12 APRIL 1916 * 25 MARCH 2007
DR. ROBERT AUSTRIAN, who died on 25 March 2007, a few weeks short of his ninety-first birthday, was a notable student of the pneumococcus and a link with the great physicians of the past. He was famed for having reestablished the importance of this organism as a cause of blood stream infection and pneumonia, and for having influenced by his work the development of a vaccine that is recommended universally for older adults.
Bob Austrian's life was the tale of three cities: Baltimore, where he was born and educated; New York, where he had his early productive career; and Philadelphia, where his career flourished. Dr. Austrian's father was a professor of medicine at Johns Hopkins and a well-known specialist in pulmonary diseases. He was much admired and emulated by Bob, who often spoke of his father's good judgment and skill in physical examination.
Bob graduated in 1941 from Johns Hopkins University School of Medicine, where he also did his internship and residency. From 1943 to 1945 he served on the Typhus Commission of the U.S. Army, working in Southeast Asia. He returned to the medical staff at Hopkins, but during the ensuing years also spent time doing research and consulting in New York City. In 1952 he moved to the State University of New York Downstate Medical Center in Brooklyn, where I was a medical student.
Although at the time Bill Dock and Perrin Long, the two other senior physicians, were better known, Bob, then about forty years old and at the height of his powers, was clearly a scientist as well as a clinician. He was the attending physician on the ward at Kings County Hospital to which I was assigned, and in the usual fashion I followed him from patient to patient. Bob's physical examinations were detailed and precise. It was wonderful to see how much information he could extract from them. Bob was knowledgeable not only about infectious diseases, but about other aspects of internal medicine.
Here in his own words1 is what Bob taught about histories and physicals: "Time spent in the careful taking of a history provides an opportunity for physician and patient to know one another better and the record should include not only the conventional 'Present Illness' and 'Review of Systems,' but also a reasonably detailed social history providing insights into the patient's past and present occupations, social adjustment, and habits. Confidence is inspired by compassionate interest on the part of the physician, and clues to diagnosis are often forthcoming." And also, "It is easier to obtain an X-ray of the chest than to carry out and record the inspection, palpation, percussion, and auscultation thereof, but I have seen at least four instances in which an erroneous clinical diagnosis of pneumonia was concurred in by the radiologist when both the history and physical examination pointed clearly to the true nature of the illness, tuberculous pleurisy with effusion."
Bob's clinical skills alone were enough to make students in awe of him, but in addition he was able to bring science to bear on the diagnosis and treatment of the patient's illness. The following year I did a research project in Bob's laboratory, which eventually produced my first research paper. Close contact in the laboratory permitted me to realize that he was the quintessence of the clinician-scientist. …