Infectious Diseases in Clinical Practice:
Reflections of an ID Specialist
*Section on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem and †Mint Hill, NC.
Address correspondence and reprint requests to Robert J. Sherertz, MD, Section on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC 27107. Email: firstname.lastname@example.org.
In 1917, during the influenza pandemic, my grandfather (F.S.), then 20 years old, contracted influenza, hospitalized, and nearly died. He got out of the hospital just in time for his wife to deliver their first child, my father (H.S.). In 1936, my father, then 19 years old, developed influenza and nearly died. In 1972, as a 22-year-old senior in college, I developed influenza and was hospitalized in my university's infirmary for 4 days. None of us ever had influenza again during our lifetimes.
Although current physicians are familiar with advances that occurred in the prevention and treatment of influenza during the 20th century (1940s, the influenza vaccine; 1960s, amantadine was introduced; 1990s, neuraminidase inhibitors), almost no physician currently in practice is likely to be familiar with how influenza was treated in the preantibiotic era. My father's (H.S.) case is summarized below to delineate treatment modalities in vogue during the early 20th century.
In 1936, my father (H.S.) was a senior in high school when he developed an influenza-like illness characterized by high fever, dry cough, prostration, severe myalgias, and delerium. His physician arranged for him to get 24-hour nursing care at home because he felt home care would be better than hospital care. His nursing records were saved by his mother and found many years later in his attic.
The first 6 days of his illness were notable for high temperatures (Fig. 1) and severe delirium. On day 6, his fever lysed and his mental status improved significantly, but he then developed pleuritic chest pain on the right side (day 8) accompanied by a productive cough. The pleuritic symptoms peaked on days 14 to 17, when frequent codeine was required for pain relief; he steadily improved thereafter. Overall, he missed 6 weeks of school and lost nearly 30 lb. The course is consistent with an initial episode of influenza followed by a bacterial pneumonia with associated pleurisy. The treatment modalities are listed on the right side of the figure and are shown temporally as to their frequency of use. They include several topical aromatic agents to help his lungs (mustard plaster, camphorated oil, and tincture benzoin), cough medicines (codeine and whiskey), and a large number of therapies targeting his gastrointestinal tract (phenolphthalein, milk of magnesia, castor oil, enemas, and Pitressin). Urotropin was given to help him empty his bladder. Notice in particular the number of home physician visits. It is remarkable that he survived the illness given the severity of his initial influenza episode, his subsequent probable bacterial pneumonia with pleurisy, and the lack of availability of antibiotics.