What does it mean when a computer can make better medical decisions than a human? The progress in large language models, and in particular the popularity of ChatGPT, has brought these questions to the forefront in 2023, but we’ve been discussing this for over 50 years. In this episode, Dr. Shani Herzig and I are going all the way back to the early 1970s with the invention of AAPHELP, the first real clinical decision support system, and the first time doctors had to contemplate working with – or competing against – computer systems.

What happens when a patient far from surgical care – say, at the bottom of the Pacific ocean on a submarine, or at a research base in Antarctica in the middle of the winter – develops a surgical abdomen? This dilemma was the impetus to build the first truly effective clinical decision support system – and to grapple with what it means when a computer can make better medical decisions than a doctor. In this episode, part one of three, we discuss the dramatic stories of appendectomies at Novolazarevskaya and aboard the submarine Seadragon. Also, there’s a brand new #AdamAnswers about the origin of the word “scut.”

American doctors spend the majority of their time during the day on the computer, either writing or reading notes about their patients; only a small fraction is spent with the human beings in their care. Technology itself – especially the electronic medical record – has often been blamed for this. But in this episode – a recorded grand rounds that I gave at the San Francisco VA in 2022 – I argue that this alienation has its roots in the way we’ve decided to organize clinical data, and the assumptions that we’ve made about the nature of medical care. In particular, I’m going to discuss one of the most influential medical thinkers of the second half of the 20th century, Larry Weed, his invention of the problem-oriented medical record and the SOAP note, and how his insight – that medical documentation fundamentally influences how we think about our patients – changed the way we think about our patients.

In the past episode, cultural and medical historians Lakshmi Krishnan and Mike Neuss discussed the history of the actual work of the doctor – Holmesian detective, data entry clerk, or something else altogether. In this episode, we conclude our discussion by talking about what type of metaphors are best suited for clinical work. Plus a brand new #AdamAnswers about the reason that American doctors are so obsessed with using, well, the # symbol in our notes.

What do doctors actually do? Are they Sherlockian detectives, hunting down obscure clues to solve intractable cases? Are they virtuosic experts, training for half a lifetime to bring the latest science to bear to cure disease? Or are they clerks, whose main job is to collect and enter data into the electronic health record? In this episode, Adam is joined by medical and cultural historians Lakshmi Krishnan and Mike Neuss to discuss the stories we tell about our own work – and how this often conflicts with the realities of clinical practice.

How do doctors actually think? And if we can answer that, can we train a computer to do a better job? In the post-WW2 period, a group of iconoclastic physicians set about to redefine the nature and structure of clinical reasoning and tried to build a diagnostic machine. Though they would ultimately fail, their failure set the stage for the birth of the electronic health records, formalized the review of systems, and set up a metacognitive conflict that remains unresolved to this day. This episode, entitled “The Database,” is the second part of this on the history of diagnosis with Gurpreet Dhaliwal.

Internal medicine physicians like to pride ourselves on our clinical reasoning – the ability to talk to any patient, pluck out seemingly random bits of information, and make a mystery diagnosis. But how does this actually work? In this episode, called The History, I’ll be joined by Gurpreet Dhaliwal as we explore the beginnings of our understanding on how clinical reasoning works – starting in the middle of the 19th century with polar tensions between two ways of approaching our patients that are still felt today. Along the way, we’ll talk about the American Civil War, Car Talk, Sherlock Holmes, and whether the practice of medicine can ever be considered a science. Sign up for Digital Education 2022 here: https://cmecatalog.hms.harvard.edu/digital-education Sources: Fitzgerald F, Curiosity. https://www.acpjournals.org/doi/full/10.7326/0003-4819-130-1-199901050-00015 Montgomery K, How Doctors Thinks (amazon link: https://www.amazon.com/How-Doctors-Think-Clinical-Judgment/dp/0195187121) Da Costa J, Medical Diagnosis, 1864. https://openlibrary.org/books/OL23402241M/Medical_diagnosis  

Modern plastic surgery was born out of the horrors of trench warfare in World War I. In this episode, Adam interviews historian Lindsey Fitzharris about her new book The Facemaker, about the life of surgeon Harold Gillies and his quest to rebuild his patients' faces. 

In the early 19th century, a strange new illness, seemingly unknown to medicine, ravaged settler communities in the American Middle West. As fierce debates about this new disease, now called milk sickness, raged – was it from toxic swamp gasses? arsenic in the soil? infectious microorganisms? from the poor constitutions of the settlers – an irregular medicine woman named Dr. Anna and an indigenous Shawnee healer discovered the cause of the disease and successfully prevented it in their community. But their discovery went unheeded for over a half century. This is a live podcast that I gave to the South Dakota chapter of the American College of Physicians – plus a new Stethospeaks with Dr. Umme H. Faisal on the history of Resusci-Annie’s mysteriously serene face!   Teepublic store: https://www.teepublic.com/stores/bedsiderounds   Sources: DOYLE JT. Milk sickness. N C Med J. 1947 Jul;8(7):404-10. PMID: 20250350. Furbee L, Snively WD Jr. Milk sickness, 1811-1966: a bibliography. J Hist Med Allied Sci. 1968 Jul;23(3):276-85. doi: 10.1093/jhmas/xxiii.3.276. PMID: 4875594. HARTMANN AF Sr, HARTMANN AF Jr, PURKERSON ML, WESLEY ME. Tremetol poisoning--not yet extinct. JAMA. 1963 Aug 31;185:706-9. doi: 10.1001/jama.1963.03060090038014. PMID: 13953145. Niederhofer RE. The milk sickness. Drake on medical interpretation. JAMA. 1985 Oct 18;254(15):2123-5. PMID: 3900448. Pickard ME and Buley RC, The Midwest Pioneer; His Ills, Cures, & Doctors. 1945. Snively WD Jr, Furbee L. Discoverer of the cause of milk sickness (Anna Pierce Hobbs Bixby). JAMA. 1966 Jun 20;196(12):1055-60. PMID: 5327806. Stenn F. Pioneer History of Milk Sickness. Ann Med Hist. 1937 Jan;9(1):23-29. PMID: 33943945; PMCID: PMC7942921. Townsend RB. Milk sickness- a plague on the new west. Scalpel Tongs. 1999 Jan-Feb;43(1):13-5. PMID: 11623628. Walker JW. Milk-sickness. Science. 1886 Dec 10;8(201):540. doi: 10.1126/science.ns-8.201.540. PMID: 17741312.

Burnout seems to stalk healthcare workers; between a third and a half of doctors and nurses had symptoms of burnout BEFORE the COVID-19 pandemic. Major medical associations have recognized burnout as a serious problem and the condition is being added to ICD-11 as an “occupational phenomenon.” How did we get ourselves into this situation? How has burnout gotten so bad? In this episode, the first #HistMedConsultService, I’m joined by historians of healthcare and emotions Agnes Arnold-Forster and Sam Schotland to historicize burnout. Along the way, we’ll talk about the different structural factors that have colored burnout in North America and the United Kingdom; the disgruntled pediatrician syndrome, physician “impairment”, whether burnout is a disease, and what we might all be able to do to make everyone less miserable. Sources: https://www.nejm.org/doi/pdf/10.1056/NEJMp2112095 https://www.washingtonpost.com/outlook/2021/04/29/covid-19-only-exacerbated-longer-pattern-healthcare-worker-stress/

How can we medically tell whether or not someone is alive or dead? The answer is much more complicated than you'd think. In this episode, which is a live podcast I gave with Tony Breu at the Massachusetts Chapter of the American College of Physicians annual meeting on October 16, 2021, we track the evolution and controversies of the death exam, from a trans-Atlantic scandal surrounding a possible vivisection, a 19th century “X-prize” to determine a technology that could diagnose death, the important distinction between “permanent” and irreversible, and the mysterious Lazarus phenomenon.    References: Rodman A, Breu A. The last breath: historical controversies surrounding determination of cardiopulmonary death. Chest. 2021; [online ahead of print August 13, 2021]. https://doi.org/10.1016/j.chest.2021.08.006

During World War II, the US Army launched a seemingly routine experiment to find the ideal way to screen soldiers for tuberculosis. Jacob Yerushalmy, the statistician in charge of this project, would succeed at this task -- and end up fundamentally changing our conception of medical diagnosis in the process. This episode features Dr. Shani Herzig, as well as a new segment featuring Dr. Umme H. Faisal on Yellapragada Subbarow and his discovery of ATP. Bedside Rounds store: https://www.teepublic.com/stores/bedsiderounds Umme H. Faisal on Twitter: @stethospeaks

What does it mean when different physicians disagree about a diagnosis? I am joined by Dr. Shani Herzig as we explore this issue in the second part of my series on the development of diagnosis. We’re going to discuss the advent of signal detection theory in the middle of the 20th century as new diagnostics such as laboratory testing and x-rays started to challenge the classical view of diagnosis. Along the way, we’re going to talk about focal infection theory and why it seems that everyone in older generations had their tonsils removed as children, early and very inefficient chest x-rays, British radar operators trying to figure out if they were looking at a flock of geese or a German bomber, and finally probably one of the most important people in medical diagnostics that you’ve never heard of -- Jacob Yerushalmy.   If you want to purchase any Bedside Rounds swag, the store is at https://www.teepublic.com/stores/bedsiderounds.

Elizabeth Blackwell -- the first woman to earn a medical degree in the United States -- and her sister Emily Blackwell are some of the most important physicians of the 19th century, firmly establishing the role of women as physicians, starting an infirmary and hospital for poor women and children, and founding a women’s medical college that was decades ahead of its time. In this episode, Dr. Nora Taranto joins me to explore the legacy of the Blackwells along with Janice Nimura, who recently published a biography of the sisters.

Words matter. At its best, etymology gives us insight not only into the origins of words, but why they remain so important today, especially in medicine, where we’ve been accruing jargon for millennia. In this episode, we’re delving into four specific words -- doctor, cerebrovascular accident, rounds, and zebras.  And along the way, we’re going to discuss pre-historical pastoralists on the Eurasian steppes, medieval universities, Octagonal air-ventilated chambers in 19th century Baltimore, and of course, early 21st century sitcoms.   Works cited: OSLER W. THE NATURAL METHOD OF TEACHING THE SUBJECT OF MEDICINE. JAMA. 1901;XXXVI(24):1673–1679. doi:10.1001/jama.1901.52470240001001 Fair, A 2014, 'A Laboratory of Heating and Ventilation: The Johns Hopkins Hospital as experimental architecture, 1870–90', The Journal of Architecture, vol. 19, no. 3, pp. 357-81. https://doi.org/10.1080/13602365.2014.930063 Engelhardt E. Apoplexy, cerebrovascular disease, and stroke: Historical evolution of terms and definitions. Dement Neuropsychol. 2017 Oct-Dec;11(4):449-453. doi: 10.1590/1980-57642016dn11-040016. PMID: 29354227; PMCID: PMC5770005. Coupland AP, Thapar A, Qureshi MI, Jenkins H, Davies AH. The definition of stroke. J R Soc Med. 2017 Jan;110(1):9-12. doi: 10.1177/0141076816680121. Epub 2017 Jan 13. PMID: 28084167; PMCID: PMC5298424. An Updated Definition of Stroke for the 21st Century Ralph L. Sacco, MD, MS, FAHA, FAAN, Co-Chair, Scott E. Kasner, MD, MSCE, FAHA, FAAN, Co-Chair, Joseph P. Broderick, MD, FAHA, Louis R. Caplan, MD, J.J. (Buddy) Connors, MD, Antonio Culebras, MD, FAHA, FAAN, Mitchell S.V. Elkind, MD, MS, FAHA, FAAN, Mary G. George, MD, MSPH, FAHA, Allen D. Hamdan, MD, Randall T. Higashida, MD, Brian L. Hoh, MD, FAHA, L. Scott Janis, PhD, Carlos S. Kase, MD, Dawn O. Kleindorfer, MD, FAHA, Jin-Moo Lee, MD, PhD, Michael E. Moseley, PhD, Eric D. Peterson, MD, MPH, FAHA, Tanya N. Turan, MD, MS, FAHA, Amy L. Valderrama, PhD, RN, and Harry V. Vinters, MD on behalf of the American Heart Association Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular and Stroke Nursing, Council on Epidemiology and Prevention, Council on Peripheral Vascular Disease, and Council on Nutrition, Physical Activity and Metabolism Harrison F, Roberts AE, Gabrilska R, Rumbaugh KP, Lee C, Diggle SP. A 1,000-Year-Old Antimicrobial Remedy with Antistaphylococcal Activity. mBio. 2015;6(4):e01129. Published 2015 Aug 11. doi:10.1128/mBio.01129-15 Furner-Pardoe J, Anonye BO, Cain R, Moat J, Ortori CA, Lee C, Barrett DA, Corre C, Harrison F. Anti-biofilm efficacy of a medieval treatment for bacterial infection requires the combination of multiple ingredients. Sci Rep. 2020 Jul 28;10(1):12687. doi: 10.1038/s41598-020-69273-8. PMID: 32724094; PMCID: PMC7387442. American Heritage Dictionary of Indo-European Roots, third edition, 2011 Oxford English Dictionary Online Johnson S, Dictionary. Retrieved online: https://johnsonsdictionaryonline.com/doctor-noun/ Riva MA. No renaissance for doctors in Shakespeare's plays. BMJ. 2017 May 22;357:j2223. doi: 10.1136/bmj.j2223. PMID: 28533302.

For a special holiday treat, we’re going to explore two tales of salmonella disease detectives -- the first about Mary Mallon (“Typhoid Mary”) and the birth of the genre; and the second about a mysterious salmonella outbreak at Massachusetts General Hospital solved with the assistance of a very jolly patient. Along the way, we’ll talk about clinical epidemiology, the long-lasting influence of Berton Roueché, and the joys of being an internist!   You can sign up for the Digital Education conference at cmeregistration.hms.harvard.edu/digitaleducation.   Sources:   Buckle GC, Fischer Walker CL, and Black RE, Typhoid fever and paratyphoid fever: Systematic review to estimate global morbidity and mortality for 2010.J Glob Health. 2012 Jun; 2(1): 010401. Marineli F et al, Mary Mallon (1869-1938) and the history of typhoid fever.Ann Gastroenterol. 2013; 26(2): 132–134. Soper GA, The Curious Career of Typhoid Mary, read on May 10, 1939 before the Section of Historical and Cultural Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1911442/pdf/bullnyacadmed00595-0063.pdf Norrington B, Cochineal: A Little Insect Goes a Long Way, UCSB Geography.  Roueche B,  The Santa Claus Culture, The New Yorker, Aug 27, 1971. Lang DJ et al, Carmine as a Source of Nosocomial Salmonellosis, NEJM. Apr 13, 1967.   You can buy Medical Detectives here: https://www.amazon.com/Medical-Detectives-Collection-Award-Winning-Investigative/dp/0452265886

Diagnosis is arguably the most important job of a physician. But what does it actually mean to make a diagnosis? In this episode, we’ll explore this question by tracking the development of the “classical” model of diagnosis and pathological anatomy and discussing three cases over three hundred years. Along the way, we’ll ponder the concept of the lesion, iatromechanistic theories of the human machine, the birth of the International Classification of Diseases, and the rise and decline of the autopsy. You can sign up for the iMED Digital Education conference at cmeregistration.hms.harvard.edu/digitaleducation.   Sources: Hooper R, The Physician’s Vade-Mecum: Containing the Symptoms, Causes, Diagnosis, Prognosis and Treatment of Diseases. 1812.  Holdman L et al, The Value of the Autopsy in Three Medical Eras. N Engl J Med 1983; 308:1000-1005. Cabot RC et al. CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITALANTE-MORTEM AND POST-MORTEM RECORDS AS USED IN WEEKLY CLINICO-PATHOLOGICAL EXERCISES. Case 9431. Boston Med Surg J 1923; 189:595-599. Shojania KG and Burton EC, The Vanishing Nonforensic Autopsy. N Engl J Med 2008; 358:873-875 Morgagni GB. The seats and causes of diseases investigated by anatomy in five books, containing a great variety of dissections, with remarks. To which are added ... copious indexes. 1769. Retrieved online: https://openlibrary.org/works/OL15821973W/The_seats_and_causes_of_diseases_investigated_by_anatomy Castiglioni A, GB Morgagni and the Anatomico-pathological Conception of the Clinical. Proceedings of the Royal Society of Medicine, November 7, 1934. Thiene G, Padua University: The role it has played in the History of Medicine and Cardiology and its position today. European Heart Journal, Volume 30, Issue 6, March 2009, Pages 629–635. Zampieri F et al, Origin and development of modern medicine at the University of Padua and the role of the “Serenissima” Republic of Venice. Glob Cardiol Sci Pract. 2013; 2013(2): 149–162. Conner, Annastasia (2017) "Galen’s Analogy: Animal Experimentation and Anatomy in the Second Century C.E.," Anthós: Vol. 8: Iss. 1, Article 9.  Zampieri F et al. The clinico-pathological conference, based upon Giovanni Battista Morgagni's legacy, remains of fundamental importance even in the era of the vanishing autopsy. Virchows Arch. 2015 Sep;467(3):249-54. Ghosh SK, Giovanni Battista Morgagni (1682-1771): father of pathologic anatomy and pioneer of modern medicine. Anat Sci Int. 2017 Jun;92(3):305-312.  O’Neal JC, Auenbrugger, Corvisart, and the Perception of Disease. Eighteenth-Century Studies Vol. 31, No. 4, The Mind/Body Problem (Summer, 1998), pp. 473-489 Brown TM, THE COLLEGE OF PHYSICIANS AND THE ACCEPTANCE OF IATROMECHANISM IN ENGLAND, 1665-1695. Bulletin of the History of Medicine Vol. 44, No. 1 (JANUARY-FEBRUARY 1970), pp. 12-30  Roos AM, Luminaries in Medicine: Richard Mead, James Gibbs, and Solar and Lunar Effects on the Human Body in Early Modern England. Bulletin of the History of Medicine Vol. 74, No. 3 (Fall 2000), pp. 433-457 (25 pages) Frith J, History of Tuberculosis. Part 1 – Phthisis, consumption and the White Plague. JMVH. 2014; 22(2). World Health Organization, History of the development of the ICD. https://www.who.int/classifications/icd/en/HistoryOfICD.pdf Laennec RTH, A treatise on diseases of the chest and on mediate auscultation. 1834. Retrieved from: https://archive.org/details/b21987002. Marinker M, Why make people patients? J Med Ethics. 1975 Jul; 1(2): 81–84. King LS, Medical Thinking: A Historical Preface. Princeton University Press, 2016.

