I have in front of me a weathered copy of Cecil’s Textbook of Medicine from 1947. It belonged to my father, who graduated from medical school in the 1940s. Even then, it was known that pneumoccus, a common bacterium, can live harmlessly in the nose and throat and only sometimes causes disease. Pneumoccocal disease was and is still a leading cause of disease and death*, killing perhaps a million children per year. It causes ear and sinus infections, but also meningitis, and is the most common cause of pneumonia. In the past it was referred to as “the captain of the men of death” for it’s ability to claim so many. It is also closely associated with influenza—the pneumococcus that may live harmlessly in the mouth may find the damaged lung of the flu patient a nice place to set up shop. The pneumonia that follows an influenza infection can be devastating and preventing it is an important public health goal.
The bacteria itself has been known for over a century, when it was discovered by US Army doctor George Sternberg in a frontier post in 1881. A couple of decades later, sera were developed to fight the disease. There were no antibiotics at the beginning of the 20th century, and as influenza killed millions, often of pneumonia, scientists were were working feverishly (and often dying) trying to save lives. They discovered some of the most important serotypes of pneumococcus, created serum from horses, and injected it into sick patients with significant good results.
The role of pneumococcal infections as a cause of death has been amazingly diminished by the introduction of sulfonamide and penicillin therapy.
Pneumonia may terminate by crisis or lysis. The typical crisis of pneumonia is one of the most striking features of the disease. The patient, struggling against a virulent infection, often appears on the verge of collapse. The whole organism seems to be affected by the toxemia. Suddenly the patient begins to perspire freely; there is a rapid drop in temperature to normal or subnormal, accompanied by a corresponding fall in the respiratory and pulse rate. In a few hours the entire clinical picture is changed. The patient looks and feels much better and drops off into a quiet sleep…
Each year in the United States, there are an estimated 175,000 hospitalized cases of pneumococcal pneumonia; it is a common bacterial complication of influenza and measles. In addition, in terms of invasive disease, there are more than 50,000 cases of bacteremia and 3,000 to 6,000 cases of meningitis annually. Invasive disease bacteremia and meningitis is responsible for the highest rates of death among the elderly and patients who have underlying medical conditions. According to the Centers for Disease Control and Prevention (CDC), invasive pneumococcal disease causes more than 6,000 deaths annually. More than half of these cases involve adults for whom vaccination against pneumococcal disease is recommended.