SPMC Journal of Health Care Services

REPUBLICATION

Report of a case of bronchopneumonia without cough secondary to influenza: commentary

SPMC J Health Care Serv. 2017;3(1):7. ARK: https://n2t.net/ark:/76951/jhcs69h7cu

Eugene Lee Barinaga¹

¹Department of Anesthesiology, Southern Philippines Medical Center, JP Laurel Ave, Davao City, Philippines

Correspondence Eugene Lee Barinaga, eugeneleebarinaga1976@gmail.com
Received 19 June 2017
Accepted 11 June 2017
Cite as Barinaga EL. Report of a case of bronchopneumonia without cough secondary to influenza: commentary. SPMC J Health Care Serv. 2017;3(1):6. https://n2t.net/ark:/76951/jhcs69h7cu

I never thought that reading a very short medical report written almost a century ago would move me in so many levels. The first time I read it, I was figuratively looking through a doctor’s eyes, focusing on the management of the patient, and noting how the doctor arrived at the diagnosis and the therapeutics employed. The second time I read it, I was appreciating the beautiful, succinct language that was used by the author and the quaint typeset used, vividly transporting me to an era long gone and helping me to come up with a mental image of the suffering patient. A young woman “from Davao, Davao, was taken ill on the eve of her marriage, February 5, 1926.” How tragic this must have been. I ceased counting after the third reading. I may have gone over the case report twenty, or even thirty, more times. It wasn’t its brevity—four pages—that made it such an interesting reading. It harks from a bygone era, and piqued the nostalgic historical buff in me.

This was written at a time when Davao was not yet a city, and not yet subdivided (it was inaugurated as a charter city in 1937¹ by then President Manuel L. Quezon, then divided into three provinces, namely Davao del Norte, Davao Oriental and Davao Del Sur in 1967).² Electricity was probably still non-existent, as a quick check on the Internet showed that the Davao Light and Power Company only came into being in 1929.³ My imagination conjured gaslight lamps and the clip-clop of horses pulling carriages, with the occasional car rumbling past.

Dr. Juan Belisario was a resident physician in Davao Public Hospital (DPH), one of the early incarnations of the sprawling, sophisticated hospital we now know as Southern Philippines Medical Center (SPMC). DPH had 50 beds and was located in JP Laurel Avenue, Davao City where the present SPMC-Institute of Psychiatry and Behavioral Medicine now stands. Dr. Belisario published this report when the hospital was still in its infancy, and we can imagine the health facility’s very limited resources at that time in terms of diagnostic modalities and available medicines. But these did not deter Dr. Belisario. The clinical history and narration of the course of the illness are almost Holmesian in their thoroughness. The physical examination, especially of the pulmonary system, was done repeatedly and painstakingly. The charting of symptoms and temperature was obsessively undertaken. One of the sentences on the 3rd page really captivated me—“The physician attending her had stayed near the bed of the patient for hours waiting for a cough but was sorely disappointed.” If this is not professionalism and compassion for the patient, then I don’t know what is.

On a more scientific note, I researched some of the archaic items mentioned so that we can further appreciate this article. Bayer’s Cafiaspirina was given to the patient. Now only available in Latin countries, this drug was formulated between the world wars by IG Farben, a subsidiary of Bayer, to compete with other brands of aspirin in Latin America.⁴ A combination of caffeine and aspirin, it was given as an analgesic for pains associated with fatigue and tiredness.⁵ Due to the patient’s very strong family history of tuberculosis, “pneumonic type of tuberculosis, galloping type of tuberculosis, and tuberculous meningitis” were considered by the physicians. The antiformin method mentioned in the third page (page 689 in the original print) is an alkaline antiseptic, which dissolves mucin and freezes tubercle bacilli so they can be sedimented.⁶

The ultimate question I asked myself was “Did I learn anything from this article?” My answer is an emphatic yes. I realized that we should emulate the professionalism, compassion, and perseverance that the author inadvertently—but quite successfully—demonstrated with his blow-by-blow account of the care of the patient. These values, upheld by our forebears in DPH, must also be embraced by the physicians of SPMC today. I realized that we have it relatively easy now. With the fast-paced advance of technology, we now have state-of-the-art diagnostic and therapeutic modalities. Dr. Juan Belisario and the other doctors did not even have a simple x-ray then to monitor the progress of the patient’s condition. I felt intense admiration for these doctors who preceded us. They did what they had to do with what little they had.

Now that we have grown into one of the largest tertiary government hospitals not only in our country but also in the Southeast Asian region, we are expected to be at the forefront in the provision of quality and humane medical services. The future holds so much more potential for improving the way we will care for our patients. But it helps to look back and appreciate where we came from. To paraphrase a famous line by Sir Isaac Newton,⁷ who in turn paraphrased a passage from the Metalogicon by the 12th century theologian John of Salisbury,⁸ if we have seen further than others, it is by standing on the shoulders of giants.

Acknowledgments

I would like to send my sincerest gratitude to Dr Manuel Belisario and family for providing additional information on Dr Juan Belisario.

Article source

Commissioned

Peer review

Internal

Competing interests

None declared

Access and license

This is an Open Access article licensed under the Creative Commons AttributionNonCommercial 4.0 International License, which allows others to share and adapt the work, provided that derivative works bear appropriate citation to this original work and are not used for commercial purposes. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0/

References

1. President of the Philippines. Setting aside March 1, 1937, as a day for the inauguration of the City of Davao, and declaring it a special public holiday for the Province of Davao, Proclamation No. 132, s. 1937 (23 January 1937).

2. Republic of the Philippines. An Act creating the provinces of Davao Del Norte, Davao Del Sur and Davao Oriental, Republic Act No. 4867 (1967).

3. davaolight.com [Internet]. Davao: Davao Light an Aboitiz company; c2017. Available from: https://www.davaolight.com/.

4. Mann CC, Plummer ML. The aspirin wars: money, medicine, and 100 years of rampant competition. New York: Knopf; 1991.

5. aspirin.com [Internet]. Leverkusen: Aspirin®; c2017. Available from: https://aspirin.com/.

6. Fine MJ. The antiformin sputum cup. JAMA. 1917;LXVIII(16):1177-1178.

7. Letter from Sir Isaac Newton to Robert Hooke, 1675 Feb 5. In: Simon Gratz collection.

8. McGarry DD. The metalogicon of John Salisbury: a twelfthcentury defense of the verbal and logical arts of the trivium. Berkeley: University of California Press; 1955.

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Published

July 18, 2017

Issue

Volume 3 Issue 1 (2017)

Section

Republication

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