In this episode, I talk about my podcasting journey -- how I started Bedside Rounds for inspiration during a low period in residency, how it changed me as a physician, and how it has changed my views about digital education and the future of medical education in general. This is a live recording of a talk I gave at the Michigan ACP annual meeting last month. Also, we are hosting the first annual iMED conference in January (virtual this year, of course) -- the link is cmeregistration.hms.harvard.edu/digitaleducation to sign up!

The COVID-19 pandemic laid bare the racial health disparities in the United States, with markedly increased mortality especially among Blacks and Native Americans. In this episode, Tony Breu and I discuss the conception of race, racism, and the social determinants of health through three historic plagues in the United States -- from yellow fever in New Orleans, to poliomyelitis, and finally the early days of HIV/AIDS -- and what lessons we can draw for COVID-19. Along the way, we’ll discuss the unique social capital afforded by acclimation, immunity passports, the concept of the “original antigenic sin,” and constitutionalism and eugenics. This presentation was performed live at the annual meeting of the Massachusetts American College of Physicians, and is only lightly edited.   SOURCES:   Monath TP, Yellow fever: an update. Lancet Infect Dis. 2001 Aug;1(1):11-20. doi: 10.1016/S1473-3099(01)00016-0. Kallas EG, D'Elia Zanella LGFAB, Moreira CHV, Buccheri R, Diniz GBF, Castiñeiras ACP, Costa PR, Dias JZC, Marmorato MP, Song ATW, Maestri A, Borges IC, Joelsons D, Cerqueira NB, Santiago E Souza NC, Morales Claro I, Sabino EC, Levi JE, Avelino-Silva VI, Ho YL. Predictors of mortality in patients with yellow fever: an observational cohort study. Lancet Infect Dis. 2019 Jul;19(7):750-758. doi: 10.1016/S1473-3099(19)30125-2. Epub 2019 May 16. Erratum in: Lancet Infect Dis. 2019 Nov;19(11):e370. PMID: 31104909. Blake LE, Garcia-Blanco MA. Human genetic variation and yellow fever mortality during 19th century U.S. epidemics. mBio. 2014 Jun 3;5(3):e01253-14. doi: 10.1128/mBio.01253-14. PMID: 24895309; PMCID: PMC4049105. Jelili Ojodu, MPH1, Mary M. Hulihan, MPH2, Shammara N. Pope, MPH2, Althea M. Grant, PhD2,, MMWR, Incidence of Sickle Cell Trait — United States, 2010. IthaMaps, Haemoglobin Epidemiology. https://www.ithanet.eu/db/ithamaps?country=GR Serjeant GR, The natural history of sickle cell disease. Cold Spring Harb Perspect Med. 2013 Oct; 3(10): a011783. Hamosh A, FitzSimmons SC, Macek M Jr, Knowles MR, Rosenstein BJ, Cutting GR. Comparison of the clinical manifestations of cystic fibrosis in black and white patients. J Pediatr. 1998 Feb;132(2):255-9. doi: 10.1016/s0022-3476(98)70441-x. PMID: 9506637. Gershman KD et al, Yellow Fever Vaccine & Malaria Prophylaxis Information, by Country. CDC.  Kofler N and Baylis F, Ten reasons why immunity passports are a bad idea. Nature 21 May 2020. NASEM, National Academies Release Framework for Equitable Allocation of a COVID-19 Vaccine for Adoption by HHS, State, Tribal, Local, and Territorial Authorities. Schmidt H et al, Covid-19: how to prioritize worse-off populations in allocating safe and effective vaccines.BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3795 (Published 05 October 2020). Siegal FP, Lopez C, Hammer GS, Brown AE, Kornfeld SJ, Gold J, Hassett J, Hirschman SZ, Cunningham-Rundles C, Adelsberg BR, et al. Severe acquired immunodeficiency in male homosexuals, manifested by chronic perianal ulcerative herpes simplex lesions. N Engl J Med. 1981 Dec 10;305(24):1439-44. doi: 10.1056/NEJM198112103052403. PMID: 6272110. Lushniak BD, Surgeon General’s Perspectives. Public Health Rep. 2014 Mar-Apr; 129(2): 112–114. Booske BC et al, “Different Perspectives For Assigning Weights to Determinants of Health,” University of Wisconsin Population Health Institute.  Marc LG et al,HIV among Haitian-born persons in the United States, 1985–2007, AIDS. Author manuscript; available in PMC 2011 Aug 24. Rogers N, Race and the Politics of Polio: Warm Springs, Tuskegee, and the March of Dimes. Am J Public Health. 2007 May; 97(5): 784–795. Curran JW and Jaffe HW, AIDS: the Early Years and CDC’s Response. MMWR. Olivarius Kathryn, Immunity, Capital, and Power in Antebellum New Orleans. The American Historical Review, Volume 124, Issue 2, April 2019, Pages 425–455,

In August of 1918, a horrific second wave of the Spanish Flu crashed across the world. In this episode, the third of a four-part series exploring hydroxychloroquine and COVID-19, I’ll explore this single moment in time, through the mysterious origins of the Spanish Flu and historiographical controversies, scientific missions to mass burial sites in remote Alaskan villages, the ill-fated journey of the HMS Mantua, debates about how to count victims of a pandemic, and the mystery behind Pfeiffer’s bacillus. Plus a new #AdamAnswers about that annoying yellow on blue powerpoint template so common in the medical field!   Sources: Viboud, C. et al. Age- and Sex-Specific Mortality Associated With the 1918–1919 Influenza Pandemic in Kentucky. J Infect Dis 207, 721–729 (2013). Oxford, J. S. & Gill, D. A possible European origin of the Spanish influenza and the first attempts to reduce mortality to combat superinfecting bacteria: an opinion from a virologist and a military historian. Hum Vacc Immunother 15, 2009–2012 (2019). Epps, H. L. V. Influenza: exposing the true killer. J Exp Medicine 203, 803–803 (2006). Patterson, S. W. & Williams, F. E. PFEIFFER’S BACILLUS AND INFLUENZA. Lancet 200, 806–807 (1922). Taubenberger, J. K. & Morens, D. M. The 1918 Influenza Pandemic and Its Legacy. Csh Perspect Med a038695 (2019) doi:10.1101/cshperspect.a038695. Trilla, A., Trilla, G. & Daer, C. The 1918 “Spanish Flu” in Spain. Clin Infect Dis 47, 668–673 (2008). Taubenberger, J. K. The origin and virulence of the 1918 “Spanish” influenza virus. P Am Philos Soc 150, 86–112 (2006). Heinz, E. The return of Pfeiffer’s bacillus: Rising incidence of ampicillin resistance in Haemophilus influenzae. Microb Genom 4, (2018). Barry, J. M. The site of origin of the 1918 influenza pandemic and its public health implications. J Transl Med 2, 3 (2004). Johnson, N. P. A. S. & Mueller, J. Updating the Accounts: Global Mortality of the 1918-1920 “Spanish” Influenza Pandemic. B Hist Med 76, 105–115 (2002).   Tomkins SM, Colonial Administration in British Africa during the Influenza Epidemic of 1918-19. Canadian Journal of African Studies / Revue Canadienne des Études Africaines. Vol. 28, No. 1 (1994), pp. 60-83 (24 pages) Qiang Liu et al, The cytokine storm of severe influenza and development of immunomodulatory therapy. Cell Mol Immunol. 2016 Jan; 13(1): 3–10. Spreeuwenberg et al. Reassessing the Global Mortality Burden of the 1918 Influenza Pandemic.Am J Epidemiol . 2018 Dec 1;187(12):2561-2567. doi: 10.1093/aje/kwy191. R. F. J. Pfeiffer: Vorläufige Mittheilungen über den Erreger der Influenza. Deutsche medicinische Wochenschrift, Berlin, 1892, 18: 28. Die Aetiologie der Influenza. Zeitschrift für Hygiene und Infektionskrankheiten, 1893, 13: 357-386.

The 1889 Russian Flu was the first influenza pandemic in an increasingly globalized world. In this episode, the second of a two-parter on how hydroxychloroquine became a great hope in COVID-19, we’ll talk about how quinine became the standard of care for influenza. Along the way, we’ll discuss the astrological origins of the flu, the nosological difficulties of identifying past pandemics, conspiracy theories about previous global coronavirus outbreaks, the media panic over the Russian Flu, first year law school cases about Carbolic Smoke Balls, and the first studies into quinine’s efficacy in influenza.    References   Seeler, A. O., Graessle, O. & Ott, W. H. Effect of Quinine on Influenza Virus Infections in Mice. J Infect Dis 79, 156–158 (1946). Barberis, I., Myles, P., Ault, S. K., Bragazzi, N. L. & Martini, M. History and evolution of influenza control through vaccination: from the first monovalent vaccine to universal vaccines. J Prev Medicine Hyg 57, E115–E120 (2016). Ewing, E. T. La Grippe or Russian influenza: Mortality statistics during the 1890 Epidemic in Indiana. Influenza Other Resp 13, 279–287 (2019). Gold, E. Pandemic Influenza 1700-1900: A Study in Historical Epidemiology. Jama 257, 2656–2656 (1987). Rice, G. W. & Palmer, E. Pandemic Influenza in Japan, 1918-19: Mortality Patterns and Official Responses. J Jpn Stud 19, 389 (1993). Mulder, J., Masurel, N., Deggars, E. M. & Webbers, P. T. PRE-EPIDEMIC ANTIBODY AGAINST 1957 STRAIN OF ASIATIC INFLUENZA IN SERUM OF OLDER PEOPLE LIVING IN THE NETHERLANDS. Lancet 271, 810–814 (1958). Refresher Course for General Practitioners. J Amer Med Assoc 152, 773 (1953). Moore, J. W. The influenza epidemic of 1889–90, as observed in Dublin. Transactions Royal Acad Medicine Irel 8, 56–74 (1890). Textbook of Influenza. (n.d.). Coghill, J. G. S. The Prophylaxis of Influenza. Brit Med J 1, 751 (1895). When early modern Europe caught the flu. A scientific account of pandemic influenza in sixteenth century Sicily. (n.d.). Potter. A history of influenza.  Valleron AJ et al, Transmissibility and geographic spread of the 1889 influenza pandemic. PNAS May 11, 2010 107 (19) 8778-8781 Cavallaro JJ and Monto AS. Community-wide Outbreak of Infection with a 229E-like Coronavirus in Tecumseh, Michigan.The Journal of Infectious Diseases. Vol. 122, No. 4 (Oct., 1970), pp. 272-279 Mulder J and Masurel N, Pre-epidemic Antibody Against 1957 Strain of Asiatic Influenza in Serum of Older People Living in the Netherlands. Lancet. 1958 Apr 19;1(7025):810-4 Vijgen L et al. Complete Genomic Sequence of Human Coronavirus OC43: Molecular Clock Analysis Suggests a Relatively Recent Zoonotic Coronavirus Transmission Event. J Virol. 2005 Feb; 79(3): 1595–1604. Saunders-Hastings PR and Krewski D. Reviewing the History of Pandemic Influenza: Understanding Patterns of Emergence and Transmission. Pathogens. 2016 Dec; 5(4): 66. Pappas G et al. Insights into infectious disease in the era of Hippocrates.International Journal of Infectious Diseases Volume 12, Issue 4, July 2008, Pages 347-350. Flint A, Principles and Practice of Medicine. https://collections.nlm.nih.gov/bookviewer?PID=nlm:nlmuid-100894695-bk#page/234/mode/2up/search/influenza Osler W, Principles and Practice of Medicine.  https://archive.org/details/principlespract00osle/page/1002/mode/2up Taubenberger JK and Morens DM. Influenza: The Once and Future Pandemic. Public Health Rep. 2010; 125(Suppl 3): 16–26. Shope RE. Influenza: history, epidemiology, and speculation. Public Health Rep. 1958 Feb; 73(2): 165–179. Ewing ET. Will It Come Here? Using Digital Humanities Tools to Explore Medical Understanding during the Russian Flu Epidemic, 1889–90. Med Hist. 2017 Jul; 61(3): 474–477.

This bonus episode introduces episode four of the Curious Clinicians, about Vincent Van Gogh and digitalis. The Curious Clinicians is a new medical podcast produced by Hannah Abrams, Avi Cooper, and Tony Breu; you can download them all at curiousclinicians.com.

Where did cinchona, the first medication to cure malaria, come from? This episode explores the murky history of the bark of the fever tree and its derivative chloroquine with mysterious pre-Columbian Pacific crossings of the plasmodium parasite, Jesuit priests and Inca healers, a Chinese Emperor performing a clinical trial to treat his fever, chemistry leading to the first modern pharmaceuticals, and imperialism on a global scale. This episode is the first of a multi-part series exploring how hydroxychloroquine became the great hope for treating COVID-19.   Sources: Jaramillo‐Arango, J. A Critical Review of the Basic Facts in the History of Cinchona. J Linn Soc Lond Botany 53, 272–311 (1949). Smith, N. K. A Cure for Ague. J Roy Soc Med 90, 589–590 (1997). Potter, C. W. A history of influenza. J Appl Microbiol 91, 572–579 (2001). Cunha, C. B. & Cunha, B. A. Brief history of the clinical diagnosis of malaria: from Hippocrates to Osler. J Vector Dis 45, 194–9 (2008). Goss, A. Building the world’s supply of quinine: Dutch colonialism and the origins of a global pharmaceutical industry. Endeavour 38, 8–18 (2014). Al-Bari, Md. A. A. Chloroquine analogues in drug discovery: new directions of uses, mechanisms of actions and toxic manifestations from malaria to multifarious diseases. J Antimicrob Chemoth 70, 1608–1621 (2015). Guastalegname, M. & Vallone, A. Could chloroquine /hydroxychloroquine be harmful in Coronavirus Disease 2019 (COVID-19) treatment? Clin Infect Dis (2020) doi:10.1093/cid/ciaa321. Alia, E. & Grant-Kels, J. M. Does Hydroxychloroquine Combat COVID-19? A Timeline of Evidence. J Am Acad Dermatol (2020) doi:10.1016/j.jaad.2020.04.031. Seeler, A. O., Graessle, O. & Ott, W. H. Effect of Quinine on Influenza Virus Infections in Mice. J Infect Dis 79, 156–158 (1946). Savarino, A., Boelaert, J. R., Cassone, A., Majori, G. & Cauda, R. Effects of chloroquine on viral infections: an old drug against today’s diseases. Lancet Infect Dis 3, 722–727 (2003). Chakrabarti, P. Empire and Alternatives: Swietenia febrifuga and the Cinchona Substitutes. Med Hist 54, 75–94 (2010). Lonie, I. M. Fever pathology in the sixteenth century: tradition and innovation. Med Hist 25, 19–44 (1981). Luke, T. C. et al. Hark back: Passive immunotherapy for influenza and other serious infections. Crit Care Med 38, e66–e73 (2010). Shanks, G. D. Historical Review: Problematic Malaria Prophylaxis with Quinine. Am J Tropical Medicine Hyg 95, 269–272 (2016). Harrison, N. In celebration of the Jesuit’s powder: a history of malaria treatment. Lancet Infect Dis 15, 1143 (2015). Gerszten, E., Allison, M. J. & Maguire, B. Paleopathology in South American Mummies: A Review and New Findings. Pathobiology 79, 247–256 (2012). Haas, L. F. Pierre Joseph Pelletier (1788-1842) and Jean Bienaime Caventou (1795-1887). J Neurology Neurosurg Psychiatry 57, 1333 (1994). PROPHYLACTIC QUININE IN INFLUENZA. Lancet 204, 1152 (1924). Gensini, G. F. & Conti, A. A. The evolution of the concept of ‘fever’ in the history of medicine: from pathological picture per se to clinical epiphenomenon (and vice versa). J Infection 49, 85–87 (2004). Bergman, G. J. The history and importance of cinchona bark as an anti‐malarial febrifuge. Sci Educ 32, 93–103 (1948). Thompson, C. & MBE. The History and Lore of Cinchona. (n.d.). THE HUXLEY MEMORIAL. Lancet 146, 1381 (1895). Urdang, G. The Legend on Cinchona. (n.d.). Castro, M. C. de & Singer, B. H. Was malaria present in the Amazon before the European conquest? Available evidence and future research agenda. J Archaeol Sci 32, 337–340 (2005). Kummu M et al, How Close Do We Live to Water? A Global Analysis of Population Distance to Freshwater Bodies. PLoS One. 2011; 6(6): e20578. Dawson WT et al, IDIOSYNCRASY TO QUININE, CINCHONIDINE AND ETHYLHYDROCUPREINEv AND OTHER LEVOROTATORY ALKALOIDS OF THE CINCHONA SERIES: PRELIMINARY REPORT. JAMA 8 Mar 1930. Bynum WF, Cullen and the study of fevers in Bitain, 1760-1820. Medical History, supplement no 1, 1981.   Rodrigues PT et al, Human migration and the spread of malaria parasites to the New World. Nature, 31 January 2018.  Achan J et al, Quinine, an old anti-malarial drug in a modern world: role in the treatment of malaria. Malar J. 2011; 10: 144. Norn PH, On the history of Cinchona bark in the treatment of Malaria.Dansk Medicinhistorisk Arbog, 31 Dec 2015, 44:9-30. Cook H (2010). Testing the effects of Jesuit’s bark in the Chinese Emperor’s court. JLL Bulletin: Commentaries on the history of treatment evaluation (https://www.jameslindlibrary.org/articles/testing-the-effects-of-jesuits-bark-in-the-chinese-emperors-court/)

The 1918 influenza pandemic, or the Spanish Flu, is the obvious parallel to the COVID-19 pandemic -- a worldwide plague attacking a scientific and global society much like our own. In this guest episode by Hannah Abrams and Gaby Mayer, we chase these parallels wherever they take us, talking etiology, presentation, treatments, masking, curve-flattening, and mortality measures.

