Non-Natural Causes

--- The online site that lists 'causes of deaths of famous philosophers' has Grice as dying of 'non-natural causes'.

But, strictly, if you look up 'emphsema' (what is offensive is that the list of causes of deaths was published when Grice's obituary was, to say the least, premature), the very first sentence, in wiki, features our dear friend, Dupre's " ... causes ...":

"Emphysema is [=df. JLS] a long-term,

progressive disease of the lung that

primarily causes shortness of breath."


--- That's different from saying it causes death, right?

Plus, isn't SMOKING that causes death. Surely I don't care how you call it with your fancy Greek names!

---

"In people with emphysema, the lung tissues

necessary to support the physical shape and

function of the lung are destroyed."

--- by the cigarette, or the tobacco thereby contained, rather.

"It is included in a group of diseases

called chronic obstructive pulmonary disease or

COPD (pulmonary refers to the lungs)."

--- of which we have, ceteris paribus, two.

"Emphysema is called an obstructive lung disease

because the destruction of lung tissue around smaller

airways, called alveoli, makes these airways unable to

hold their functional shape upon exhalation."


--- I would hold that 'makes ...' HERE, means '... causes ...'. It's like the sinking and the senking of the Belgrano.

"The term means swelling and comes from the Greek

emhysan meaning inflate, itself composed of en meaning

in and physa meaning breath, blast. [1]"

---- a pedigree that ironically Grice enjoyed. He spent hours discussing with staff at the hospital about the etymology of this or that disease -- 'coronary thrombosis' preferred to 'dropsy' --.

"Emphysema can be classified into primary and secondary color. However, it is more commonly classified by location."

--- Makes sense to me.

"Emphysema can be subdivided into

panacinary and centroacinary (or panacinar and centriacinar,[2] or

centrilobular and panlobular).[3]"


"Panacinar (or panlobular) emphysema: The entire respiratory acinus, from respiratory bronchiole to alveoli, is expanded. Occurs


more commonly


in the lower lobes, especially basal segments, and anterior margins of the lungs.[2]"

--- "more commonly" is a frequentative, not definitional.

"Centriacinar (or centrilobular) emphysema: The respiratory bronchiole (proximal and central part of the acinus) is expanded. The distal acinus or alveoli are unchanged. Occurs more commonly in the upper lobes.[2]"


Again, 'more commonly' not used definitionally or analytically.

"Other types include distal acinar and irregular.[2]"


"A special type is congenital lobar emphysema (CLE)."

"Congenital lobar emphysema (CLE) results in overexpansion of a pulmonary lobe and resultant compression of the remaining lobes of the ipsilateral lung, and possibly also the contralateral lung."

-- results? This looks like causal efficacy in reverse.

"There is bronchial narrowing because of weakened or absent bronchial cartilage.[4]"

"There may be congenital extrinsic compression, commonly by an abnormally large pulmonary artery. This causes malformation of bronchial cartilage, making them soft and collapsible.[4]"

"CLE is potentially reversible, yet possibly life-threatening, causing respiratory distress in the neonate.[4]"

-- if this was the case with Grice we would need to study the foetus back in 1913, I suppose.

"Signs and symptoms. Emphysema is a disease of the lung tissue caused by destruction of structures feeding the alveoli,"

Note the rather cavalier use of 'caused'.

"in some cases owing to the action of alpha 1-antitrypsin deficiency. This causes the small airways to collapse"

Again, the 'causes'.

"during forced exhalation, as alveolar collapsibility has decreased. As a result, airflow is impeded and air becomes trapped in the lungs, in the same way as other obstructive lung diseases."

---- "That MEANS he has emphysema"

"Symptoms include shortness of breath on exertion, and an expanded chest. However, the constriction of air passages isn't always immediately deadly, and treatment is available."

Cfr. "the constriction of air passages isn't always immediately TELLING". Or it could occur by other causes?

"Most of the people who have emphysema are smokers."

---- Cigarette gets into the picture as non-analytic.

"Damage caused by emphysema is permanent even after the person stops smoking."

---- This shows the long-term or long reach of a cause. Some empricists, on the other hand, stick to immediate causes as the only efficacious ones.

"People with this disease do not get enough oxygen and cannot eradicate the carbon dioxide, so they always have a shortage of breath."

AITIOLOGY:

"Causes. The primary cause of emphysema is the smoking of cigarettes."

or tobacco in general.


