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Anything Else To Say?

Anything Else To Say?

As we move through the Winter, the days have been warmer than usual in Memphis. There seems a lot of people coming down with flu like symptoms, even one of our staff members was out last week with some kind of upper respiratory crud.

William Osler, M.D. is considered by many to be one of the greatest physicians to have lived at the turn of the nineteenth century. He was a prolific author and lectured throughout Europe and the United States. In a copy of his book "The Principles and Practice of Medicine" copyright 1894, Dr. Osler wrote about Influenza (La Grippe). At that time, many also referred to the disease as Pandemic Influenza.

He characterized Influenza as an infectious disease that manifested in great prostration and often catarrh of the mucous membranes, particularly located in the respiratory and gastrointestinal systems. There had been massive outbreaks of Influenza known throughout centuries. Many outbreaks began in Russia and moved eastward geographically, hence the name Russian fever. During the years 1889-90, Influenza prevailed extensively in October 1889 in St. Petersburg. In November and December of that year, the disease spread to Germany and France. In December of that year, it arrived in London, England.

Although many had tried to find the conditions that favored the development and rapid spread of the disease, no one succeeded in finding any. In addition, it was clear even then that the onset of the epidemics were independent of meteorological conditions. It is humorous that weather change inducing the flu seems to be one of those old wives tales that seems to continue from generation to generation because there were a number of scientists who were convinced that the affliction was due to a miasmic material in the atmosphere. Others more correctly believed the condition was due to a specific virus of the most infectiveness. Interestingly enough, in 1934 Francis Blake M.D. stated that there was no satisfactory evidence that influenza was caused by an ultramicroscopic filterable virus. He thought that is was caused by a filterable bacillary organism named Bacterium pneumosintes, but he also recognized that the bacteria's etiological relationship to influenza was at the most, uncertain.

The symptoms of influenza were described as an attack that closely resembled an ordinary catarrh with slight fever, dryness and swelling of the nasal mucosa, and then increases in the secretion. In severe cases the coryza was subsidiary or absent, and the symptoms were those of an infection of varying grades of severity. A striking feature was the severe nervous manifestations at the onset, the headache, pain in the back and legs, and a general soreness as if bruised or beaten. With the exception of dengue and small-pox, there was no affliction in which these symptoms were more pronounced. Delirium may be marked. Associated with these was a prostration and cardiac weakness out of proportion to the intensity of the fever and sometimes very alarming. The pulse was feeble, small and intermittent. Death may result directly from heart failure.

Affections of the respiratory organs were the most serious. Many cases present an intense bronchitis, involving the large and small tubes and coming on with high fever, sometimes with delirium. An intense general bronchitis was common. By far the most serious complication was pneumonia, which may follow the bronchitis or set in with the well-characterized symptoms. Sometimes the symptoms would be obscure and the pneumonia atypical.

Thus after an initial rigor, with some dyspnea and high fever, the local signs would be obscure and it may not be until the third or fourth day or even later, that the physical signs of a pneumonia were detected. The sputa may not be rusty until the third or fourth day. The crisis may be deferred or the defervescence may be by lysis. A considerable proportion of the cases, however, ran a normal course. Abscess of the lung may follow. Pleurisy was not an uncommon complication, and empyema may also have developed.

Treatment requires careful management, and it might have been weeks or months until the patient was restored to full health. A good nutritious diet, change of air and pleasant surroundings were essential. Too much stress should not be laid upon the mental features. The depression of spirits following this disease was one of its most unpleasant and obstinate features.

Dr. Osler and I have a lot in common. He composed a treatise of medicine that I believe is still pertinent to today's practice of medicine. He was the Physician-In-Chief to the John's Hopkins Hospital, Baltimore, Maryland. I am the Physician-In-Chief to the Stone Institute, Center for the Medicinal Arts, Eads, Tennessee.

The most notable difference between his treatment rendered over one hundred years ago and today is the use of intravenous fluids and medications when necessary, including antibiotics. I think if he were alive today, he would have espoused the use of antibiotics for the influenza to prevent or interrupt the progression of pulmonary complications. I doubt he would have entered into a debate about the indiscriminant use of antibiotics for influenza and the potential for inducement of drug resistant bacteria.

If someone had the flu, suffered the complication of bacterial pneumonia and died, no physician I know of would stand behind the doctor who resisted prescribing antibiotics because he/she was worried about the potential breeding of superbugs. Getting a flu shot does not prevent the flu and Tamiflu only reduces the duration of the flu by twelve hours on average. Let me reiterate the profound words of Dr. Osler:

Treatment requires careful management, and it may be weeks or months until the patient is restored to full health. A good nutritious diet, change of air and pleasant surroundings are essential. Too much stress should not be laid upon the mental features. The depression of spirits following this disease is one of its most unpleasant and obstinate features.

Is there anything else to say?

Doc

Posted by Amanda Sanders at 11:51 AM
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