Plagues have fascinated us since antiquity, but the Antonine Plague stands out because one of the most famous physicians in Western history was present to make detailed observations. In this episode, guest host Liam Conway-Pearson explores what we know -- and what we don't know -- about this plague, which ravaged Rome two millennia ago. Plus a brand new #AdamAnswers about using convalescent plasma to treat the Spanish Flu of 1918!   Sources: Adrian Muraru, “On Galen of Pergamum: The Greek Physician and Philosopher of Late Antiquity in the Roman Empire,” Agathos 9, no.2 (2018): 7-20. H. Clifford Lane and Anthony S. Fauci, “Microbial Bioterrorism,” in Harrison’s Principles of Internal Medicine, 20e, ed. J. Larry Jameson et al. (New York: McGraw Hill, 2018), S2. James Greenberg, “Plagued by Doubt: Reconsidering the Impact of a Mortality Crisis in the 2nd C. A.D.,” Journal of Roman Archaeology 16 (2003): 413-425.  Jennifer Manley, “Measles and Ancient Plagues: A Note on New Scientific Evidence,” Classical World 107, no. 3 (Spring 2014): 393-397.  J. F. Gilliam, “The Plague under Marcus Aurelius,” The American Journal of Philology 82, no. 3 (July 1961): 225-251. John Haldon, Hugh Elton, Sabine R. Huebner, Adam Izdebski, Lee Mordechai, and Timothy P. Newfield, “Plagues, Climate Change, and the End of an Empire. A Response to Kyle Harper’s The Fate of Rome (2): Plagues and a Crisis of Empire,” History Compass 6, no. 12 (November 2018). Joseph B. Fullerton and Mark E. Silverman, “Claudius Galen of Pergamum: Authority of Medieval Medicine,” Clinical Cardiology 32, no. 11 (January 2008): E82-E84. Joseph R. McConnell, Andrew I. Wilson, Andreas Stohl, Monica M. Arienzo, Nathan J. Chellman, Sabine Eckhardt, Elisabeth M. Thompson, A. Mark Pollard, and Jørgen Pender Steffensen, “Lead Pollution Recorded in Greenland Ice Indicates European Emissions Tracked Plagues, Wars, and Imperial Expansion during Antiquity,” PNAS 115, no. 22 (May 2018): 5726-5731. J. Rufus Fears, “The Plague under Marcus Aurelius and the Decline and Fall of the Roman Empire,” Infectious Disease Clinics of North America 18 (2004): 65-77. Kyle Harper, The Fate of Rome (Princeton NJ: Princeton University Press, 2017), 23-118. Mike Duncan, The History of Rome, Podcast Audio, 2007-2013. https://thehistoryofrome.typepad.com/the_history_of_rome/archives.html  R. J. Littman and M. L. Littman, “Galen and the Antonine Plague,” The American Journal of Philology 94, no. 3 (Autumn 1973): 243-255. R. P. Duncan-Jones, “The Impact of the Antonine Plague,” Journal of Roman Archaeology 9 (1996): 108-136. “Smallpox,” CDC, last modified June 7, 2016, https://www.cdc.gov/smallpox/transmission/index.html. Vivian Nutton, “The Chronology of Galen’s Early Career,” The Classical Quarterly 23, no. 1 (May 1973): 158-171. Yuki Furuse, Akira Suzuki, and Hitoshi Oshitani, “Origin of Measles Virus: Divergence from Rinderpest Virus between the 11th and 12th Centuries,” Virology Journal 7, no. 52 (March 2010): 1-4.  Catherine Thėves, Eric Crubėzy, and Philippe Biagini, “History of Smallpox and Its Spread in Human Populations,” Microbiology Spectrum 4, no. 4 (April 2015):  Walter Scheidel, “A Model of Demographic and Economic Change in Roman Egypt after the Antonine Plague,” Journal of Roman Archaeology 15 (2002): 97-114.

As the COVID-19 pandemic increasingly spreads across the globe, Bedside Rounds is going on hiatus. This short message explains why and gives some historical context. Stay in touch on Twitter in the upcoming months @AdamRodmanMD.

Over the past several centuries, the medical field has established a firm graph on the domain of the human body, with one very notable exception -- the teeth. In this episode, we’re going to explore this historic split between medicine and dentistry, and the moment in history where the two fields could have been rejoined but were “rebuffed.” Along the way we’ll talk about barbers and enemas, a fun tool called the dental pelican, 19th century professional drama between doctors and dentists, and the sometimes disastrous consequences this can have for our patients.    Sources: British Dental Association -- Dental Pelicans, retrieved from: https://bda.org/museum/collections/dental-equipment/pelican “Dentistry,” The Oxford Encyclopedia of the History of American Science, Medicine, and Technology Gevitz N, Autonomous Profession or Medical Specialty: The Stomatological Movement and American Dentistry. Bulletin of the History of Medicine; Baltimore, Md. Vol. 62, Iss. 3,  (Fall 1988): 407. Loudon I, Why are (male) surgeons still addressed as Mr? BMJ. 2000 Dec 23; 321(7276): 1589–1591. Otto M, Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America, The New Press, 2017. Tung T and Organ CH, Ethics in Surgery: Historical Perspective Arch Surg. 2000;135(1):10-13.

Did Hippocrates call consults for chest pain? Were there specialists in black bile? Where does our poetic terminology for heart and lung sounds come from? Is there a historical parallel for #MedTwitter? I’ve fallen off the bus with #AdamAnswers, so in this month’s episode I’m playing catch up on many of the amazing questions you guys send me with the first Winter Short (#spoileralert -- not actually short) -- the Backlog!

At the end of 2019, William Osler’s legacy is stronger than ever; he has been called the “Father of Modern Medicine” and held up as the paragon of the modern physician. In this episode, I’m going to explore the historical Osler -- just who was William Osler in the context of rapidly changing scientific medicine at the dawn of the 20th century, and how did he become so influential? But I’m also going to explore Osler the myth -- what does the 21st century obsession with the man say about us, a century after his death?    Sources: Bliss M, William Osler: A Life in Medicine. Bryan CS, Osler goes viral: “The Fixed Period” revisited, Proc (Bayl Univ Med Cent). 2018 Oct; 31(4): 550–553.  Cooper B, Osler’s role in defining the third corpuscle, or “blood plates”, Proc (Bayl Univ Med Cent). 2005 Oct; 18(4): 376–378.  Davis E, Vaginismus, The medical news, 1884. Retrieved online from: https://archive.org/details/medicalnews45philuoft/page/672 Flint AF, A Treatise on the Principles and Practice of Medicine. Retrieved from: https://books.google.com/books?id=1mvmA1ajwfUC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false Justin MS, "The Entry of Women into Medicine in America: Education and Obstacles 1847-1910". Retrieved from: https://www.hws.edu/about/blackwell/articles/womenmedicine.aspx Ludmerer KM, Cultural origins of residency training, OUP Blog, retrieved from https://blog.oup.com/2015/05/cultural-origins-residency-training/. Ludmerer KM, Learning to Heal: The Development of American Medical Education (New York: Basic, 1985). National Library of Medicine, The William Osler Papers, retrieved from: https://profiles.nlm.nih.gov/spotlight/gf/feature/biographical-overview Osler W, Aequanamitas. Retrieved from: https://medicalarchives.jhmi.edu:8443/osler/aequessay.htm Osler W, An Alabama Student and Other Biographical Essays, retrieved from: https://medicalarchives.jhmi.edu:8443/osler/alabacontents.htm Periyakoil VS, What Would Osler Do? J Palliat Med. 2013 Feb; 16(2): 118–119.  Rezaie S, From Hippocrates to Osler to FOAM, retrieved from: https://rebelem.com/hippocrates-osler-foam/. Sokol D, Doctors: use social media with restraint, STAT 2019 Jun 10. Retrieved from: https://www.statnews.com/2019/06/10/doctors-social-media-restraint/ Warner JH, The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1783-1784.  

What does it mean to know something in medicine? In this episode, we’ll explore this question by developing a historical framework of medical epistemologies in a journey that involves King Nebuchadnezzar, citrus fruit, leeches, water pumps, ICD-10, Socrates, skepticism, and 1970's computer programs designed to replace doctors. This is a version of a Grand Rounds given at BIDMC on October 25, 2019.    Sources:   Bothwell LE et al, “Assessing the Gold Standard -- Lessons from the History of RCTs,” NEJM June 2, 2016. Khushf G, “A Framework for Understanding Medical Epistemologies,” Journal of Medicine and Philosophy, 38: 461-486, 2013. Guyatt G and Tonelli M, Med Roundtable Gen Med Ed.;June 13, 2012 1(1): 75 - 84. Morabia A, A History of Epidemiologic Methods and Concepts, 2004. Tonelli MR, “Integrating evidence into clinical practice: an alternative to evidence-based approaches,” Journal of Evaluation in Clinical Practice, 12(3) 248-256.   Music from https://filmmusic.io "Tango de Manzana" and “Return of the Mummy” by Kevin MacLeod (https://incompetech.com) License: CC BY (http://creativecommons.org/licenses/by/4.0/)

The world before anesthesia was brutal -- surgeons inflicted torture on largely conscious patients, hoping to finish an operation as quickly as possible. But all of that changed with the introduction of inhaled ether. This episode covers the context behind the discovery of etherization, with myths about screaming medicinal plants, a “missing recipe” of medieval general anesthesia, 19th century recreational drug use, and a controversy carved in granite.   Sources: Brown, M. The Palgrave Handbook of the History of Surgery. 327–348 (2017). doi:10.1057/978-1-349-95260-1_16  Dorrington, K. & Poole, W. The first intravenous anaesthetic: how well was it managed and its potential realized? Bja Br J Anaesth 110, 7–12 (2013).  Robinson, D. H. & Toledo, A. H. Historical Development of Modern Anesthesia. J Invest Surg 25, 141–149 (2012).  Chidiac, E. J., Kaddoum, R. N. & Fuleihan, S. F. Mandragora. Anesthesia Analgesia 115, 1437–1441 (2012).  Vargas, I. Ether Frolic: The Day Pain Stopped. Bulletin Anesthesia Hist 28, 53–56 (2010).  Whalen, F. X., Bacon, D. R. & Smith, H. M. Inhaled anesthetics: an historical overview. Best Pract Res Clin Anaesthesiol 19, 323–330 (2005).  Prioreschi, P. Medieval anesthesia – the spongia somnifera. Med Hypotheses 61, 213–219 (2003).  Stallings, S. & Montagne, M. A chronicle of anesthesia discovery in New England. Pharm Hist 35, 77–80 (1993).  Litoff, J. & Pernick, M. S. A Calculus of Suffering: Pain, Professionalism, and Anesthesia in Nineteenth-Century America. Am Hist Rev 91, 176 (1986).  Leake, C. D. Letheon: The Cadenced Story of Anesthesia. Science 199, 857–860 (1978).  CRAWFORD W. LONG (1815-1878) DISCOVERER OF ETHER FOR ANESTHESIA. Jama 194, 1008–1009 (1965).  Riches, E. Samuel Pepys and His Stones. J Urology 118, 148–151 (1977).  CWRIGHT, F. The early history of ether. Anaesthesia 15, 67–69 (1960).  Insensibility during Surgical Operations Produced by Inhalation. New Engl J Medicine 35, 379–382 (1846).  SURGICAL HUMBUG. Lancet 5, 646–647 (1826).  Locations in Boston: Ether Monument (https://www.atlasobscura.com/places/ether-monument) Ether Dome (https://www.atlasobscura.com/places/ether-dome?utm_source=atlas-forum&utm_medium=referral) Warren Anatomic Museum (https://www.atlasobscura.com/places/warren-anatomical-museum)

Because of dad brain, the original musical tracks for episode 48 were offset by almost 30 seconds (even more embarrassing, because I actually LISTENED to it before uploading). I've fixed the audio for the original episode, but anyone who downloaded it already is stuck with the bad audio version. Because of limitations in the podcasting medium, the only way I can get a new episode to those who have downloaded but haven't listened yet is to release a new episode to the feed. Eventually (maybe after a month or so) I will delete this, so only the fixed original remains.   Sorry for the inconvenience guys! 

Germs are regarded today with a combination of fear and disgust. But mankind’s first introduction to the microbial world started off on a very different foot. In this episode, as part of a larger series contextualizing germ theory, we’ll talk about the discovery of animalcules and how they forever changed our conception of the natural world -- and what causes disease. Plus, a new #AdamAnswers about the influence of Bayes Theorem on medicine!   Sources: Albury WR, Marie-Francois-Xavier Bichat, Encyclopedia of Life Science, 2001.  Ball CS, The Early History of the Compound Microscope, Bios, Vol 37, No2 (May 1966). Findlen P, Athanasius Kircher: The Last Man Who Knew Everything.  Feinstein AR, “An Analysis of Diagnostic Reasoning,” Yale Journal of Biology and Medicine, 1973. Forsberg L.Nature's Invisibilia: The Victorian Microscope and the Miniature Fairy, Victorian Studies 2015. Gest H. The discovery of microorganisms by Robert Hooke and Antoni van Leeuwenhoek, Fellows of The Royal Society. Notes and Records of the Royal Society of Lond, 2004.  Hall, GH, The Clinical Application of Bayes Theorem, The Lancet, September 9, 1967.  Howard-Jones N, Fracastoro and Henle: A Re-Appraisal of their Contribution to the Concept of Communicable Diseases,” Medical History, 1977, 21: 61-68. Lane N, The unseen world: reflections on Leeuwenhoek (1677) ‘Concerning little animals’. Philosophical Transactions of the Royal Society, 19 April 2015.  Lawson I, Crafting the microworld: how Robert Hooke constructed knowledge about small things, Notes and Records of the Royal Society of Lond, 2015. McLeMee S, Athanasius Kirchehr, Dude of Wonders, The Chronicle of Higher Education, May 28, 2002.  Van Leeuwenhoek A, Observations, communicated to the publisher by Mr. Antony van Leewenhoeck, in a dutch letter of the 9th Octob. 1676. here English'd: concerning little animals by him observed in rain-well-sea- and snow water; as also in water wherein pepper had lain infused (https://royalsocietypublishing.org/doi/10.1098/rstl.1677.0003) “Little worms which propagate plague,” J R Coll Physicians Edinb, 2008.  Van Zuylen J, “The microscopes of Antoni van Leeuwenhoek,” Journal of Microscopy., 1981. Music from https://filmmusic.io, "Wholesome," “Pookatori and Friends,” and  by Kevin MacLeod (https://incompetech.com). License: CC BY

Bedside Rounds is on a summer vacation! In the meantime, I'm joined by journalist Dan Weissmann of the podcast An Arm and a Leg to talk about the tawdry history of the discovery of insulin. 