"In some cases it may be due to alpha 1-antitrypsin deficiency."

Not Grice's.

"Severe cases of A1AD may also develop cirrhosis of the liver, where the accumulated A1AT leads to a fibrotic reaction."

"Pathophysiology. Pathology of lung showing centrilobular emphysema characteristic of smoking. Closeup of fixed, cut surface shows multiple cavities lined by heavy black carbon deposits. (CDC/Dr. Edwin P. Ewing, Jr., 1973)."

"In normal breathing, air is drawn in through the bronchi and into the alveoli, which are tiny sacs surrounded by capillaries. Alveoli absorb oxygen and then transfer it into the blood. When toxicants, such as cigarette smoke, are breathed into the lungs, the harmful particles become trapped in the alveoli, causing a localized inflammatory response."

To think that those things are SOLD freely ...

"Chemicals released during the inflammatory response (e.g., elastase) can eventually cause the alveolar septum to disintegrate. This condition, known as septal rupture, leads to significant deformation of the lung architecture.[5] The large cavities left by the septal degeneration are known as bullae (sin. = bulla). These deformations result in"

-- cause, only different.

"a large decrease of alveoli surface area used for gas exchange. This results in"

again, causes.

"a decreased Transfer Factor of the Lung for Carbon Monoxide (TLCO). To accommodate the decreased surface area, thoracic cage expansion (barrel chest) and diaphragm contraction (flattening) take place. Expiration increasingly depends on the thoracic cage and abdominal muscle action, particularly in the end expiratory phase."

There's something 'causal' about 'depends on'.

"Due to decreased ventilation, the ability to exude carbon dioxide is significantly impaired. In the more serious cases, oxygen uptake is also impaired. As the alveoli continue to break down, hyperventilation is unable to compensate for the progressively shrinking surface area, and the body is not able to maintain high enough oxygen levels in the blood."

So THAT's the cause. People tend to think of 'cause' as abnormal. But first we need to understand the physiology of NORMAL: the CAUSES of normal.

"The body's last resort is vasoconstricting appropriate vessels. This leads to pulmonary"

- causes -

"hypertension, which places increased strain on the right side of the heart, the side responsible for pumping deoxygenated blood to the lungs. The heart muscle thickens in order to pump more blood. This condition is often accompanied by the appearance of jugular venous distension."

correlation rather than causation? Don't think so! Why bother with correlation if causation is not at least implicated? Surely it is a matter of our ignorance, as naive Einstein would have it?

"Eventually, as the heart continues to fail, it becomes larger and blood backs up in the liver."

"Patients with alpha 1-antitrypsin deficiency (A1AD) are more likely to suffer from emphysema."

By what percentage? Quantify!

"A1AT inhibits inflammatory enzymes (such as elastase) from destroying the alveolar tissue. Most A1AD patients do not develop clinically significant emphysema, but smoking and severely decreased A1AT levels (10-15%) can cause emphysema at a young age."

Again, note the pleonetetic quantifier, "most", and the dispositional "can".

"The type of emphysema caused by A1AD is known"

-- so we ¨know¨ the ¨cause¨.

"as panacinar emphysema (involving the entire acinus) as opposed to centrilobular emphysema, which is caused by smoking."

Or rather by the tobacco in the cigarette.

"Panacinar emphysema typically affects the lower lungs, while centrilobular emphysema affects the upper lungs. A1AD causes about 2% of all emphysema."

Probably.

"Smokers with A1AD are at the greatest risk for emphysema. Mild emphysema can often develop into a severe case over a short period of time (1–2 weeks). While A1AD provides some insight into the pathogenesis of the disease, hereditary A1AT deficiency only accounts for a small proportion of the disease."

-- "accounts for": explains the causation.

"Studies for the better part of the past century have focused mainly upon the putative role of leukocyte elastase (also neutrophil elastase), a serine protease found in neutrophils, as a primary contributor to the connective tissue damage seen in the disease."

-- contributing causal agent, that is.

"This hypothesis, a result of the observation that neutrophil elastase is the primary substrate for A1AT, and A1AT is the primary inhibitor of neutrophil elastase, together have been known as the "protease-antiprotease" theory, implicating neutrophils as an important mediator of the disease."

-- implicating -- NOT in Grice´s sense.

