The infectious diseases community mourns the loss of one its founders and great teachers, Dr. Louis Weinstein, who passed away on 16 March 2000 at the age of 92. Over his long career, he served on the faculty of the three Boston medical schools, imparting his clinical wisdom to generations of students and physicians. Dr. Weinstein made significant contributions to antibiotic therapy, since his career bridged the preantibiotic and the antibiotic eras. By the end of the 1940s, he was warning of overuse of and impending resistance to these agents. During the polio epidemic in the 1950s, Dr. Weinstein rose to prominence as the master clinician of this illness. He personally attended many victims of the paralytic forms, caring for them when they were in respirators and even delivering their babies when other physicians were afraid of contact with this feared disease.
I had the privilege of serving under Dr. Weinstein as a medical student, clinical and research infectious diseases fellow, and then serving as his successor when he retired from Tufts University School of Medicine. Reflecting on the influence he has had on my perceptions as a physician and researcher, his teachings echo clearly in my memory. As a teacher, a medical scientist, and a practitioner of the art, Dr. Weinstein was a supreme inspiration to me, as well as to hundreds of students, house officers, and practicing physicians. We, his spiritual offspring, have built our own modest achievements on this tradition and thus are standing on the shoulders of a giant.
Dr. Weinstein's talent for inspiring young people in medicine seemed to flow naturally from his dedication to his profession and his charisma as a teacher. In my case, it began as a student with his introductory lectures on the science and art of infectious diseases. Even after 40 years, I still remember being impressed with the passion he displayed as he listed the virulent properties of the pathogens, the triumph at conquering the culprits with appropriate treatment, and, yes, even the sadness at lacking the therapeutic weapons to fight back the powers of darkness.
Some years later, when I came across this passage in the writings of Hans Zinsser [1] it reminded me of Dr. Weinstein's sense of mission:
Infectious disease is one of the few genuine adventures left in the world … however secure and well regulated civilized life may become, bacteria, protozoa, viruses, infected fleas, lice, ticks, mosquitoes and bedbugs will always lurk in the shadows ready to pounce when neglect, poverty, famine or war lets down the defenses…. About the only genuine sporting proposition that remains unimpaired by the relentless domestication of a once free-living human species is the war against these ferocious little fellow creatures which lurk in the dark corners and stalk us in the bodies of rats, mice and all kinds of domestic animals; which fly and crawl with the insects and waylay us in our food and drink and even in our love (pp. 13–14).
To wage war on infectious agents, Dr. Weinstein preached a scientific approach balanced judiciously with clinical judgment. He emphasized the trilogy of a wise physician's concern: the pathogen, the drug, and the patient. My previous orientation was to diagnose disease. Dr. Weinstein taught us to diagnose the etiologic agent of an infectious process—was it pneumococcal or mycoplasma or viral pneumonia?—so that specific antimicrobial therapy could be initiated. Above all, the diagnosis and treatment must be based on sound principles. As physicians, we should not act by blind instinct. He taught us to bring science to the bedside, to apply the lessons of the laboratory to the healing of the sick. Dr. Weinstein taught that the selection of drugs was not a random rummaging through our bag of therapeutic tricks, but a carefully designed battle plan, with full knowledge of and respect for our adversary, those resourceful microbes that are capable of biochemical chicanery that can circumvent our best therapeutic maneuvers.
Dr. Weinstein never yielded in his battle with infection. Under his direction, we were urged to continue the search for new remedies and new ideas to cure our patients. For the specialty of infectious disease is, like politics, the art of the possible. We possess many potent drugs that can restore life to the critically ill and rescue the patient with profound sepsis from the valley of despair. To his disciples, Dr. Weinstein stressed what was his recurring nightmare: the great tragedy of a patient dying of a curable disease, a life that might have been spared by a wise physician.
As students and fellows, we rarely presented the easy cases to “the Chief” but rather sought his advice on the perplexing ones. Here, Dr. Weinstein showed remarkable clinical skills that can best be described as creative inspiration. We could only marvel, without fully comprehending, how a series of seemingly unrelated historical facts and clinical findings could be woven into the fabric of a working hypothesis and thence to a cogent diagnosis. Dr. John Brown described this intellectual resource:
It is in medicine as in the piloting of a ship—rules may be laid down, principles expounded, charts exhibited; but when a man has made himself master of all these, he will often find his ship among breakers and quicksands, and must at last have recourse to his own craft and courage.
These sessions with the Chief were more than a diagnostic tour de force; they were meant to instruct his followers in the need for careful analysis, judgment, and forbearance in the practice of medicine. “The essence of wisdom,” stated Alan Gregg, “is the ability to make the right decision on the basis of inadequate evidence.” As physicians, we are frequently faced with the unknown and the imponderable, yet we must set a course with due regard to our patient's welfare on the basis of our own best judgment. Dr. Weinstein, in addition to his clinical skills and scientific background, possessed in fine measure this gift of medical intuition, this unerring sense of the correct route through the uncharted sea.
Dr. Weinstein had the unique capacity to convey his knowledge, his skill, and even his intuition to his students. Education is a historical process in which the lessons of a great teacher, having been sown in his own time, cultivate academic descendants that transmit the enriched nurture to future generations of inquiring minds. It is a measure of his immortality that we, his students, transmit his message to future generations of students and young physicians, shaping them to mature practitioners of the art.
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