Can we ever know what causes a chronic disease? In this episode, I’m joined again by Dr. Shoshana Herzig to finish a three-part miniseries on Bradford Hill and Doll’s attempts to prove that smoking caused lung cancer. We’ll talk about the first prospective cohort trial in history, 1960s “Fake News” from tobacco companies, public spats with the most famous statistician of the 20th century, and the development of the Bradford Hill Criteria, a guideline, however imperfect, that gives doctors a blueprint to finally figure out what causes diseases. Sources: Crofton J, The MRC randomized trial of streptomycin and its legacy: a view from the clinical front line. J R Soc Med. 2006 Oct; 99(10): 531–534. Daniels M and Bradford Hill A, Chemotherapy of Pulmonary Tuberculosis in Young Adults, Br Med J. 1952 May 31; 1(4769): 1162–1168. Dangers of Cigarette-smoking. Brit Med J 1, 1518 (1957). Doll, R. & Hill, B. A. Lung Cancer and Other Causes of Death in Relation to Smoking. Brit Med J 2, 1071 (1956). Doll, R. & Hill, B. A. Smoking and Carcinoma of the Lung. Brit Med J 2, 739 (1950). Hill, A. The Environment and Disease: Association or Causation? J Roy Soc Med 58, 295–300 (1965). HOFFMAN, F. L. CANCER AND SMOKING HABITS. Ann Surg 93, 50–67 (1931). Keating C, Smoking Kills: The Revolutionary Life of Richard Doll. 2009. Morabia, A. Quality, originality, and significance of the 1939 “Tobacco consumption and lung carcinoma” article by Mueller, including translation of a section of the paper. Prev Med 55, 171–177 (2012). Ochsner, A. & bakey. Primary pulmonary malignancy: treatment by total pneumonectomy; analysis of 79 collected cases and presentation of 7 personal cases. Ochsner J 1, 109–25 (1999). Ochsner, A. My first recognition of the relationship of smoking and lung cancer. Prev Med 2, 611–614 (1973). Parascandola, M. Two approaches to etiology: the debate over smoking and lung cancer in the 1950s. Endeavour 28, 81–86 (2004). Phillips, C. V. & Goodman, K. J. The missed lessons of Sir Austin Bradford Hill. Epidemiologic Perspectives Innovations 1, 1–5 (2004). Proctor, R. Angel H Roffo: the forgotten father of experimental tobacco carcinogenesis. B World Health Organ 84, 494–495 (2006). Wynder, E. RE: “WHEN GENIUS ERRS: R. A. FISHER AND THE LUNG CANCER CONTROVERSY”. Am J Epidemiol 134, 1467–9 (1991).

Does smoking cause lung cancer? How could you ever know? The second in a three-part series on causality, I’m joined by Dr. Shoshana Herzig to discuss how Austin Bradford Hill and Richard Doll set out to try and answer this question -- and along the way revolutionized the way we think about what causes disease. In this episode, we’ll talk about the first double-blinded randomized controlled trial, the long shadow of tuberculosis, and why epidemiology is beautiful. Plus, a brand new #AdamAnswers about chest compressions! Please support Bedside Rounds by filling out the listener demographic survey: https://survey.libsyn.com/bedsiderounds Sources: Bost TC. Cardiac arrest during anaesthesia and surgical operations. Am J Surg 1952;83: 135-4 Council, T. Tobacco Smoking and Lung Cancer. Brit Med J 1, 1523 (1957). Crofton J, The MRC randomized trial of streptomycin and its legacy: a view from the clinical front line. J R Soc Med. 2006 Oct; 99(10): 531–534. Daniels M and Bradford Hill A, Chemotherapy of Pulmonary Tuberculosis in Young Adults, Br Med J. 1952 May 31; 1(4769): 1162–1168. Dangers of Cigarette-smoking. Brit Med J 1, 1518 (1957). Doll, R. & Hill, B. A. Lung Cancer and Other Causes of Death in Relation to Smoking. Brit Med J 2, 1071 (1956). Doll, R. & Hill, B. A. Smoking and Carcinoma of the Lung. Brit Med J 2, 739 (1950). Hill, A. The Environment and Disease: Association or Causation? J Roy Soc Med 58, 295–300 (1965). HOFFMAN, F. L. CANCER AND SMOKING HABITS. Ann Surg 93, 50–67 (1931). Hurt R, Modern cardiopulmonary resuscitation—not so new after all. J R Soc Med. 2005 Jul; 98(7): 327–331. Keating C, Smoking Kills: The Revolutionary Life of Richard Doll. 2009. Keith A, Three Hunterian Lectures ON THE MECHANISM UNDERLYING THE VARIOUS METHODS OF ARTIFICIAL RESPIRATION PRACTISED SINCE THE FOUNDATION OF THE ROYAL HUMANE SOCIETY IN 1774. (1909). The Lancet, 173(4464), 825–828. Kouwenhoven WB et al, Closed-chest cardiac massage, JAMA, JAMA. 1960;173(10):1064-1067. Morabia, A. Quality, originality, and significance of the 1939 “Tobacco consumption and lung carcinoma” article by Mueller, including translation of a section of the paper. Prev Med 55, 171–177 (2012). Ochsner, A. & bakey. Primary pulmonary malignancy: treatment by total pneumonectomy; analysis of 79 collected cases and presentation of 7 personal cases. Ochsner J 1, 109–25 (1999). Ochsner, A. My first recognition of the relationship of smoking and lung cancer. Prev Med 2, 611–614 (1973). Parascandola, M. Two approaches to etiology: the debate over smoking and lung cancer in the 1950s. Endeavour 28, 81–86 (2004). Phillips, C. V. & Goodman, K. J. The missed lessons of Sir Austin Bradford Hill. Epidemiologic Perspectives Innovations 1, 1–5 (2004). Proctor, R. Angel H Roffo: the forgotten father of experimental tobacco carcinogenesis. B World Health Organ 84, 494–495 (2006). Wynder, E. RE: “WHEN GENIUS ERRS: R. A. FISHER AND THE LUNG CANCER CONTROVERSY”. Am J Epidemiol 134, 1467–9 (1991).

In 1495, a mysterious and deadly plague struck the city of Naples. Over the next 500 years, the medical attempts to understand and treat this new disease -- syphilis -- would mold and shape medicine in surprising ways. In this episode, Tony Breu and I will perform an historical and physiological biography of syphilis, covering the development of germ theory, epic poetry, mercury saunas, intentionally infecting patients with malaria, magic bullets, and lots and lots of experiments on poor rabbits. This presentation was performed live at the American College of Physicians’ national meeting in Philadelphia on April 11, 2019.   Sources (WARNING -- LONG LIST):   Swain, K. ‘Extraordinarily arduous and fraught with danger’: syphilis, Salvarsan, and general paresis of the insane. Lancet Psychiatry 5, (2018).   Kępa, M. et al. Analysis of mercury levels in historical bone material from syphilitic subjects – pilot studies (short report). Kępa Małgorzata 69, 367-377(11) (2012).   Forrai, J. Syphilis - Recognition, Description and Diagnosis. (2011). doi:10.5772/24205   Parascandola, J. From mercury to miracle drugs: syphilis therapy over the centuries. Pharm Hist 51, 14–23 (2009).   Eisler, C. Who Is Dürer’s ‘Syphilitic Man’? Perspect Biol Med 52, 48–60 (2009).   Rothschild, B. M. History of Syphilis. Clin Infect Dis 40, 1454–1463 (2005).   Schwartz, R. S. Paul Ehrlich’s Magic Bullets. New Engl J Medicine 350, 1079–1080 (2004).   Fee, E. The wages of sin. Lancet 354, SIV61 (1999).   O’Shea, J. ‘Two Minutes with Venus, Two Years with Mercury’-Mercury as an Antisyphilitic Chemotherapeutic Agent. J Roy Soc Med 83, 392–395 (1989).   Mahoney, J., Arnold, R., Sterner, B. L., Harris, A. & Zwally, M. Penicillin Treatment of Early Syphilis: II. Jama 251, 2005–2010 (1984).   Waugh, M. Role played by Italy in the history of syphilis. Sex Transm Infect 58, 92–95 (1982).   Thorburn, A. Fritz Richard Schaudinn, 1871-1906: protozoologist of syphilis. Sex Transm Infect 47, 459–461 (1971).   CROSBY, A. W. The Early History of Syphilis: A Reappraisal. Am Anthropol 71, 218–227 (1969).   Clark, E. G. & Danbolt, N. The Oslo study of the natural history of untreated syphilis An epidemiologic investigation based on a restudy of the Boeck-Bruusgaard material a review and appraisal. J Chron Dis 2, 311–344 (1955).   MUNGER, R. S. Guaiacum, the Holy Wood from the New World. J Hist Med All Sci IV, 196–229 (1949).   Thomas, E. & r, W. Rapid Treatment of Early Syphilis with Multiple Injections of Mapharsen. J Nerv Ment Dis 99, 88 (1944).   WIEDER, L., FOERSTER, O. & FOERSTER, H. MAPHARSEN IN THE TREATMENT OF SYPHILIS: FURTHER EXPERIENCES. Arch Dermatol Syph 35, 402–413 (1937).   THON, L. SHOULD THE INTERNIST KNOW SYPHILIS? J Amer Med Assoc 97, 994–996 (1931).   Sarton, G. The Earliest Printed Literature on Syphilis, being Ten Tractates from the Years 1495-1498. Karl Sudhoff , Charles Singer , Henry E. Sigerist. Isis 8, 351–354 (1926).   COLE, H., GERICKE, A. & SOLLMANN, T. THE TREATMENT OF SYPHILIS BY MERCURY INHALATIONS: HISTORY, METHOD AND RESULTS. Arch Dermatol Syph 5, 18–33 (1922).   Mason, U. Observation: Use and Abuse of Salvarsan. J Natl Med Assoc 3, 340–3 (1911).   Fleming, A. & Colebrook, L. ON THE USE OF SALVARSAN IN THE TREATMENT OF SYPHILIS. Lancet 177, 1631–1634 (1911).   Evans, A. The Treatment of Syphilis by Salvarsan (Dioxy-diamido-arseno-benzol). Brit Med J 1, 617 (1911).   Boeck, W. History, Theory and Practice of Syphilisation. New Engl J Medicine 73, 20–25 (1865).   Veale, H. Remarks on Syphilis and Its Treatment. Edinb Medical J 10, 10–26 (1864).   LaFond RE and Lukehart SA, Biological Basis for Syphilis. Clinical Microbiology Reviews 2006.   Secher L et al, Treponema pallidum in peripheral nerve tissue of syphilitic chancres. Acta dermato-venereologica 1982.  Hollander DH, Turner TB, The role of temperature in experimental treponemal infection. American journal of syphilis, gonorrhea, and venereal diseases, 1954   Eagle H, et al. The effect of hyperpyrexia on the therapeutic efficacy of penicillin in experimental syphilis. American journal of syphilis, gonorrhea, and venereal diseases, 1947.   Kampmeier RH, Syphilis therapy: an historical perspective. Journal of the American Venereal Disease Association 1976.   Pachner AR, Spirochetal Diseases of the CNS. Neurologic clinics, 1986.   Sell S et al, Experimental syphilitic orchitis in rabbits: ultrastructural appearance of Treponema pallidum during phagocytosis and dissolution by macrophages in vivo. Laboratory investigation; a journal of technical methods and pathology, 1982.   Taylor SH, Diuretics in cardiovascular therapy. Perusing the past, practising in the present, preparing for the future. Zeitschrift für Kardiologie, 1985.   Ovchinnikov NM, [Treponema pallidum in peripheral nerves of rabbit syphiloma]. Vestnik dermatologii i venerologii, 1975.   Cheek DB, Wu F, The Effect of Calomel on Plasma Epinephrine in the Rat and the Relationship to Mechanisms in Pink Disease, Archives of Disease in Childhood, 1959   Vogl A, The discovery of the organic mercurial diuretics, American Heart Journal, 1950   Schwemlein GX et al, Penicillin and fever therapy in early syphilis, Journal of the American Medical Association, 1948.   Stringham JS, On the Diuretic Effects of Mercury in a Case of Syphilis. The Medical and physical journal, 1807   Evanson RL et al, Effect of mercurial diuretics on tubular sodium and potassium transport in the dog. The American journal of physiology, 1972   Sell S and Salman J, Demonstration of Treponema pallidum in Axons of Cutaneous Nerves in Experimental Chancres of Rabbits, Sexually Transmitted Diseases, 1992   Penn CW, Avoidance of Host Defences by Treponema pallidum in Situ and on Extraction from Infected Rabbit Testes, Microbiology 1981.   Beutler B and Munford RS, Tumor Necrosis Factor and the Jarisch–Herxheimer Reaction, The New England Journal of Medicine 1996.   Radolf JD et al, Treponema pallidum: doing a remarkable job with what it's got. Trends in Microbiology, 1999   Tight RR, Perkins RL, Treponema pallidum infection in subcutaneous polyethylene chambers in rabbits. Infection and immunity, 1976   Salazar JC et al, Treponema pallidum Elicits Innate and Adaptive Cellular Immune Responses in Skin and Blood during Secondary Syphilis: A Flow-Cytometric Analysis. The Journal of Infectious Diseases, 2007   Azevedo BF et al, Toxic Effects of Mercury on the Cardiovascular and Central Nervous Systems. Journal of Biomedicine and Biotechnology 2012,   Clarkson TW and Magos L, The Toxicology of Mercury and Its Chemical Compounds, Critical Reviews in Toxicology 2008.   Fitzgerald TJ, The Th1/Th2-like switch in syphilitic infection: is it detrimental? Infection and immunity, 1992   Batterman RC et al, THE SUBCUTANEOUS ADMINISTRATION OF MERCAPTOMERIN (THIOMERIN®): Effective Mercurial Diuretic for the Treatment of Congestive Heart Failure. Journal of the American Medical Association, 1949   Batterman RC, The status of mercurial diuretics for the treatment of congestive heart failure. American Heart Journal, 1951   Bleich HL et al, The Role of Regional Body Temperature in the Pathogenesis of Disease, The New England Journal of Medicine, 1981   Vander Veer JB et al, The Prolonged Use of an Oral Mercurial Diuretic in Ambulatory Patients with Congestive Heart Failure. Circulation 1950   Cox DL et al, The outer membrane, not a coat of host proteins, limits antigenicity of virulent Treponema pallidum. Infection and immunity, 1992.   Fildes P, The Mechanism of the Anti-bacterial Action of Mercury. Br J Exp Pathol, 1940   Clarkson TW, THE MECHANISM OF ACTION OF MERCURIAL DIURETICS IN RATS; THE METABOLISM OF 203Hg‐LABELLED CHLORMERODRIN. British Journal of Pharmacology and Chemotherapy, 1965   Engelkens HJ et al, The localisation of treponemes and characterisation of the inflammatory infiltrate in skin biopsies from patients with primary or secondary syphilis, or early infectious yaws. Genitourinary Medicine, 1993   Belum GR et al, The Jarisch–Herxheimer reaction: Revisited. Travel Medicine and Infectious Disease, 2013   Arando M et al, The Jarisch–Herxheimer reaction in syphilis: could molecular typing help to understand it better? Journal of the European Academy of Dermatology and Venereology, 2018.   Butler T, The Jarisch–Herxheimer Reaction After Antibiotic Treatment of Spirochetal Infections: A Review of Recent Cases and Our Understanding of Pathogenesis. The American Journal of Tropical Medicine and Hygiene, 2016   Carlson JA et al, The Immunopathobiology of Syphilis: The Manifestations and Course of Syphilis Are Determined by the Level of Delayed-Type Hypersensitivity. The American Journal of Dermatopathology 2011.   Aronson IK and Soltani K, The enigma of the pathogenesis of the Jarisch-Herxheimer reaction. The British Journal of Venereal Diseases, 1976   Sellato TJ et al, The Cutaneous Response in Humans to Treponema pallidum Lipoprotein Analogues Involves Cellular Elements of Both Innate and Adaptive Immunity, The Journal of Immunology 2001   Spiller HA, Rethinking mercury: the role of selenium in the pathophysiology of mercury toxicity. Clinical Toxicology 2017   Sell S et al, Reinfection of chancre-immune rabbits with Treponema pallidum. I. Light and immunofluorescence studies. The American journal of pathology 1985.    Grant SS and Hung DT, Persistent bacterial infections, antibiotic tolerance, and the oxidative stress response, Virulence 2013   Lant AF, Modern diuretics and the kidney. Journal of Clinical Pathology, 1981   Kamath SU et al, Mercury-based traditional herbo-metallic preparations: a toxicological perspective, Archives of Toxicology 2012.   Yeter et al, Mercury Promotes Catecholamines Which Potentiate Mercurial Autoimmunity and Vasodilation: Implications for Inositol 1,4,5-Triphosphate 3-Kinase C Susceptibility in Kawasaki Syndrome. Korean Circulation Journal 2013   Wöβmann W et al, Mercury intoxication presenting with hypertension and tachycardia. Archives of Disease in Childhood, 1999   Giacani L et al, Identification of the Treponema pallidum subsp. pallidum TP0092 (RpoE) Regulon and Its Implications for Pathogen Persistence in the Host and Syphilis Pathogenesis. Journal of Bacteriology 2013.   Edwards AM, From tooth to hoof: treponemes in tissue‐destructive diseases. Journal of Applied Microbiology, 2003   Wolgemuth CW, Flagellar motility of the pathogenic spirochetes. Seminars in Cell & Developmental Biology 2015.   Solomon HC and Kopp I, Fever Therapy. The New England Journal of Medicine 1937.   Rice KM et al, Environmental Mercury and Its Toxic Effects. Journal of Preventive Medicine and Public Health 2014.   Drusin LM, Electron microscopy of Treponema pallidum occurring in a human primary lesion. Journal of bacteriology 1969.   McNeely MC et al, Cutaneous secondary syphilis: Preliminary immunohistopathologic support for a role for immune complexes in lesion pathogenesis. Journal of the American Academy of Dermatology 1986.   Borenstein LA et al, Contribution of rabbit leukocyte defensins to the host response in experimental syphilis. Infection and immunity 1991.   Cabot RC et al, Case 51-1976 — Bicentennial CPC — Syphilis, Diarrhea and Death in the 1820's. The New England Journal of Medicine 1976.   Hobman JL and Crossman LC, Bacterial antimicrobial metal ion resistance. Journal of Medical Microbiology 2015   Gelpi A and Tucker JD, After Venus, mercury: syphilis treatment in the UK before Salvarsan. Sexually Transmitted Infections 2015.   MacHaffie et al, A study of the effectiveness of mercurial diuretics in treatment of cardiac decompensation. The American Journal of Cardiology 1958   Aberer W et al, Ammoniated mercury ointment: outdated but still in use. Contact Dermatitis 1990   Farhi D, Dupin N, Origins of syphilis and management in the immunocompetent patient: Facts and controversies. Clinics in Dermatology (2010) 28, 533–538   Frith J, “Syphilis – Its early history and Treatment until Penicillin and the Debate on its Origins,” Journal of Military and Veterans’ Health, 20(4), retrieved online at: http://jmvh.org/article/syphilis-its-early-history-and-treatment-until-penicillin-and-the-debate-on-its-origins/   Howes OD et al, “Julius Wagner-Jauregg, 1857-1940,” American Journal of Psychiatry, April 2009 Volume 166 Number 4, Volume 166, Issue 4, April, 2009, pp. 409-409.   Karamanou M et al, “Julius Wagner-Jauregg (1857-1940): Introducing fever therapy in the treatment of neurosyphilis.” Psychiatriki. 2013 Jul-Sep;24(3):208-12.   Simpson WM, “Artificial fever therapy of syphilis,” JAMA. 1935;105(26):2132-2140.   Tsay CJ, “Julius Wagner-Jauregg and the Legacy of Malarial Therapy for the Treatment of General Paresis of the Insane,” Yale J Biol Med. 2013;86(2): 245–254   Wagner-Jauregg J, “The history of malaria treatment of general paralysis.” Am J Psychiatry. 1946;02: 577-582   Shafer JK et al, Untreated syphilis in the male Negro: A prospective study of the effect on life expectancy. Public Health Rep. 1954 Jul; 69(7): 684–690.   Abara WE et al, Syphilis Trends among Men Who Have Sex with Men in the United States and Western Europe: A Systematic Review of Trend Studies Published between 2004 and 2015. PLoS One. 2016; 11(7): e0159309.   Nutton V, The Reception of Fracastoro's Theory of Contagion: The Seed That Fell among Thorns? Osiris, Vol. 6, Renaissance Medical Learning: Evolution of a Tradition (1990)   Tsaraklis A, Preventing syphilis in the 16th century: the distinguished Italian anatomist Gabriele Falloppio (1523-1562)  and the invention of the condom. Le Infezioni in Medicina, n. 4, 395-398, 2017.

