Sir,

In connection with differentiating viral fevers from bacterial, a simple clinical clue is very useful. It is important to be certain of viral aetiology so that patient is not subjected to unnecessary and harmful antibiotic therapy. It is well-known that while antibiotics are useful yet there are dangerous side-effects and expenses are an important factor for majority. So, it is essential to use antibiotics judiciously.

Even in all the bacterial cases, many minor ones like mild throat infections which are very common, many a times, healing takes place without antibiotic; but in some bacterial like pneumonia, antibiotic therapy at the earliest is life-saving and there again the clue of rapid respiratory rate is very useful. Generally in adults a respiratory rate of above 40 per minute and above 60 per minute in children should make us verify pneumonia. Respiratory rate rises in very high fevers also.

To differentiate viral fevers, in earlier than seventies clinical method, it was clearly mentioned that normally pulse rate varies between seventy plus minus five beats per minute and rises at the rate of ten beats with each (F) degree rise of temperature except in viral infections where the rise of pulse in proportion to is slower. This clue of comparative bradycardia proved of tremendous help to me in saving many a viral from being subjected to unnecessary antibiotics. In viral, there is always a chance of secondary infection which may or may not require antibiotic, but then the pulse will rise and depending on the severity, the therapy can be initiated.

In later publications of clinical methods, this para had been avoided perhaps due to lack of space. I tried to propagate this point as much as I could. It was suggested by some colleagues that I should prepare a scientific paper giving data of number of cases in which I worked. In those days where each one of us had to attend 50 to 100 cases per day, it was not practicable to record such details but I wrote in health magazines and others.

So when there is a spurt in viral cases this clue can be utilised. On certain days we were so busy that there was no time to check pulse and temperature personally; then I utilised the assistance of nurse or dresser in adjacent room so that pulse and temperature and breathing rate was recorded and treatment given.

– Dr. Sarla Bhatnagar,

[Retired from UCIL Medical Hospital, Jadugoda], Yadavagiri, 13.6.2017