"However, more recent studies have brought into light the possibility that one of the many other numerous proteases, especially matrix metalloproteases might be equally or more relevant than neutrophil elastase in the development of non-hereditary emphysema."

Causal relevance is said by some to be THE key notion in ontological causation.

"The better part of the past few decades of research into the pathogenesis of emphysema involved animal experiments where various proteases were instilled into the trachea of various species of animals."

These would have been illegal with humans.

"These animals developed connective tissue damage, which was taken as support for the protease-antiprotease theory. However, just because these substances can destroy connective tissue in the lung, as anyone would be able to predict, doesn't establish causality."

Indeed.

"More recent experiments have focused on more technologically advanced approaches, such as ones involving genetic manipulation. One particular development with respect to our understanding of the disease involves the production of protease "knock-out" animals, which are genetically deficient in one or more proteases, and the assessment of whether they would be less susceptible to the development of the disease."

I hope they don´t have genetically disabled toads to smoke till they explode.

"Often individuals who are unfortunate enough to contract this disease have a very short life expectancy, often 0–3 years at most. Diagnosis. A severe case of emphysema.The diagnosis is usually confirmed by pulmonary function testing (e.g. spirometry); however, X-ray radiography may aid in the diagnosis."

Grice was diagnosed in 1984.


"Prognosis and treatment. Emphysema is an irreversible degenerative condition. The most important measure to slow its progression is for the patient to stop smoking and avoid all exposure to cigarette smoke and lung irritants. Pulmonary rehabilitation can be very helpful to optimize the patient's quality of life and teach the patient how to actively manage his or her care."

So, it´s the reverse of the probability condition:

Pr(enphysema/do-smoking)

"Patients with emphysema and chronic bronchitis can do more for themselves than patients with any other disabling disease. Emphysema is also treated by supporting the breathing with anticholinergics, bronchodilators, steroid medication (inhaled or oral), effective body positioning (High Fowlers), and supplemental oxygen as required. Treating the patient's other conditions including gastric reflux and allergies may improve lung function. Supplemental oxygen used as prescribed (usually more than 20 hours per day) is the only non-surgical treatment which has been shown to prolong life in emphysema patients."

Grice did undergo surgery.

"There are lightweight portable oxygen systems which allow patients increased mobility. Patients can fly, cruise, and work while using supplemental oxygen. Other medications are being researched."

"Lung volume reduction surgery (LVRS) can improve the quality of life for certain carefully selected patients. It can be done by different methods, some of which are minimally invasive. In July 2006 a new treatment, placing tiny valves in passages leading to diseased lung areas, was announced to have good results, but 7% of patients suffered partial lung collapse."

This was after Grice´s time, who died in 1988.

"The only known "cure" for emphysema is lung transplant, but few patients are strong enough physically to survive the surgery. The combination of a patient's age, oxygen deprivation and the side-effects of the medications used to treat emphysema cause damage to the kidneys, heart and other organs. Surgical transplantation also requires the patient to take an anti-rejection drug regimen which suppresses the immune system, and can lead to microbial infection of the patient. Patients who think they may have contracted the disease are recommended to seek medical attention as soon as possible."

So, intentions ARE relevant.

"Research. A study published by the European Respiratory Journal suggests that tretinoin (an anti-acne drug commercially available as Retin-A) derived from vitamin A can reverse the effects of emphysema in mice by returning elasticity (and regenerating lung tissue through gene mediation) to the alveoli.[6][7]".

But a mouse is not a man.

"While vitamin A consumption is not known to be an effective treatment or prevention for the disease, this research could in the future lead to a cure. A follow-up study done in 2010 found inconclusive results ("no definitive clinical benefits") using Vitamin A (retinoic acid) in treatment of emphysema in humans and stated that further research is needed to reach conclusions on this treatment.[8]"

A cure while still smoking? (I guess one should not have his cake and eat it?).

"Notable cases. Notable cases of emphysema have included Ava Gardner,"

The most beautiful woman that ever existed. I love her portrayal by Kate Beckinsale in "The Aviator" -- another beauty.

"Don Cornell, Spencer Tracy,[9] Leonard Bernstein, Eddie Dean,[10] Dean Martin, Norman Rockwell, Samuel Beckett, Johnny Carson, Al Capp, T. S. Eliot, Tallulah Bankhead,"

Sir Noel Coward detested her. "Tallulah called". "Tallulah who?".