What was behind the mysterious increase in lung cancer deaths at the turn of the 20th century? The first of a three-parter investigating the cigarette-smoking link and causality, this episode looks at that early debate, which largely focused on environmental pollution. Along the way, we’re going to talk about toxic vapors -- and not Miasma theory, but the actual literal Great Smog of London in 1952 that killed over 10,000 people -- as well as the birth of the case-control study, Nazi attempts at tobacco control programs, and the rather prosaic beginnings of a debate that rages to this day. Plus a new #AdamAnswers about the medical cause of Game of Thrones greyscale featuring Dr. Jules Lipoff!   Sources: Bell, M. L., Davis, D. L. & Fletcher, T. A retrospective assessment of mortality from the London smog episode of 1952: the role of influenza and pollution. Environ Health Persp 112, 6–8 (2003). Brunekreef B, Air Pollution and Life Expectancy: Is There a Relation? Occupational and Environmental Medicine, Vol. 54, No. 11 (Nov., 1997), pp. 781-784. Des Voeux HC, Smoke and Fog, The Lancet, 1679-1680 (1904). Logan WPD, Mortality in the London Fog Incident, 1952. The Lancet, 336-338 (1953). Heirdorn KC, The Weather Doctor's Weather Almanac: The Infamous London Smog of 1952, 2012. HOFFMAN, F. L. CANCER AND SMOKING HABITS. Ann Surg 93, 50–67 (1931). Morabia, A. Quality, originality, and significance of the 1939 “Tobacco consumption and lung carcinoma” article by Mueller, including translation of a section of the paper. Prev Med 55, 171–177 (2012). Ochsner, A. My first recognition of the relationship of smoking and lung cancer. Prev Med 2, 611–614 (1973). Ochsner, A. & bakey. Primary pulmonary malignancy: treatment by total pneumonectomy; analysis of 79 collected cases and presentation of 7 personal cases. Ochsner J 1, 109–25 (1999). Parascandola, M. Two approaches to etiology: the debate over smoking and lung cancer in the 1950s. Endeavour 28, 81–86 (2004). Press, D. J. & Pharoah, P. Risk Factors for Breast Cancer. Epidemiology 21, 566–572 (2010). Proctor, R. Angel H Roffo: the forgotten father of experimental tobacco carcinogenesis. B World Health Organ 84, 494–495 (2006). Proctor, R. N. The anti-tobacco campaign of the Nazis: a little known aspect of public health in Germany, 1933–45. Bmj 313, 1450 (1996). Proctor, R. On playing the Nazi card. Tob Control 17, 289–290 (2008). Winkelstein, W. Vignettes of the History of Epidemiology: Three Firsts by Janet Elizabeth Lane-Claypon. Am J Epidemiol 160, 97–101 (2004). Proctor R, The history of the discovery of the cigarette–lung cancer link: evidentiary traditions, corporate denial, global toll. Tobacco Control. 21:2 (2013).

What killed Charles II of Spain, the inbred monarch whose autopsy famously showed a heart the size of a peppercorn, a head full of water, and a bloodless body? This episode addresses that medical mystery by not only delving deep into Charles’ unfortunate past, but by exploring some of the fundamental assumptions physicians have made about the nature of disease. Along the way we’ll walk about inbreeding coefficients, postmodern philosophy, and two thousand years of anatomy and autopsy. Plus a new #AdamAnswers about whether Vincent van Gogh’s love of the color yellow was caused by digitalis poisoning!   Sources: Alvarez G, Ceballos FC, Quinteiro C (2009) The Role of Inbreeding in the Extinction of a European Royal Dynasty. PLoS ONE 4(4): e5174. https://doi.org/10.1371/journal.pone.0005174 Burchell HB, Digitalis poisoning: historical and forensic aspects. J Am Coll Cardiol. 1983 Feb;1(2 Pt 1):506-16. Burton JL, A Bite Into the History of the Autopsy: From Ancient Roots to Modern Decay. Forensic Sci. Med. Pathol. 1:4:277. Cerda JL. Charles II of Spain, «the bewitched». Rev. méd. Chile  [Internet]. 2008 Feb [cited 2019 Feb 11] ; 136( 2 ): 267-270.Cullen W, Nosology. Retrieved online at: https://books.google.com/books?id=3IgUAAAAQAAJ&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false Foucault, Michel. The Birth of the Clinic: An Archaeology of Medical Perception. New York: Vintage Books, 1975. Gargantilla Madera P. Enfermedades de los reyes de España, los Austrias : de la locura de Juana a la impotencia de Carlos II el Hechizado. Madrid 2005.Ghosh SK, “Giovanni Battista Morgagni (1682-1771): father of pathologic anatomy and pioneer of Modern Medicine, Anat Sci Int, 6 Sep 2016. Gruener A. Vincent van Gogh's yellow vision. Br J Gen Pract. 2013;63(612):370-1.Hodge GP. A Medical History of the Spanish Habsburgs: As Traced in Portraits. JAMA. 1977;238(11):1169–1174. Lagay F, The Legacy of Humoral Medicine, Virtual Mentor. 2002;4(7): Lee TC. Van Gogh's Vision: Digitalis Intoxication? JAMA. 1981;245(7):727–729. Lesney MS, Flowers for the heart, ACS, March 2002, Vol. 5, No. 3, pp 46, 48 López AG et al, Charles II: From Spell to Genitourinary Pathology. Arch. Esp. Urol. 2009; 62 (3): 179-185. Somberg J et al, Digitalis: Historical Development in Clinical Medicine, The Journal of Clinical Pharmacology, Volume 25, Issue 7 Starkstein, S., & Berrios, G. (2015). The “Preliminary Discourse” to Methodical Nosology, by François Boissier de Sauvages (1772). History of Psychiatry, 26(4), 477–491. Viale G, The rete mirabile of the cranial base: a millenary legend. Neurosurgery. 2006 Jun;58(6):1198-208.

Florence Nightingale stands as one of the most important reformers of 19th century medicine -- a woman whose belief in the power of reason and statistical thinking would critically shape the both the fields of epidemiology and nursing. This episode discusses the fascinating story of Nightingale’s legacy -- how modern nursing was born out of the horrors of war, medical theories about poisonous air, the outsize influence of the average man, the first graph in history, and how a woman who died over a century ago presciently foresaw some of the most important scientific and social issues in medicine that are still with us today. Plus, a new #AdamAnswers about the doctor-nurse relationship.   Sources:   Beyersmann J and Schrade C, Florence Nightingale, William Farr and competing risks, Journal of the Royal Statistical Society: Series A (Statistics in Society) Volume 180, Issue 1 Fagin CM, Collaboration between nurses and physicians: no longer a choice. Academic Medicine. 67(5):295–303, May 1992. Fee E and Garofalo ME, Florence Nightingale and the Crimean War, Am J Public Health. 2010 September; 100(9): 1591. Garofalo ME and Fee E, Florence Nightingale (1820–1910): Feminism and Hospital Reform. Am J Public Health. 2010 September; 100(9): 1588. Halliday Stephen, Death and miasma in Victorian London: an obstinate belief. BMJ. 2001 Dec 22; 323(7327): 1469–1471. Hardy A, The medical response to epidemic disease during the long eighteenth century. Epidemic Disease in London, ed. J.A.I. Champion (Centre for Metropolitan History Working Papers Series, No.1, 1993): pp. 65-70. Jahoda G, Quetelet and the emergence of the behavioral sciences. Springerplus. 2015; 4: 473. Keith JM, Florence Nightingale: statistician and consultant epidemiologist. Int Nurs Rev. 1988 Sep-Oct; 35(5):147-50. Kopf EW, Florence Nightingale as statistician.. Res Nurs Health. 1978 Oct; 1(3):93-102. Kramer M, Schmalenberg C. Securing “good” nurse–physician relationships. Nurs Manage 2003;34(7):34-8. McDonald L Florence Nightingale and the early origins of evidence-based nursing Evidence-Based Nursing 2001;4:68-69. McDonald L, Florence Nightingale, statistics and the Crimean War, J. R. Statist. Soc. A (2014)177, Part 3, pp. 569–586. McDonald L, Florence Nightingale at First Hand, London and New York: Continuum, 2010. Oyler L, “It’s Really Sickening How Much Florence Nightingale Hated Women,” Vice Broadly, retrieved online at https://broadly.vice.com/en_us/article/kb4jd3/its-really-sickening-how-much-florence-nightingale-hated-women “Rank for Nurses,” The American Journal of Nursing, Vol. 20, No. 3 (Dec., 1919), pp. 241-24. Rowen L, The Medical Team Model, the Feminization of Medicine, and the Nurse's Role. AMA Journal of Ethics, Virtual Mentor. 2010;12(1):46-51. Soine AH, From Nursing Sisters to a Sisterhood of Nurses: German Nurses and Transnational Professionalization, 1836-1918, Published Dissertation, August 2009. Stein LI. The doctor–nurse game. Arch Gen Psychiatry 1967;16(6):699-703. Stein LI, et al. The doctor–nurse game revisited. N Engl J Med 1990;322(8):546-9. Young D A B. Florence Nightingale's fever BMJ 1995; 311 :1697.

Mesmerism has had an outsize influence on medicine, despite the rapid rise and fall of its inventor Dr. Franz Mesmer and hostility from the medical establishment. This curious story covers the healing powers of magnets, secret societies in pre-Revolutionary France, fundamental questions about what makes someone alive, and one of the most fascinating medical investigations in history led by a dream team of Benjamin Franklin, Lavoisier, and Guillotine on behalf of King Louis XVI. Plus, a #AdamAnswers about the origin of the phrase “Code Blue.”   Sources: Damton R. Mesmerism and the End of the Enlightenment in France. Cambridge, MA: Harvard University Press, 1968.   Dyer R, Mesmerism, Ancient and Modern. Victorian Web. Franklin B et al, The Reports of the Royal Commission on Mesmer’s System of Animal Magnetism and other contemporary documents, James Lind Library, translated by Iml Donaldson. Retrieved online at https://www.rcpe.ac.uk/sites/default/files/files/the_royal_commission_on_animal_-_translated_by_iml_donaldson_1.pdf Lanska JT and Lanska DJ, Mesmer, Franz. Encyclopedia of the Neurological Sciences, 2014, pp 1106-1107. Lanska DJ and Lanksa JT, Franz Anton Mesmer and the Rise and Fall of Animal Magnetism: Dramatic Cures, Controversy, and Ultimately a Triumph for the Scientific Method. Brain, Mind and Medicine: Essays in Eighteenth-Century Neuroscience pp 301-320 “Mesmerism,” Boston Med Surg J 1837; 17:185-187 Normandin S, Visions of Vitalism: Medicine, Philosophy and the Soul in NineteenthCentury France, October 2005 Shermer, M, Testing the Claims of Mesmerism: The First Scientific Investigation of the Paranormal Ever Conducted. Skeptic, retrieved online at https://www.skeptic.com/eskeptic/10-09-22/ Sollberg, G. Vitalism and Vital Force in Life Sciences – The Demise and Life of a Scientific Conception Weckowicz TE and Liebel-Weckowicz HP, 7 Nineteenth Century: Vitalist-Mechanist and Psychic-Somatic Controversies. Advances in Psychology, Volume 66, 1990, Pages 109-152   Youtube videos of the Armonica: Adagio for Glass Armonica, Mozart: https://www.youtube.com/watch?v=QkTUL7DjTow Rutgers video on history of Armonica: https://www.youtube.com/watch?v=BdtLK9pAh5k

Bacteriophages -- viruses that target and kill bacteria -- were one of the most promising medical treatments of the early 20th century, and were used to treat all sorts of infections, from cholera to staph, and everything in between. But by the 1950s, they had all but died out in the West. This episode tells the story of the humble phage, from its discovery in the waters of the Ganges, love trysts ending in a KGB execution, and to a resurgence of this once forgotten therapy in the 21st century as an answer to antibiotic resistance. Sources:   Abedon ST, Bacteriophage prehistory: Is or is not Hankin, 1896, a phage reference? Bacteriophage. 2011 May-Jun; 1(3): 174–178. Blair JE and Williams REO, “Phage Typing of Staphylococci,” Bull Org mond. Ste, 1961, 24, 771-784. Davis BM and Waldor MK, Filamentous phages linked to virulence of Vibrio cholera, Current Opinion in Microbiology 2003, 6:35-42. d’Herelle F, “Bacteriophage as a treatment in acute medical and surgical infections,” Bull N Y Acad Med. 1931 May; 7(5): 329–348. d'Herelle F.  Sur un microbe invisible antagoniste des baccilles dysenteriques.  CR Acad Sci Paris 1917,163,173-5. Eaton MD, Bayne-Jones S. Bacteriophage Therapy. JAMA 1934; 103:1769-76; 1847-53; 1934-9. Fruciano DE and Bourne S, Phage as an antimicrobial agent: d’Herelle's heretical theories and their role in the decline of phage prophylaxis in the West, Can J Infect Dis Med Microbiol. 2007 Jan; 18(1): 19–26 Hankin EH.  L'action bactericide des eaux de la Jumna at du Gange sur le vibrion du cholere. Ann Int Pasteur (Paris) 1896,10,511-23. Himmelweit F. Combined action of penicillin and bacteriophage on Staphylococci. Lancet. 1945;ii:104. Hicks DJ et al, “Developments in rabies vaccines,” Clin Exp Immunol. 2012 Sep; 169(3): 199–204. Kingwell K, Bacteriophage therapies re-enter clinical trials, Nature, Vol 14, Aug 2015, 515. Jensen MA et al, Modeling the role of bacteriophage in the control of cholera outbreaks, Proc Natl Acad Sci U S A. 2006 Mar 21; 103(12): 4652–4657. Hargreaves KR and Clokie MRJ, Clostridium difficile phages: still difficult? Front Microbiol. 2014 Apr 28;5:184. La Fee S and Buschman H, Novel Phage Therapy Saves Patient with Multidrug-Resistant Bacterial Infection. Retrieved from: https://health.ucsd.edu/news/releases/Pages/2017-04-25-novel-phage-therapy-saves-patient-with-multidrug-resistant-bacterial-infection.aspx Leitner L et al, Bacteriophages for treating urinary tract infections in patients undergoing transurethral resection of the prostate: a randomized, placebo-controlled, double-blind clinical trial. BMC Urol. 2017 Sep 26;17(1):90. Pearce J, Louis Pasteur and Rabies: a brief note, Journal of Neurology, Neurosurgery & Psychiatry 2002;73:82. Schooley et al, Development and use of personalized bacteriophage-based therapeutic cocktails to treat a patient with a disseminated resistant acinetobacter baumannii infection. Antimicrobial Agent and Chemotherapy, 14 Aug 2017. Strathdee S, How Sewage Saved My Husband's Life from a Superbug, TEDxNashville, retrieved from: https://www.youtube.com/watch?v=AbAZU8FqzX4. Summers WC, Bacteriophage Therapy, Annual Review of Microbiology, Vol. 55:437-451 (Volume publication date October 2001) Summers WC, The strange history of phage therapy. Bacteriophage. 2012 Apr 1; 2(2): 130–133. Taylor M.W. (2014) Introduction: A Short History of Virology. In: Viruses and Man: A History of Interactions. Springer, Cham Thiel, K. (2004). Old dogma, new tricks—21st Century phage therapy. Nature Biotechnology, 22(1), 31–36. Twort FW, An investigation on the nature of Ultra-Microscopic Viruses, The Lancet, Jan 10th, 1914. 101. Wittebole X et al, A historical overview of bacteriophage therapy as an alternative to antibiotics for the treatment of bacterial pathogens. Virulence. 2014 Jan 1; 5(1): 226–235. Ujmajuridze et al, Adapted Bacteriophages for Treating Urinary Tract Infections. Front Microbiol. 2018; 9: 1832. Ventola CL, “The Antibiotic Resistance Crisis: Part 1: Causes and Threats,” P T. 2015 Apr; 40(4): 277–283.

