You do not want to miss it—the story of H influenzae meningitis

The 1940 film Courageous Dr. Christian shows a meningitis outbreak in “squatter town.” When Dr (Jean Hersholt) is called to diagnose child, he warns the community of more come. Once informed, unfazed mayor interjects that slums alone are at risk. Christian—deeply serious and upset by mayor's lack compassion for poor—tells him infection could also get town administrators. portrayed might have superficially represented an actual meningococcal epidemic hit major American cities early 1900s. Epidemic meningitis, with its devastating consequences (nearly 100% mortality if caused Haemophilus influenzae), one main story lines Janet Gilsdorf's engagingly written revelatory book on bacterial meningitis. catchy title Continual Raving: A History Meningitis People Who Conquered It refers diagnosis phrensy, which Thomas Willis described as “continual raving or depravation chief faculties brain arising from inflammation meninges continual fever.” remains hypothetical was truly diagnosing infectious because key symptoms actually opposite: patients were typically withdrawn obtunded. Definitive descriptions came John Abercrombie, who specifically pointed meningeal substrate identified different types severity involving base convexities, well type additional pus ventricles, emphasising hydrocephalus important complication (figure). You cannot judge cover (the straightened leg mischaracterised Kernig's sign Peruvian trepanned skull very much out context), but Gilsdorf provides number superb chapters microbiology chapter Simon Flexner (1863–1946) his intrathecal horse serum particularly outstanding. not clinical history treatise discovery H influenzae poignant reminder investigators found characterised pathogen There parade (“steadily laboring”) researchers photographed their laboratories microscopes. Extensive biographies, including researchers’ relationships demeanors, described; many seemed gruff, difficult work with, critical others. emphasis Richard Pfeiffer's contributions and, epilogue, author even takes us grave-seeking trip (not found). 1890 Russian influenza led Pfeiffer find bacillus, later influenzae, although willing concede after virus be culprit (we should startled—his exemplary time). For microbiologists, there rich how dedicated scientists meticulously bacteria using simple common sense logic. example, entitled “The most famous graph microbiology” about inverse relationship incidence immunity age, showing proclivity strike hard neonates toddlers. we dive into molecular biology immunology (and another circuitous route genomic project), loses some relevance becomes somewhat exasperating clinicians. makes grand detour other outbreaks (plague smallpox) explain significance agglutination reaction devotes Nobel Prize-winning restriction enzymes model. struggle treat meningitis—improvement streptomycin discovered Selman Waksman painful Albert Schatz controversy covered). Penicillin ineffective, had already been observed Alexander Flemming, saw untouched Penicillium mold. Streptomycin sulfa became standard treatments until chloramphenicol ampicillin around. search vaccine relentless (truly) saved lives—although without aftermath morbidity. Despite images afflicted “epidemic meningitis”, little information physicians struggled make adequately describe entity. classic finding irritation, causing limb contraction passive movements, carries two eponyms Vladimir Kernig (1840–1917) Polish pediatrician Josef Brudzinski (1874–1917). Epidemics would lead large patients, when opportunity existed, they allowed observation pattern recognition. books cerebrospinal appeared late 1800's 1900's, each outbreak. Each added phenotype, provided illustrations temperature curves showed distress. Many these tried point signs differentiated typhus. Major, recent several clinicians marginally described. Moreover, goes she retrospectively attributes Helen Keller's blindness hearing loss Keller rare survivor sick age 19 months. In Donald G Bates's words, “the historian like mathematician equation unknowns.” Pathology solidified our historical knowledge. Things worse bygone days, now “bad memory.” has eradicated “conquered”, meningitis—particularly septicemia—remains deadly ever. packed insights, rightly praises gave vaccines. However, neurology deserves praise. Thinking globally, can say primary care patient slipping away decide whether high fever often still is) decisions faced before luxury consulting colleagues radiology. But wonderful convinces need laboratory immeasurably thankful what did.