"Dick York, James Franciscus, R. J. Reynolds, R. J. Reynolds Jr., R. J. Reynolds, III,[11] Don Imus,[12] Ike Turner, Charlie Simpson, Yosef Hayim Yerushalmi, Elizabeth Dawn, Jerry Reed, Boris Karloff,"

He was born Pratt and he has a good recording of "The Hunting of the Snark".

"Leonid Brezhnev and Paul Avery.[13]"

-- and of course Paul Grice, author of "Logic and Conversation".

"[edit] Additional images. H&E (haematoxylin and eosin) stained lung tissue sample from an end-stage emphysema patient. RBCs are red, nuclei are blue-purple, other cellular and extracellular material is pink, and air spaces are white."

"Micrograph demonstrating emphysema (left of image - large empty spaces) and lung tissue with relative preservation of the alveoli (right of image). H&E stain.".

Demonstrating or monstrating?

"See also: Paraseptal emphysema, Subcutaneous emphysema"

1.^ emphysema at dictionary.com
2.^ a b c d "Emphysema". http://www.meddean.luc.edu/Lumen/MedEd/MEDICINE/PULMONAR/pathms/mpath6.htm. Retrieved 2008-11-20.
3.^ Anderson AE, Foraker AG (September 1973). "Centrilobular emphysema and panlobular emphysema: two different diseases". Thorax 28 (5): 547–50. doi:10.1136/thx.28.5.547. PMID 4784376. PMC 470076. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=4784376.
4.^ a b c eMedicine Specialties > Radiology > Pediatrics --> Congenital Lobar Emphysema Author: Beverly P Wood, MD, MS, PhD, University of Southern California. Updated: December 1, 2008
5.^ "SURGICAL PHYSIOPATHOLOGY OF EMPHYSEMA AND LUNG VOLUME REDUCTION". http://www.fondazionecarrel.org/carrel/thorac/files/enphys/new/emphysema1.html.
6.^ Mao J, Goldin J, Dermand J, Ibrahim G, Brown M, Emerick A, McNitt-Gray M, Gjertson D, Estrada F, Tashkin D, Roth M (1 March 2002). "A pilot study of all-trans-retinoic acid for the treatment of human emphysema". Am J Respir Crit Care Med 165 (5): 718–23. PMID 11874821. http://ajrccm.atsjournals.org/cgi/content/full/165/5/718.
7.^ "Vitamin may cure smoking disease". BBC News. December 22, 2003. http://news.bbc.co.uk/2/hi/health/3329103.stm. Retrieved 2006-11-18.
8.^ Roth M, Connett J, D'Armiento J, Foronjy R, Friedman P, Goldin J, Louis T, Mao J, Muindi J, O'Connor G, Ramsdell J, Ries A, Scharf S, Schluger N, Sciurba F, Skeans M, Walter R, Wendt C, Wise R (2006). "Feasibility of retinoids for the treatment of emphysema study". Chest 130 (5): 1334–45. doi:10.1378/chest.130.5.1334. PMID 17099008. http://www.chestjournal.org/cgi/content/full/130/5/1334.
9.^ "Spencer Tracy". Hollywood.com. http://www.hollywood.com/celebrity/Spencer_Tracy/196686. Retrieved 2009-09-12.
10.^ "Eddie Dean Obituary". Allbusiness.com. http://www.allbusiness.com/retail-trade/miscellaneous-retail-retail-stores-not/4625955-1.html. Retrieved March 14, 2009.
11.^ ""Death from Smoking in the R. J. Reynolds Family by Patrick Reynolds"". Tobaccofree.org. http://www.tobaccofree.org/famobit.htm. Retrieved 2009-09-12.
12.^ ""Don Imus's Last Stand: Politics & Power"". Vanityfair.com. 2009-01-06. http://www.vanityfair.com/politics/features/2006/02/imus200602?currentPage=2. Retrieved 2009-09-12.
13.^ music (2008-10-27). ""Amy Winehouse rushed to hospital"". Entertainment.uk.msn.com. http://entertainment.uk.msn.com/music/news/nme/article.aspx?cp-documentid=10434337>1=61501. Retrieved 2009-09-12.
[edit] External links
https://health.google.com/health/ref/Chronic+obstructive+pulmonary+disease
Images of Emphysema http://www.radrounds.com/photo/paraseptal-and-centrilobular-1