Tuberculosis has been humanity’s oldest and greatest killer. Starting at the turn of the nineteenth century, the White Plague was decimating entire generations in the crowded and unclean cities of Europe, North America, and across the globe. But as medical science learned more about the disease, doctors and reformers developed new ways to combat it, most notably specialized tuberculosis hospitals that sought to heal their patients with fresh air, rest, and a nutritious diet. This episode discusses the sanatorium movement and the gradual conquest of tuberculosis, long before effective antibiotic therapy existed. Along the way we’re going to talk about the King’s Evil, the dangers of rebreathed air, the healing powers of mountains, and the social determinants of health. Plus, a brand new #AdamAnswers about maternal placentophagy. All this and more on Episode 39 of Bedside Rounds, monthly podcast on the weird, wonderful, and intensely human stories that have shaped modern medicine, brought to you in partnership with the American College of Physicians. To claim CME and MOC credit, please go to www.acponline.org/BedsideRounds.   Sources: Adams, J. F. Alleyne. "The Segregation of Consumptives." The Boston Medical and Surgical Journal 157, no. 2 (1907): 35-40. Barberis I et al, The history of tuberculosis: from the first historical records to the isolation of Koch's bacillus, J Prev Med Hyg. 2017 Mar; 58(1): E9–E12. Bertolaccini et al, Surgical treatment of pulmonary tuberculosis: the phoenix of thoracic surgery? J Thorac Dis. 2013 Apr; 5(2): 198–199. CDC: World TB Day 2018, retrieved from: https://www.cdc.gov/tb/worldtbday/history.htm Cox GL. Sanatorium treatment contrasted with home treatment. After-histories of 4,067 cases. Br J Tuberc 1923; 17:27–30. Coyle CW et al, Placentophagy: Therapeutic Miracle or Myth? Arch Womens Ment Health. 2015 Oct; 18(5): 673–680. Daniel TM, Hermann Brehmer and the origins of tuberculosis sanatoria, Int J Tuberc Lung Dis. 2011 Feb; 15(2):161-2. Daniel TM, Jean-Antoine Villemin and the infectious nature of tuberculosis, Int J Tuberc Lung Dis 19(3):267–268 Daniel TM, “The history of tuberculosis,” Respiratory Medicine (2006) 100, 1862–1870. Daniel VS and Daniel TM,, Old Testament Biblical References to Tuberculosis, linical Infectious Diseases, Volume 29, Issue 6, 1 December 1999, Pages 1557–1558. Davies RPO, Tocque K, Bellis MA, Rimmington T, Davies PDO. Historical declines in tuberculosis in England and Wales: improving social conditions or natural selection. Int J Tuberc Lung Dis 1999;3:1051–4. Dormandy T, The White: A History of Tuberculosis, 1999. Farr et al, “Human Placentophagy: A review,” AJOG, April 2018. Frith J, History of Tuberculosis. Part 1 – Phthisis, consumption and the White Plague. J Mil Vet Health, 22,2. Gaensler EA. The surgery for pulmonary tuberculosis. Am Rev Respir Dis 1982;125:73–84. Grigg RN. (1958), The arcana of tuberculosis. Am Rev Tuberc Resp Dis; 78:151-172. Hayman J, “Mycobacterium Ulcerans: An infection from Jurassic Time?” The Lancet, Nov 3, 1984. Holloway-Kew KL et al, Lessons from history of socioeconomic improvements: A new approach to treating multi-drug-resistant tuberculosis, Journal of Biosocial Science 46(5):1-21, October 2013. Jacobaeus HC. The Cauterization of Adhesions in Artificial Pneumothorax Treatment of Pulmonary Tuberculosis under Thoracoscopic Control. Proc R Soc Med 1923;16:45-62 Morse D, Brothwell DR, Ucko PJ. Tuberculosis in ancient Egypt. Am Rev Respir Dis. 1964;90:524–541. Murray JF. Bill Dock and the location of pulmonary tuberculosis: how bed rest might have helped consumption. Am J Respir Crit Care Med 2003;168:1029–1033. Murray JF. Mycobacterium tuberculosis and the cause of consumption: from discovery to fact. Am J Respir Crit Care Med 2004;169: 1086–1088. Murray JF, Sanatoriums and climate, The Lancet Infectious Disease, Vol 16, Issue 7, P786, July 01, 2016. Murray JF. The white plague: down and out, or up and coming? J. Burns Amberson Lecture. Am Rev Respir Dis 1989;140:1788–1795. Murray JF et al, “Treatment of Tuberculosis. A Historical Perspective,” Annals of the American Thoracic Society. Vol. 12, No. 12 , Dec 01, 2015. Pomerantz M. Surgery for the management of mycobacterium tuberculosis and nontuberculous mycobacterial infections of the lung. In: Shields TW, Lo Cicero J, Ponn RB, et al. eds. General Thoracic Surgery, 6th ed. Lippincott Williams & Wilkins: Philadelphia, PA; 2005:1251-61. Tuberculosis Chemotherapy Centre, A concurrent comparison of home and sanatorium treatment of pulmonary tuberculosis in South India, Bull World Health Organ. 1959; 21(1): 51–144. Warren P, The evolution of the sanatorium: the first half-century, 1854-1904, Can Bull Med Hist. 2006;23(2):457-76.

The first population study in history was born out of a dramatic debate involving leeches, “medical vampires,” professional rivalries, murder accusations, and, of course, bloodletting, all in the backdrop of the French Revolution. The second of a multipart series on the development of population medicine, this episode contextualizes Pierre Louis’ “numerical method,” his famous trial on bloodletting, and the birth of a new way for doctors to “know”. Plus a brand new #AdamAnswers about Occam’s razor and Hickam’s Dictum. All this and more on Episode 38 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine! To claim CME and MOC credit, please go to www.acponline.org/BedsideRounds.   Best M and Neuhauser D, “Pierre Charles Alexandre Louis: Master of the spirit of mathematical clinical science,” Qual Saf Health Care 2005;14:462–464. Duffin J, “Laennec and Broussias: The ‘Sympathetic’ Duel,” from La Berge A and Hannaway C, Paris Medicine: Perspective Past and Present. (1977) The French Revolution: A Revolution in Medicine, Too, Hospital Practice, 12:11, 127-138 Hillard A, et al. “Occam’s Razor versus Saint’s Triad, N Engl J Med 2004;350:599-603. Lo Re V 3rd, Bellini LM, William of Occam and Occam's razor. Ann Intern Med. 2002 Apr 16;136(8):634-5. Kirk GW and Pemberton N. Leech, 2013 Kirk GW and Pemberton N, Re-imagining Bleeders: The Medical Leech in the Nineteenth Century Bloodletting Encounter. Med Hist. 2011 Jul; 55(3): 355–360. La Berge A and Hannaway C, Paris Medicine: Perspective Past and Present. Louis PCA. Researches On The Effects Of Bloodletting In Some Inflammatory Diseases. Boston: Hilliard, Gray, 1836. Morabia A. PCA Louis and the birth of clinical epidemiology. J Clin Epidemiol 1996;49: 1327-33 Morabia A, Pierre-Charles-Alexandre Louis and the evaluation of bloodletting. J R Soc Med. 2006 Mar; 99(3): 158–160. Niehyl PH. The English bloodletting revolution, or modem medicine before 1950. Bull Hist Med 1977; 51, pp. 464-483. Papavramidou N and Christopolou-Aletra H, Medicinal use of leeches in the texts of ancient Greek, Roman and early Byzantine writers. Intern Med J. 2009 Sep;39(9):624-7. “Suckers for Success,” Nature volume 484, page 416 (26 April 2012). “Walter Chatton,” Stanford Encyclopedia of Philosophy, retrieved from: https://plato.stanford.edu/entries/walter-chatton/ Wardrop D, “Ockham’s Razor: sharpen or re-sheathe?” J R Soc Med. 2008 Feb; 101(2): 50–51.

Many podcasts start with an “Episode 0”, basically a mission statement for the podcast. Well, better late than never! This episode explores why I make Bedside Rounds, my philosophy about medical history, and a little bit about who I am and my research methods. Hopefully listeners new and old alike will find it interesting!

For thousands of years, bloodletting was the standard of care for any number of medical conditions, but at the turn of the nineteenth century, often acrimonious debates about the practice would lead to a new method of medical knowledge. The first of a multi-part series on the birth of population medicine, this episode visits the controversies surrounding the death of George Washington and Benjamin Rush’s bleeding of Philadelphia during the 1793 yellow fever epidemic and asks the big question -- how do doctors truly “know” what actually helps their patients? Plus, a brand new #AdamAnswers about military metaphors in medicine. All this and more on Episode 37 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine!   Sources: Brickell J, Observations on the Medical Treatment of General Washington in His Illness, retrieved from https://books.google.com/books?id=YXA3AQAAMAAJ&pg=PA90&lpg=PA90&dq=craik+dick+washington+medical+repository&source=bl&ots=IZB72sSdaS&sig=kUY0JZHft1HbRrarR9RE4r-2w_A&hl=en&sa=X&ved=2ahUKEwju3PT439TcAhVOxVkKHZPHBVQQ6AEwA3oECAcQAQ#v=onepage&q&f=false Cohen B, The death of George Washington (1732-99) and the history of cynanche. J Med Biogr. 2005 Nov;13(4):225-31. Craik J and Dick E, The Medical Repository and Review of American Publications onSurgery, Third Quarter, 1805. Fuks A, “The Miliary Metaphors of Modern Medicine,” 2009. Harington J, Regimen Sanitatis Salernitanum (ca. 11th c.), retrieved from https://faculty.humanities.uci.edu/bjbecker/PlaguesandPeople/week3f.html Kopperman P, "Venerate the Lancet": Benjamin Rush's Yellow Fever Therapyin Context. Bulletin of the History of Medicine, Volume 78, Number 3, Fall 2004, pp.539-574 Lane HP et al, “The war against dementia: are we battle weary yet?” Age and Ageing, Volume 42, Issue 3, 1 May 2013, Pages 281–283. Moed et al, “Cantharidin Revisited: A Blistering Defense of an Ancient Medicine,” JAMA Dermatology, October 2001. Morens DM, Death of a President, NEJM Dec 9, 1999 Niehyl PH. The English bloodletting revolution, or modem medicine before 1950. Bull Hist Med 1977; 51, pp. 464-483.   North RL, “Benjamin Rush, MD: assassin or beloved healer?” Proc (Bayl Univ Med Cent). 2000 Jan; 13(1): 45–49. Parapia LA, History of bloodletting by phlebotomy. British Journal of Haematology Volume 143, Issue 4 Rush, Benjamin. Observations Upon the Origin of the Malignant Bilious, or Yellow Fever in Philadelphia, and Upon the Means of Preventing It: Addressed to the Citizens of Philadelphia. Philadelphia: Printed by Budd and Bartram, for Thomas Dobson, at the Stone House, No. 41, South Second Street., 1799, retrieved from: https://iiif.lib.harvard.edu/manifests/view/drs:6483213$1i Wallenborn WM, George Washington’s Terminal Illness: A Modern Medical Analysis of the Last Illness and Death of George Washington, retrieved from: http://gwpapers.virginia.edu/history/articles/illness/

The southern United States was hit by a dramatic epidemic of a mysterious disease called pellagra in the early twentieth century. This episode discusses the cultural and scientific sources of the outbreak -- from the cotton fields of the south, to the cow pastures of rural Germany, to the river basins of Uganda -- and the incredible lengths a young doctor named Joseph Goldberger went through to try and put an end to this plague. Plus, a new #AdamAnswers about the source of the name “internal medicine.” All this and more on episode 36 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine!   Bean WB,  “Origin of the Term Internal Medicine,” N Engl J Med 1982; 306:182-183 Blevins SM and Bronze MS, Robert Koch and the ‘golden age’ of bacteriology, Int J of Inf Dis, Vol 14, #9, Sep 2010. Bloomfield AL, “The origin of the term ‘internal medicine,” JAMA, April 4, 1959. Bressani R et al, Corn Nutrient Losses, Chemical Changes in Corn during Preparation of Tortillas, J Agr and Food Chem, 6, 10, 770-774. Brim CJ. Job's Illness: Pellagra. Archives of Dermatology and Syphilology. 1942;45:371-6. Carpenter KJ, The relationship of pellagra to corn and the low availability of niacin in cereals, Experientia Suppl. 1983;44:197-222. Clay K et al, Rise and Fall of Pellagra in the American South. Elmore JG and Feinstein AR, Joseph Goldberger: An Unsung Hero of American Clinical Epidemiology, Ann Intern Med. 1994;121:372-375. Goldberger J. The transmissibility of pellagra: Experimental attempts at transmission to human subjects. Public Health Rep. 1916;31:3159–73 Goldberger J. Public Health Reports, June 26, 1914. The etiology of pellagra. The significance of certain epidemiological observations with respect thereto. Public Health Rep. 1914;29(26):1683–1686. Goldberger J, Wheeler GA, Sydenstricker E. A study of the relation of diet to pellagra incidence in seven textile-mill communities of South Carolina in 1916. Public Health Rep. 1920;35(12):648–713. Goldberger J, Waring CH, Willets DG, et al. The Treatment and Prevention of Pellagra. Washington, DC: Government Printing Office; 1914. Goldberger J, Wheeler GA. Experimental pellagra in the human subject brought about by a restricted diet. Public Health Rep. 1915;30(46):3336–3339. Harris HF: Ankylostomiasis in an individual presenting all of the typical symptoms of pellagra. Am Med 1902; 4:99-100, retrieved from: https://babel.hathitrust.org/cgi/pt?id=uc1.c3312358;view=1up;seq=107;size=125 Lavinder CH, Pellagra, The American Journal of Nursing, Vol. 13, No. 10 (Jul., 1913), pp. 746-754. MacNeal WJ, The Alleged Production of Pellagra by an Unbalanced Diet, JAMA. 1916;LXVI(13):975-977. Middleton J, Pellagra and the blues song ‘Cornbread, meat and black molasses’. J R Soc Med. 2008 Nov 1; 101(11): 569–570. Mooney et al, The Thompson-McFadden Commission and Joseph Goldberger: Contrasting 2 Historical Investigations of Pellagra in Cotton Mill Villages in South Carolina. Am J Epidemiol. 2014 Aug 1; 180(3): 235–244. Morabia A (2006). Joseph Goldberger’s research on the prevention of pellagra. JLL Bulletin: Commentaries on the history of treatment evaluation. Niles GM. Pellagraphobia: A word of caution. JAMA. 1912;58:1341. Roberts CS, Goldberger and the Mal de la Rosa, Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Roberts SR, SAMBON'S NEW THEORY OF PELLAGRA AND ITS APPLICATION TO CONDITIONS IN GEORGIA, JAMA. 1911;LVI(23):1713-1715. Searcy GH: An epidemic of acute pellagra. Transactions of the Medical Association of Alabama, 1907, pp 387-393 Wacher, C. (2003). Nixtamalization, a Mesoamerican technology to process maize at small-scale with great potential for improving the nutritional quality of maize based foods.

Sir Arthur Conan Doyle considered The Adventure of the Speckled Band to be his best Holmes story, and Adam does too. Meant to be a companion to Episode 35 (Sherlock), this is the story in its entirety. THIS IS NOT AN EPISODE! It's Adam reading for almost 50 minutes. Consider yourself forewarned!

