Sir,
In reference to my letter ‘Viral fevers: Simple clinical clue’ (SOM dated June 15), there is a very important factor to keep in mind which is about malignant malaria. In this case also, there is relative bradycardia and it is important to exclude malignant malaria in which patient looks more toxic and signs of upper respiratory infection are generally absent. So, with whatever means available we must differentiate malaria from viral fever as malignant malaria can be fatal if not diagnosed and treated early.
In the forties, when we did not use the term viral fever, perhaps because they were not common, we used the term Pyrexia of unknown origin (PUO). Since there were no antibiotics in the beginning of forties, every fever case was treated with home remedy of raisin or munakka.
A big variety of raisins is heated on coal fire with salt and pepper. Generally for children five or six munakkas were used. It used to taste super and was very energy-giving. There were very few hospitals and people went to hospital very late when all the home remedies failed and patient was very sick.
Gradually, doctors coaxed the patients for coming to hospital for early treatment. And by seventies, in free hospitals like the public sector undertakings, patients started coming for very minor ailments too and by eighties, all our hospitals were flooded for demands of medical certificates along with any slight ailment while the ladies gathered for gossiping with each other since the hospital was near the residential colony.
The result was that we doctors became busier and busier to the point of frustration and had to use real skill to sort out the really sick from malingerers. In hospitals we treated the fever cases with APC (combination of aspirin phenacetin and caffeine). At that time we were not aware of the side effects of aspirin in viral fevers. Aspirin was given only for high fever and others were just given most mix soda sal (called Mixtures)!
For urinary infection which have become so resistant to antibiotics now, we were simply changing the ph of urine. If urine was acidic we gave alkali solution and in alkaline urine, we gave Ammonium Chloride. With this simple treatment, majority responded as in opposite medium the infective organism could not thrive. That is the history of fever management!
– Dr. Sarla Bhatnagar, via e-mail, Mysuru, 23.6.2017
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