Remembrances of an old infectious diseases doctor

As older infectious disease specialists such as myself become senior citizens, one of our favourite pastimes is reminiscing about ‘the good old days’ of medicine. For this old fellow, reminiscing conjures up memories of working as a resident on the infectious diseases ward at The Hospital for Sick Children in Toronto, Ontario; as a senior resident at the Willard Parker Hospital in New York, New York; and later as a staff member at The Hospital for Sick Children. I have fond memories of working as a senior resident at Willard Parker Hospital, which was the principal hospital treating infectious diseases in New York city at the time in 1948. It was a great educational experience during the days when the hospital admitted patients with polio, diphtheria, complicated measles, scarlet fever, whooping cough or gastroenteritis – any patient who had symptoms that looked like an infectious disease rash or an unexplained fever was a potential admission. As residents, we rode the well-equipped ambulance to pick up severely ill patients with paralytic polio, whooping cough or other complicated infectious diseases. We used to tell the ambulance driver (a man with a tracheotomy following laryngeal diphtheria) to drive a little more carefully, lest we were all killed! Ambulance driving through New York city’s busy streets was a challenge and an art, but we always made it safely. Most of the patients treated were quite ill and required around-the-clock care. Children with laryngeal diphtheria needed to have membranes removed from their vocal cords by laryngoscopy two or three times a day. A half teaspoon of good whiskey on a lump of sugar in a tablespoon of warm water served as an excellent sedative for these patients and seemed to relax their respiratory distress. Some of the patients with pharyngeal diphtheria progressed to diphtheritic paralysis or myocarditis, and required special care. We treated all types of polio cases (ie, nonparalytic, paralytic, bulbar and encephalitis) using modern respirators for individuals with intercostal weakness and breathing difficulties. For patients with severe limb pain due to paralytic disease of the extremities, the nurses applied the Sister Kenny technique. She was a nurse who devised the technique of applying hot moist compresses to paralytic limbs for several hours each day, which seemed to help relieve the pain but did not alter the paralysis. The treatment required a great deal of time and effort on the part of the dedicated nursing staff. While practically all of the attending staff physicians were outstanding personalities in the field of infectious diseases, great teachers and researchers, one attending physician stands out in my memory. Making his rounds one morning, he came into the room of a patient who was admitted during the previous night with a diagnosis of paralytic polio. The physician informed the patient that he was faking it, and told him to get out of bed and walk down the hall. This, the lad did, with apparent pain and weakness, and returned to his bed where he died 1 h later. It was a lesson not to stress an acute polio patient. People experiencing influenza-like illnesses, which during polio epidemics may have been patients with nonparalytic disease, needed to rest and avoid trying to continue usual activity because this appeared to be a factor that contributed to developing paralytic disease. While the patients with infectious diseases at Willard Parker were an educational gold mine and provided the opportunity to gather a wealth of knowledge, the most memorable part of my residency was the teaching provided by the attending staff, most of whom were leaders in the world of infectious diseases. Teachers and researchers, and developers of treatment and preventive measures, these infectious diseases experts left an indelible impression on all of us. The attending staff included Drs Saul Krugman, Sam Karelitz, Jerome Cohn, Dorothy Horstman, Albert Sabin and Horace Hodes. They were the medical leaders who developed new techniques in the treatment and prevention of whooping cough, measles, mumps, rubella and polio. They were also involved in the development of vaccines for the prevention of these serious diseases that ravaged people in the 1940s, 1950s and 1960s. During those years in Canada, Drs Beverley Hannah and Nelles Silverthorne were the leading lights in the field of infectious diseases, serving as teachers, clinicians and researchers while serving on the staff at The Hospital for Sick Children. At that time, residents were responsible for admitting infectious disease patients from the emergency department and caring for them on the infectious disease wards. During polio outbreaks, we would perform between 20 to 30 lumbar punctures a day. Dr Silverthorne’s contributions to managing infectious diseases are well documented in the annals of The Hospital for Sick Children. He was actively involved in the development of the early whooping cough vaccines and the treatment of various types of purulent meningitis. Friends and colleagues remember him as a fine teacher and a conscientious paediatrician who enjoyed a large practice. Dr Silverthorne spent hours walking along the Trans-Canada Railway tracks looking for fecal deposits from train passengers, examining the material for polio virus and catching flies that he thought may be spreading the virus from these sites to other humans. While some of these research efforts may have failed to produce fame and fortune for the thoughtful investigator, they were certainly a lesson in diligence for others! Along with the discovery of penicillin by Alexander Fleming, the development of vaccines has been one of the greatest medical advances that has prevented untold suffering, morbidity and mortality. The eradication of smallpox was indeed a great achievement, and the virtual elimination of polio, measles, mumps, rubella and influenza B diseases in developed countries has been a significant advance in disease prevention. Worldwide employment of these preventive measures and the development of newer vaccines should be our goals in the new millennium.

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