Why do doctors love Sherlock Holmes so much? In this episode, we’ll explore this endearing, nerdy obsession with the good detective, from Holmes’ medical origins and influences, the parallels with medical reasoning, and how the Holmes stories still influence medicine to this day. Plus a new #AdamAnswers about the origin of the white coat. All this and more in Episode 35 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine! Sources: Blumhagen DW, “The Doctor’s White Coat,” Annals of Internal Medicine, Vol 91, No. 1, July 1979. Conan Doyle A, “The Adventure of the Speckled Band,”  retrieved from https://sherlock-holm.es/stories/pdf/a4/1-sided/spec.pdf Hochberg MS, “The Doctor’s White Coat -- an Historical Perspective,” Virtual Mentor. April 2007, Volume 9, Number 4: 310-314. Levine D, Revalidating Sherlock Holmes for a role in medical education.Clin Med April 1, 2012 vol. 12 McDaniels, AK, “In change in tradition, Johns Hopkins interns will no longer wear short white coats,” Baltimore Sun, retrieved from http://www.baltimoresun.com/health/bs-hs-short-white-coat-20180328-story.html Oderwald AK, Sebus JH. The physician and Sherlock Holmes. Journal of the Royal Society of Medicine 1991;84:151–2. Perry S, “It takes a medical Sherlock Holmes to solve complex neurological mysteries,” MinnPost, retrieved from https://www.minnpost.com/second-opinion/2013/09/it-takes-medical-sherlock-holmes-solve-complex-neurological-mysteries Peschel RE, Peschel E. What physicians have in common with Sherlock Holmes: discussion paper. Journal of the Royal Society of Medicine 1989;82:33–6. Rapezzi C, Ferrari R, Branzi A. White coats and fingerprints: diagnostic reasoning in medicine and investigative methods of fictional detectives. BMJ 2005;331:1491–4 FREE Full Textno. 2 146-149. Reed J, A medical perspective on the adventures of Sherlock Holmes, BMJ Medical Humanities, Volume 27, Issue 2. http://mh.bmj.com/content/27/2/76 Snyder LJ, “Sherlock Holmes: scientific detective,” Endeavor, Vol. 28 No.3 September 2004. Whitaker P, “Had Sherlock Holmes gone into medicine, he’d have been a dermatologist,” New Statesman, retrieved from https://www.newstatesman.com/politics/health/2018/03/had-sherlock-holmes-gone-medicine-he-d-have-been-dermatologist

The physical exam has become a ritual of the modern doctor’s appointment, with pokes, prods, and strange tools. How did this become a normal thing to do? In this episode, I’ll discuss how the physical exam went from the medieval examination of a flask of urine to basically what we have today in just a few decades in early 19th century France, and how the exam is still developing in the 21st century. Plus, a brand new #AdamAnswers about why Americans insist on using the Hermes’ Staff as a symbol for medicine. All this and more in episode 34 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine!   Sources: Antic T, DeMay RM. “The fascinating history of urine examination,” Journal of the American Society of Cytopathology (2014) 3, 103e107 Ghasemzadeh N and Zafari AM, “A Journey into the History of the Arterial Pulse,” Cardiology Research and Practice Volume 2011 (2011). McGee S, Evidence Based Physical Diagnosis 4th edition. Amazon link: https://www.amazon.com/Evidence-Based-Physical-Diagnosis-Steven-McGee/dp/0323392768 Nicolson M, Commentary: Nicholas Jewson and the disappearance of the sick man from medical cosmology, 1770–1870. Int J Epidemiol 2009;38:622–33) Jewson ND. The disappearance of the sick-man from medical cosmology, 1770–1870, Sociology , 1976, vol. 10 (pg. 225-44) Robertson WE. Physical diagnosis from the time of Rontgen. Ann Med Hist. 1934;6:255–63 Rodgers MM, “Piorry on Pleximetry and Auscultation,” Boston Med Surg J 1852; 46:151-152 Tan SY and Hu M, “Josef Leopold Auenbrugger (1722 - 1809): father of percussion. Singapore Med J 2004 Vol 45(3):103 Walker HK, “The Origins of the History and Physical Examination,” Clinical Methods: The History, Physical, and Laboratory Examinations.Boston: Butterworths; 1990. Wallis F, Signs and Senses: Diagnosis and Prognosis in Early Medieval Pulse and Urine Texts. Social History of Medicine Vol. 13 No. 2 pp. 265-278. Wilcox RA et al, “The Symbol of Modern Medicine: Why One Snake Is More Than Two,” Ann Intern Med. 2003;138:673-677. Verghese et al, A History of Physical Examination Texts and the Conception of Bedside Diagnosis. Voswinkel P, From uroscopy to urinalysis. Clinica Chimica Acta 297 (2000) 5–16

Alexis St. Martin and William Beaumont have one of the strangest relationships in the history of medicine -- a young French-Canadian fur trapper with a hole in his stomach from an errant shotgun blast and the American army physician who cared for him, and then made his own career by turning Alexis into a human guinea pig. Through the decades of their complicated relationship, they’d revolutionize our understanding of the physiology of the stomach, put American medicine on the map, and start a conversation about the ethics of human experimentation that goes on to this day. Plus there’s a new #AdamAnswers about whether or not your body temperature and fevers can “run low”. All this and more on the latest episode of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine.   Sources:   Beaumont W. Experiments and Observations of the Gastric Juice and the Physiology of Digestion. Plattsburgh, NY: FP Allen; 1833. Mackowiak PA et al, “A critical appraisal of 98.6 degrees F, the upper limit of the normal body temperature, and other legacies of Carl Reinhold August Wunderlich.” JAMA. 1992 Sep 23-30;268(12):1578-80. Mackowiak PA, “Feel the heat: a short history of body temperature,” BMJ. 2017;359:j5697 Markel H, “How William Beaumont and Alexis St. Martin Seized the Moment of Scientific Progress,” JAMA, August 19, 2009—Vol 302, No. 7. Myers NA and Durham Smith E, “A Debt to Alexis: The Beaumont-St Martin Story,” Aust NZ J Surg (1991) 67, 534-539. Numbers RL, “William Beaumont and the Ethics of Human Experimentation,” Journal of the History of Biology, Vol. 12, No. 1 (Spring, 1979), pp. 113-135. Obermeyer Z et al, Individual differences in normal body temperature: longitudinal big data analysis of patient records. BMJ. 2017; 359: j5468. Osler W, “William Beaumont: A Pioneer American Physiologist,” JAMA Vol XXXIX No 20, Nov 15, 1902.

The Four Humors are probably the longest-lasting idea in the history of medicine, even though they’ve been more or less completely abandoned for the past century or so. In this episode, we’ll explore how the ancient Greek idea of disease coming from imbalances in body fluids touched every aspect of medicine for two millennia, well into the modern era. And we’ll discuss how humoral explanations likely hampered adoption of the first clinical trial in history, James Lind’s famous scurvy study. Plus we have a brand new #AdamAnswers about germ theory. Listen to all this and more in Episode 32 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine!   Sources: Arikha N, Passions and Tempers: A History of the Humors. 2007. Baron JH, “Sailors' scurvy before and after James Lind--a reassessment,” Nutr Rev. 2009 Jun;67(6):315-32. Bartholomew M, “James Lind and scurvy: a revaluation,” Journal for Maritime Research. Published online: 08 Feb 2011. Lind J. A Treatise of the Scurvy in Three Parts. Containing an Inquiry into the Nature, Causes and Cure of that Disease, together with a Critical and Chronological View of what has been published on the subject. London: Miller, 1753 NLM’s Turning the Pages on the Edwin Smith Papyrus (https://www.nlm.nih.gov/news/turn_page_egyptian.html) Nutton V, Ancient Medicine. Nutton V, “The Fatal Embrace: Galen and the History of Ancient Medicine”. Science in Context 18(1), 111–121 (2005). Shoja MM et al, “Wrong theories on the origin of blood vessels: Polybus and De Natura Hominis.” Int J Cardiol. 2008 Jun 6;126(3):313-5. Sutton G, “Putrid gums and 'dead men's cloaths': James Lind aboard the Salisbury.” J R Soc Med. 2003 Dec;96(12):605-8. Trohler U, “Lind and Scurvy: 1747-1795,” J R Soc Med. 2005 Nov; 98(11): 519–522. West JB, Galen and the beginnings of Western physiology Volume 307 Issue 2 July 2014 Pages L121-L128

Malariotherapy -- infecting comatose syphilis patients with malaria to cure them of the disease -- was once the cutting edge of medicine, and earned its inventor Julius Wagner-Jauregg the Nobel Prize in Medicine or Physiology in 1927. In this episode, we’re going to talk about the fascinating story behind this remarkable treatment, from the murky beginnings of syphilis through its sordid sexual connotations, to the birth of modern psychiatry and Nazi experiments. Plus, there’s a brand new #AdamAnswers about whether or not ancient doctors thought hair served to store semen (seriously).  Listen to all this and more in Episode 31 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine. Sources: Crellato E et al, “The Hippocratic treatise ‘On glands’: the first document on lymphoid tissue on lymph nodes,” Leukemia. Retrieved online at https://www.nature.com/articles/2404618 Farhi D, Dupin N, Origins of syphilis and management in theimmunocompetent patient: Facts and controversies. Clinics in Dermatology (2010) 28, 533–538 Frith J, “Syphilis – Its early history and Treatment until Penicillin and the Debate on its Origins,” Journal of Military and Veterans’ Health, 20(4), retrieved online at: http://jmvh.org/article/syphilis-its-early-history-and-treatment-until-penicillin-and-the-debate-on-its-origins/ Gelder MG, “Biological Psychiatry in Perspective,” British Medical Bulletin. 1996;2 (No. 3H01-4G7) Howes OD et al, “Julius Wagner-Jauregg, 1857-1940,” American Journal of Psychiatry, April 2009 Volume 166 Number 4, Volume 166, Issue 4, April, 2009, pp. 409-409. Karamanou M et al, “Julius Wagner-Jauregg (1857-1940): Introducing fever therapy in the treatment of neurosyphilis.” Psychiatriki. 2013 Jul-Sep;24(3):208-12. Kent, ME and Romanelli F. Reexamining Syphilis: An Update on Epidemiology, ClinicalManifestations, and Management, The Annals of Pharmacotherapy. 2008 February, Volume 42 Kreston R, “Pyromania! On Neurosyphilis and Fighting Fire with Fire,” Body Horrors blog on Discover. Retrieved online at: http://blogs.discovermagazine.com/bodyhorrors/2014/05/31/pyromania-syphilis-malaria/#.WnTvHKinE2x Martin TW, “Paul’s argument from Nature for the Veil in 1 Corinthians 11:13-15: A Testicle Instead of a Head Covering,” Journal of Biblical Literature, Vol. 123, No. 1 pp 75-84. Rothschild, BM, “History of Syphilis Clinical Infectious Diseases.” 2005; 40:1454–63 Simpson WM, “Artificial fever therapy of syphilis,” JAMA. 1935;105(26):2132-2140. Tampa M et al, “Brief History of Syphilis.” J Med Life. 2014 Mar 15; 7(1): 4–10. Tsay CJ, “Julius Wagner-Jauregg and the Legacy of Malarial Therapy for the Treatment of General Paresis of the Insane,” Yale J Biol Med. 2013;86(2): 245–254 Wagner-Jauregg J, “The history of malaria treatment of general paralysis.” Am J Psychiatry. 1946;02: 577-582

Two hundred years ago, a few doctors, a matron, and 22 orphans set sail in a gutsy attempt to spread the new invention of vaccination across three continents in the world’s first attempt to eliminate smallpox. Learn about their epic journey, the Balmis-Salvany Expedition, as well as the medical context surrounding the invention of vaccination in “The Orphan Vaccine”. Plus, a new #AdamAnswers about why you always get sick when you first go on vacation. You can find all this and more in the latest episode of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine!   Sources: Domingo P, “Smallpox: The triumph over the most terrible of the ministers of death,” Annals of Internal Medicine, November 1997. Fenner F et al, “Smallpox and its Eradication,” World Health Organization, 1988, Franco-Paredes C, et al. “The Spanish Royal Philanthropic Expedition to Bring Smallpox Vaccination to the New World and Asia in the 19th Century”, Clinical Infectious Diseases, Volume 41, Issue 9, 1 November 2005, Pages 1285–1289 Hammarsten JF et al, “Who discovered smallpox vaccination? Edward Jenner or Benjamin Jesty?” Trans Am Clin Climatol Assoc. 1979;90:44-55. Lipton RB et al, “Reduction in perceived stress as a migraine trigger: testing the ‘let-down headache’ hypothesis,” Neurology. 2014 Apr 22; 82(16): 1395–1401. Mark C and Rigau-Peres JG, “The World’s First Immunization Campaign: The Spanish Smallpox Vaccine Expedition, 1803-1813,” Bulletin of the History of Medicine, Volume 83, Number 1, Spring 2009, pp 63-94. Morgan AJ and Poland GA, “The Jenner Society and the Edward Jenner Museum: Tributes to a physician-scientist,” Vaccine, 295 (2011) D152-D154. Tuells J. “Francisco Xavier Balmis (1753–1819), a pioneer of international vaccination,” Journal of Epidemiology and Community Health, 2002, 56:11.

Did the famous composer Gustav Mahler work his fatal heart murmur into his final ninth symphony? To try and answer this question, I’m joined by Dr. Kevin Nordstrom of the Great Composers Podcast. We’ll delve into Mahler’s diseases, a history of heart sounds, musical theory, his obsession with mortality, and the unfortunate circumstances of his own death. Classical music and medicine, in one podcast! What more could you want? And included (at no extra charge!) is a new #AdamAnswers about the origins of respiratory therapy.   You can listen to Dr. Nordstrom’s Great Composers Podcast on iTunes or on his website.   Sources: Amenta C, “The Opening of Mahler's Ninth Symphony and the Bernstein "Heart-beat" Hypothesis by Charles Amenta,” Naturlaut 4(1): 17-18, 2005. Cardoso F and Leese AJ. “Did Gustav Mahler have Syndenham’s chorea?” Mov Disord. 2006 Mar;21(3):289-92. Christy NP et al, “Gustav Mahler and his illnesses,” Trans Am Clin Climatol Assoc. 1971; 82: 200–217. Ferretti J et al, “History of Streptococcal Research.” Streptococcus pyogenes : Basic Biology to Clinical Manifestations. Hannah IR and Silverman ME, “A history of cardiac auscultation and some of its contributors,” Am J Cardiol. 2002 Aug 1;90(3):259-67. Levy D, “Gustav Mahler and Emanuel Libman: bacterial endocarditis in 1911,” Br Med J (Clin Res Ed). 1986 Dec 20-27;293(6562):1628-31. Mangione S, “Mahler at 100: a medical history,” Hektoen International. http://hekint.org/2017/01/30/mahler-at-100-a-medical-history/

The story of smallpox blankets offered as gifts to indigenous peoples as a weapon of war is ubiquitous -- but is it based in truth? And did our increased medical understanding of smallpox lead to its use as a biological weapon?  In this episode, we confront these questions and explore the history of biological warfare, smallpox, and medicine. Listen to all this, a new #AdamAnswers, and more in this episode of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine. Sources: Barras V and Groub G, “History of biological warfare and bioterrorism,” Clin Microbiol Infect 2014. Carus W, “The history of biological weapons use: what we know and what we don’t,” Health Security, Vol 13, No4, 2015. Fenner F et al, “Smallpox and its Eradication,” World Health Organization, 1988, Chapters 5 and 6. Mayor A, “The Nessus Shirt in the New World: Smallpox Blankets in History and Legend,” J Am Folklore, Vol. 108, No. 427 (Winter, 1995), 54-77. Mear C, “The origin of the smallpox outbreak in Sydney in 1789,” Journal of the Royal Australian Historical Society, June, 2008. Skwarecki B, “What is the scariest disease?” PLoS Blogs, retrieved at https://gizmodo.com/what-is-the-scariest-disease-1653943826 Theves C, et al, “The rediscovery of smallpox,” Clin Microbiol Infect 2014; 20: 210-218. Ranlet P, “The British, the Indians, and Smallpox: What actually happened at Fort Pitt in 1763?”, Pennsylvania history: 427-442. Warren C, “Smallpox at Sydney Cove -- who, when, why?” J Aust Studies, 30 Oct 2013

The United States is in the midst of an epidemic of addiction and overdose deaths due to opiate painkillers. Its causes are varied, but there’s no question that physicians share a large part of the blame. Little discussed is that this is actually the second time this has happened. Almost a century ago, a remarkably similar epidemic struck the country. In this episode, called “The First Opiate Epidemic,” I discuss what happened, the parallels to today, and the lessons we can learn from our forebearers. Learn about all this and a new #AdamAnswers in this month’s Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine!   Sources:   Courtwright DT. Dark Paradise: A History of Opiate Addiction in America. Harvard University Press, 2001. Meldrum ML, “The ongoing opiod prescription epidemic: historical context,” Am J Public Health. 2016 August; 106(8): 1365–1366. Courtwright DT, “Preventing and treating narcotic addiction -- a century of federal drug control,” N Engl J Med 2015; 373:2095-2097. Adams JFA, “Substitutes for opium in chronic diseases,” Boston Med Surg J 1889; 121:351-356. Macht DI, “The history of opium and some of its preparations and alkaloids,” JAMA. 1915;LXIV(6):477-481. Hamilton GR and Baskett TF, “In the arms of Morpheus: the development of morphine for postoperative pain relief,” Can J Anesth. 2000;47:4, 367-374. Weiner JP, “A shortage of physicians or a surplus of assumptions?” Health Aff January 2002 vol. 21 no. 1 160-162. Gudbranson BA et al, Reassessing the Data on Whether a Physician Shortage Exists. JAMA. 2017;317(19):1945-1946. Kirch DG and Petelle K, Addressing the Physician Shortage: The Peril of Ignoring Demography. JAMA. 2017;317(19):1947-1948.  

