disease exhibited a familial predisposition. Though he died in 1834, his work was published in a paper by his mentor Pierre Louis in 1837. It was not until 1963 that the genetically determined alpha-1-antitrypsin deficiency associated with emphysema was described. The physiological changes associated with emphysema have attracted the attention of many investigators over the years. The loss of lung recoil associated with emphysema was inferred from early observations. It was noted by Fritz Rohrer in 1916 and studied by K. von Neergaard and K. Wirz in 1927 and Ronald Christie in 1934 among others. Recent advances in the pathological anatomy of emphysema stem from the work of J. Gough in 1952 using techniques developed by him and by J. E. Wentworth. The precise mechanisms leading to the lung destruction characteristic of emphysema are under current investigation.

Ronald J. Knudson

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