AJPH -- eLetters for Gottlieb, 96 (6) 980-981

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VOICES FROM THE PAST:
Michael S. Gottlieb
Pneumocystis Pneumonia—Los Angeles
Am J Public Health 2006; 96: 980-981 [Full text] [PDF]

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Reflections on "Voices from the Past": Steven A Kritz (27 July 2006)

Reflections on "Voices from the Past" 27 July 2006

Steven A Kritz,
MD; Medical Administrator
Personal correspondence
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Re: Reflections on "Voices from the Past"

kritz{at}ny.freei.net Steven A Kritz

“Voices from the Past” (June 2006 issue) was a real memory jogger for me. In September of 1977 as a medical intern at Kings County Hospital in Brooklyn, NY, I admitted a 21 year-old previously healthy African-American male engaged to an African-American female. He had fever of 106F; severe headache with other soft neurological signs, and a vesicular rash that was so widespread that even the neurologists wouldn’t attempt a spinal tap for fear of introducing infected vesicular fluid into the spinal canal. Herpes was diagnosed 2-3 days later. At that time, the only treatment available was intravenous acyclovir, which had to be flown from the University of Michigan, Ann Arbor to LaGuardia Airport. The patient responded well, and was discharged about a week after IV acyclovir treatment began.
An oncologist at Downstate Medical Center, Dr. Julian Rosenthal requested a blood sample to look at the WBCs. At that time, T-cell typing was in its infancy. About four months later, Dr. Rosenthal reported to us that the patient’s WBC count was normal, but he had very few helper T- cells. It didn’t register with anyone, and I forgot about it for the next 5-6 years until HIV was determined to be the cause of AIDS and CD4 counts became the standard for following the disease. In fact, when the MMWR of 1981 was released, it did not bring to mind a 73 year-old white male retired trolley driver with CLL requiring frequent transfusions. He was admitted to State University Downstate Hospital in late 1977 with marked respiratory distress that was diagnosed bronchoscopically as PCP.
Ironically, the chairman of the Dept of Medicine at Downstate at that time was Dr. Alfred Bollet, who had written and lectured extensively on Pasteur’s “chance and the prepared mind” and its role in the advancement of medical knowledge. At least we were on the ball in late summer 1978 when we considered the diagnosis of Legionnaires in two brothers whose older brother was dying of a rapidly progressive pneumonia at another hospital. Erthromycin was begun immediately, and these two patients did well. These brothers were the index cases of the Legionnaires outbreak in NYC. Incidentally, the way we determined that they were ready to go home was when we caught them one night in the stairwell smoking joints and engaging in foreplay with their girlfriends. Clearly, they were no longer short of breath.