In 2005, a mysterious plague called Corrupted Blood hit the online denizens of World of Warcraft, ripping through cities and decimating player characters. After the smoke cleared, it became clear that this virtual plague shared many characteristics with real-world diseases and almost immediately attracted the attention of researchers. In this Summer Short, I go over the details of the in-game Corrupted Blood incident, and the very real-world epidemiological research that followed. Learn about all this and more on the latest short of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine.   Sources: Bohannon J. Slaying monsters for science. Science  20 Jun 2008. Messner S. How Blizzard coped with World of Warcraft's blood plague and other early disasters. PC Gamer. Henderson M. Analysis: Absence of risk limits parallels with real life. Times Online. October 28, 2008 Oultram S. Virtual plagues and real-world pandemics: reflecting on the potential for online computer role-playing games to inform real world epidemic research. BMJ. Lofgren E, Fefferman N. The untapped potential of virtual game worlds to shed light on real world epidemics. Lancet Infect Dis 2007;9:625–9.

The invention of dialysis -- essentially artificial kidneys for people with kidney failure -- revolutionized medicine. It also started a debate about medical rationing and ethics that rages to this day. Producer Cam Steele brings us a story about the God Squad, the group of lay people and doctors tasked with deciding who lived and who died in the early days of dialysis, and how it has informed every debate about medical rationing since. Learn about all this and more, plus a new #AdamAnswers in the latest episode of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine. Sources: Blagg CR, Development of ethical concepts in dialysis: Seattle in the 1960s. Nephrology, 1998.4, 235-238 Scheunemann L and White D, The Ethics and Reality of Rationing in Medicine, Chest, 140; 6. December 2011 White DB et al, Who should receive life support during a public health emergency? Using ethical principles to improve allocation decisions. Ann Intern Med. 2009 January 20; 150(2): 132–138. Jonson AR, The God Squad and the Origins of Transplantation Ethics and Policy, Journal of Law, Medicine, and Ethics. Levine C, The Seattle “God Committee”: A Cautionary Tale; Nov 30 2009. Blagg, CR. The Early Years of Chronic Dialysis: The Seattle Contribution. Am J Nephrol 1999;19:350–354 Persad, et al. Principles for allocation of scarce medical interventions, Lancet 2009; 373: 423–31. Bryson, et al. Addiction and Substance Abuse in Anesthesiology. Anesthesiology. 2008 Nov; 109(5): 905–917. Hughes, et al. Resident Physician Substance Use, By Specialty. Am J Psychiatry 1992; 149: 1348-1354.

The eclipse is coming! Get out your eclipse glasses (or your camera obscura, if you didn't prepare like me), and enjoy a review of the medical literature on eclipses with our guest Dr. Avi O'Glasser in our first summer short. Beyond solar retinopathy (a very good reason to not look into the sun), are there health effects on humans? Is there anything to the widespread belief of an eclipse being a bad omen? Find out all this and more in our first Bedside Rounds Summer Short. And thanks so much to Dr. O'Glasser!   References: http://www.asrs.org/patients/retinal-diseases/special-safety-edition-2017-great-american-eclipse A New Way to Look Up. Solar Retinopathy Risks and Methods of Prevention Prior to the 2015 Solar Eclipse Public health warnings of solar retinopathy risk in European newspapers prior to the 2006 solar eclipse. (http://www.oftalmo.com/seo/archivos/maquetas/C/1C6CE602-7C96-3DE8-336A-00001A483D3C/articulo.pdf) EFFECT OF ECLIPSE OF THE SUN IN 1999 ON THE PSYCHIC STATE OF PEOPLE http://www.prolekare.cz/en/general-practitioner-article/effect-of-eclipse-of-the-sun-in-1999-on-the-psychic-state-of-people-25088

Intravenous or IV fluids are a ubiquitous treatment in medicine, and one of the most cost-effective treatments that we have, costing less than a cup of coffee in the developing world. But it wasn’t always this way. In this episode, called Salt Water, we go back to the second great cholera epidemic, where a young doctor developed IV fluids to help fight this mysterious disease, only to see his invention abandoned for over half a century. We also have a new #AdamAnswers about bloodletting. So join us for another rollicking adventure of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine!   Sources:   Foex B. How the cholera epidemic of 1831 resulted in a newtechnique for fluid resuscitation. Emerg Med J 2003;20:316–318. Gill G. William O’Shaughnessy and the forgotten cure for cholerain the 1832 British epidemic. Letter from Lord Cavendish: Online at: http://mssweb.nottingham.ac.uk/elearning/view-text.asp?resource=HealthHousing&ref=pwh287&theme=3&view=text&page=1 O'Shaughnessy, W.B. (1838–40). "Case of Tetanus, Cured by a Preparation of Hemp (the Cannabis indica.)". Transactions of the Medical and Physical Society of Bengal. 8: 462–469. Chan C, et al. Historical Epidemiology of the Second Cholera Pandemic: Relevance to Present Day Disease Dynamics. PLOS One: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0072498 BB4: Diary of an Epidemic. Online at: http://www.bbc.co.uk/radio4/history/longview/longview_20030415.shtml Kresta R. The Origin of IV Fluids. Discover Magazine. Online at: http://blogs.discovermagazine.com/bodyhorrors/2016/05/31/intravenous-fluids-cholera/#.WX9z4JdtmUl Prasad V and Cifu A, Medical Reversal: Why We Must Raise the Bar Before Adopting New Technologies. Yale J Biol Med. 2011 Dec; 84(4): 471–478.   Further reading: r/AskHistorians thread: https://www.reddit.com/r/AskHistorians/comments/6nzbfz/if_bloodletting_was_rubbish_why_was_it_considered/ Ending Medical Reversal by Cifu and Prasad. On Amazon at: https://www.amazon.com/Ending-Medical-Reversal-Improving-Outcomes/dp/1421417723

In this month's #AdamAnswers, he discusses his #TipsforNewInterns (seriously, it's trending on Twitter). And we introduce the Summer Shorts for this summer -- and discuss how you can contribute and be on the show! (#spoileralert -- Tweet me @AdamRodmanMD). This is NOT an episode! Make sure you listen to Episode 24.

What makes a disease? And who gets to decide? Producer Cam Steele brings us a story that spans migrating uteruses in ancient Egypt, a disease that makes slaves want to run away in the antebellum south, and the accidental discovery of an erection pill while trying to treat heart disease. Join us in our journey to disassemble the concept of disease in Episode 24 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine!   Sources: Bynum B. Discarded Diagnoses. The Lancet. Volume 356, No. 9241, p1615, 4 November 2000. Conrad P. The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders. Drescher J. Out of DSM: Depathologizing Homosexuality. Behav Sci (Basel). 2015 Dec; 5(4): 565–575. Robison J. Look Me in the Eye: A Brief History of Nosology. Retrieved from: http://jerobison.blogspot.com/p/a-brief-history-of-nosology.html Shorter E. The history of nosology and the rise of the Diagnostic and Statistical Manual of Mental Disorders. Dialogues Clin Neurosci. 2015 Mar; 17(1): 59–67. Tasca C, et al. Women And Hysteria In The History Of Mental Health. Clin Pract Epidemiol Ment Health. 2012; 8: 110–119. Music credits: Sad Marimba Planet by Lee Rosevere Pookatori and Friends by Kevin MacLeod

A darkened laboratory with an eerie green glow; a photograph of the bones of a woman’s hand published on the front pages of newspapers throughout the globe; mysterious rays that promise to change medicine forever but also cause horrific disease in their champions and pioneers. In this episode, called Bone Portraits, I tell the story of two men -- Wilhelm Roentgen, the discoverer of x-rays who would later win a Nobel Prize, and Clarence Dally, the first victim of x-ray radiation. Listen to the thrilling conclusion of our to part series on the dawn of diagnostic imaging! We’ve got all this, plus a double-header #AdamAnswers, in Episode 23 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine. Sources: Mahroo, et al. 'Dilatation' and 'dilation': trends in use on both sides of the Atlantic. Br J Ophthalmol. 2014 Jun;98(6):845-6. doi: 10.1136/bjophthalmol-2014-304986. Epub 2014 Feb 25. King, Gilbert. “Clarence Dally — The Man Who Gave Thomas Edison X-Ray Vision.” Smithsonian.com, March 14, 2012. Goodman, et al. Medical Writing: A Prescription for Clarity. P37. Gagliardi, Raymond A. “Clarence Dally: An American Pioneer,”  American Journal of Roentgenology, November, 1991, vol. 157, no. 5, p. 922 Dunlop, Orrin. Deleterious effects of X-rays on the human body. Electrical Review 1896;29:95 Cheng, Tsung. Dilation vs. Dilatation. American Journal of Cardiology. February 15, 1994. Volume 73, Issue 5, Page 421 Brown, Percy. American martyrs to radiology. Clarence Madison Dally (1865-1904). 1936. Obrien, Frederick. In Memoriam: Percy Brown, MD. Radiology. December 1950Volume 55, Issue 6 Sansare K, et al. Early victims of X-rays: a tribute and current perception. Dentomaxillofac Radiol. 2011 Feb;40(2):123-5.

A mortally wounded American president and the quest to find his assassin’s bullet unexpectedly opened up a potentially new era of medical diagnostics in the late nineteenth century. In this episode, learn about the assassination of James Garfield and how the controversy surrounding his medical care led Alexander Graham Bell to develop an “induction balance” that could locate a piece of metal inside a human body. This is the first part of a two part series called “Sound and Light.” Also included -- a new #AdamAnswers about … hiccups! All this and more in Episode 22 of Bedside Rounds! Sources: Bell AG. Upon the electrical experiments to determine the location of the bullet in the body of the late President Garfield; and upon a successful form of induction balance for the painless detection of metallic masses in the human body, Retrieved from: https://archive.org/details/uponelectricalex00bell Paulson G. Death of a president and his assassin--errors in their diagnosis and autopsies. J Hist Neurosci. 2006 Jun;15(2):77-91. Trunkey D, et al. Medical and surgical care of our four assassinated presidents. J Am Coll Surg. 2005 Dec;201(6):976-89. Epub 2005 Jun 16. Reyburn R. Clinical history of the case of James Abram Garfield. JAMA. 1894;XXII(13):460-464. Steger M et al. Systemic review: the pathogenesis and pharmacological treatment of hiccups. Aliment Pharmacol Ther. 2015 Nov;42(9):1037-50

Does medicine have a place for renegades who play by their own rules? Producer Cam Steele brings us a story about medical mavericks drinking toxic cocktails of their own creation, threading rubber tubes through their veins, and trying to disrupt entire industries, all in the attempt to change the world. Learn about all this and more, plus a new #AdamAnswers, in Episode 21 of Bedside Rounds!

The nineteenth century was struck by a collective panic about being buried alive, leading to a bevy of new laws, regulations, and inventions like the safety coffin.  In this episode, we explore how medical science created and fueled this fear by blurring the line between life and death with the invention of new tests for death, developing life-saving technologies like rescue breathing, and even re-animating corpses. And just in case you thought the fear of premature interment was something of the past, we explore how issues raised in this panic still inform medicine today. Learn about all this, a brand new #AdamAnswers, and more in Episode 20 of Bedside Rounds, Buried Alive!

Can the moon make you crazy? The superstition is rampant in medicine, but the idea that a full moon awakens psychiatric pathologies traces back thousands of years. In Episode 19 of Bedside Rounds, producer Cam Steele looks at evidence behind the belief and traces the origins of this cultural fossil that has managed to last until the 21st century. Learn about all this and more in Of Madness and Moons!

By the time that David Livingstone died on the banks of Lake Bangweulu, his name was already legend -- first, as a great explorer, becoming the first European to lay eyes on Victoria Falls and Lake Malawi, and second as a fierce advocate against the slave trade. But we often forget that he was a medical doctor, and made significant contributions to the nascent field of tropical medicine. In Episode 18 of Bedside Rounds, I recount his innovations in fighting malaria and discuss all the fun (by which I mean quite gross, and very deadly) tropical diseases that he described in his journals. Even though the phrase was almost certainly made up, you should still listen to "Dr. Livingstone, I presume?" 

In 1991, two hikers near the Austrian-Italian border discovered the 5,000 year-old mummified body of Otzi the Iceman buried in a glacier. What have we learned about medicine from the Iceman? From a fungus-based first aid kit, ancient acupuncture , analysis of paleofeces, hints about his violent demise -- and of course the good old fashioned physical exam -- the answer is more surprising than you might think. Learn more with Episode 17 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine!

Everyone knows the story of Phineas Gage, the young man who had a tamping iron shot through his brain in a freak accident and miraculously survived, only to have extreme personality changes. But the true story is far more complex -- and more interesting. In Episode 16 of Bedside Rounds, I revisit the primary sources on Gage's injury, delve into modern research into what actually happened, and take a field trip to visit the man himself.

Understanding statistics has never been more important for the practice of medicine. Unfortunately, innumeracy plagues the medical field. Listen to Episode 15 of Bedside Rounds to learn more, and maybe find a way out of this statistical morass with this one weird trick...

The Randomized Controlled Trial (RCT) is the gold standard for how we know something works in the world of medicine. But how did we get to this point? The answer involves vegetarians and orange juice, spans two thousand years, and stretches from ancient Babylon to the high seas of the British Empire and back to America. Find all these answers (and more!) in Episode 14 of Bedside Rounds -- the First Trial!

Doctors recite an oath, often the Hippocratic Oath, when they graduate medical school, swearing to serve their patients and to do no harm. The common perception is that physicians have sworn an oath for thousands of years, leading back to Hippocrates. But the origins are far more modern and buried in the greatest atrocity of the twentieth century. Learn more in Episode 13 of Bedside Rounds!

Pimping ain't easy, especially when it happens on rounds. Where did the peculiar medical tradition of "pimping" come from? How did it get its name? Is it even effective? And does it still have a place in modern medical education? Find out in Episode 12!

Celebrate ten episodes of Bedside Rounds with a rerecording (with new material) of the first episode, Frank's Sign! The most powerful man in the world, the Roman Emperor Hadrian, dies of a mysterious illness. Learn how the case was (sort of) cracked 2000 years later using the physical exam and just a little bit of math. If that can't get you to listen to this podcast, I don't know what will ...

On episode 10, I discuss one of the best public radio shows of all time, Car Talk, and how it's an awesome example of clinical reasoning. I also talk a little bit about how doctors learn to think like doctors. Dedicated to Tom Magliozzi, who recently died.

In the beginning of a string of podcasts about sound in medicine, Bedside Rounds goes back to the beginning, with the invention of the stethoscope by Rene Laennec. How was the stethoscope invented? What are doctors listening for when they listen to their lungs? Who was Rene Laennec? Well, learn all the answers to these questions in Episode 9 of Bedside Rounds, Laennec's Cylinder!

In Episode 8 of Bedside Rounds, we explore the mysterious world of the nocebo effect, where words can literally hurt -- or kill. It's all in the mind, right?

In Episode 7, we take you to a galaxy far, far away to explore the medicine of the best Star Wars film, the Empire Strikes Back. How close are we to replicating their medical interventions? And what can Star Wars tell us about medicine back here on Earth? This is the first in (hopefully) a series of "Medicine in Science Fiction" podcasts.

In this episode of Bedside Rounds, we discuss how risks and benefits are communicated by scientists and physicians, and why those numbers you see in advertisements and newspapers might not be the clearest way to express risk.

In Episode 5, I present Beachside Rounds, a fun activity for the whole family this summer, and a brief introduction into interesting physical exam findings.

In Episode 4, I wish a hearty 202nd birthday to the New England Journal of Medicine, and look at how much things have changed over the centuries by looking at the 1912 and 1812 editions. #spoileralert: the answer is a LOT

In episode 3 of Bedside Rounds, I talk about the human triumph of small pox vaccination, and discuss the government exercise called Dark Winter which simulated a bioterrorism attack on the United States.

In episode 2 of Bedside Rounds (though still technically untitled), I talk some about the myths and realities of cardiopulmonary resuscitation (CPR) in the hospital, and how the media influences how doctors and patients approach these important conversations.

A re-recording of the very first episode of Bedside Rounds! Learn how we can use the physical exam to help solve the mysterious, 2000 year-old death of the Roman Emperor Hadrian! Learn about how biostatistics are used in every day clinical medicine! Start at the very beginning -- with Frank's Sign!