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.”

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.”

73 - Seadragon

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.

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.

72 - Problems

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.

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.

71 - A Doctor's Work, part 2

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.

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.

70 - A Doctor's Work

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.

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.

69 - The Database

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 

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: <a href="https://cmecatalog.hms.harvard.edu/digital-education" rel="nofollow" target="_blank">https://cmecatalog.hms.harvard.edu/digital-education</a> Sources: <ul> <li>Fitzgerald F, Curiosity. <a href="https://www.acpjournals.org/doi/full/10.7326/0003-4819-130-1-199901050-00015" rel="nofollow" target="_blank"> https://www.acpjournals.org/doi/full/10.7326/0003-4819-130-1-199901050-00015</a></li> <li>Montgomery K, How Doctors Thinks (amazon link: <a href="https://www.amazon.com/How-Doctors-Think-Clinical-Judgment/dp/0195187121" rel="nofollow" target="_blank"> https://www.amazon.com/How-Doctors-Think-Clinical-Judgment/dp/0195187121</a>)</li> <li>Da Costa J, Medical Diagnosis, 1864. <a href="https://openlibrary.org/books/OL23402241M/Medical_diagnosis" rel="nofollow" target="_blank">https://openlibrary.org/books/OL23402241M/Medical_diagnosis</a></li> </ul>

68 - The History

Lindsey Fitzharris

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. 

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.

The Facemaker with Dr. Lindsey Fitzharris (#histmedconsultservice)

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, &amp; 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. 

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: <a href="https://www.teepublic.com/stores/bedsiderounds" rel="nofollow" target="_blank">https://www.teepublic.com/stores/bedsiderounds</a> Sources: <ul> <li>DOYLE JT. Milk sickness. N C Med J. 1947 Jul;8(7):404-10. PMID: 20250350.</li> <li>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.</li> <li>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.</li> <li>Niederhofer RE. The milk sickness. Drake on medical interpretation. JAMA. 1985 Oct 18;254(15):2123-5. PMID: 3900448.</li> <li>Pickard ME and Buley RC, The Midwest Pioneer; His Ills, Cures, &amp; Doctors. 1945.</li> <li>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.</li> <li>Stenn F. Pioneer History of Milk Sickness. Ann Med Hist. 1937 Jan;9(1):23-29. PMID: 33943945; PMCID: PMC7942921.</li> <li>Townsend RB. Milk sickness- a plague on the new west. Scalpel Tongs. 1999 Jan-Feb;43(1):13-5. PMID: 11623628.</li> <li>Walker JW. Milk-sickness. Science. 1886 Dec 10;8(201):540. doi: 10.1126/science.ns-8.201.540. PMID: 17741312.</li> </ul>

67 - Fever on the Frontier

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/ 

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: <ul> <li><a href="https://www.nejm.org/doi/pdf/10.1056/NEJMp2112095" rel="nofollow" target="_blank">https://www.nejm.org/doi/pdf/10.1056/NEJMp2112095</a></li> <li><a href="https://www.washingtonpost.com/outlook/2021/04/29/covid-19-only-exacerbated-longer-pattern-healthcare-worker-stress/" rel="nofollow" target="_blank"> https://www.washingtonpost.com/outlook/2021/04/29/covid-19-only-exacerbated-longer-pattern-healthcare-worker-stress/</a></li> </ul>

66 - Burnout

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 

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: <ul> <li>Rodman A, Breu A. The last breath: historical controversies surrounding determination of cardiopulmonary death. Chest. 2021; [online ahead of print August 13, 2021]. <a href="https://doi.org/10.1016/j.chest.2021.08.006" rel="nofollow" target="_blank">https://doi.org/10.1016/j.chest.2021.08.006</a></li> </ul>

65 - The Last Breath

Bedside Rounds is a storytelling podcast about medical history and medicine’s intersections with society and culture.  Host Adam Rodman seeks to tell a few of these weird, wonderful, and intensely human stories that have made modern medicine.

Dr. Rodman tells fascinating stories about the history and origins of medical practice in a way that is compelling, enjoyable, and easily palatable. Probably one of my favorite medical podcasts. 10 out of 10, would recommend!

Love this podcast

Fascinating to learn various aspects of the history of medicine.

Fascinating!

Bedside Rounds

Hannah Abrams

Gaby Mayer

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.

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.

54 - 1918 (guest episode with Hannah Abrams and Gaby Mayer)

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. 

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: <ul> <li>Bohannon J. Slaying monsters for science. Science  20 Jun 2008.</li> <li>Messner S. How Blizzard coped with World of Warcraft's blood plague and other early disasters. PC Gamer.</li> <li>Henderson M. Analysis: Absence of risk limits parallels with real life. Times Online. October 28, 2008</li> <li>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.</li> <li>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.</li> </ul>

Summer Shorts #2 - Corrupted Blood

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!

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!

Winter Shorts #4 - The Backlog

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. &amp; 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. &amp; 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. &amp; r, W. Rapid Treatment of Early Syphilis with Multiple Injections of Mapharsen. J Nerv Ment Dis 99, 88 (1944).     WIEDER, L., FOERSTER, O. &amp; 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. &amp; 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. &amp; 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 &amp; 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. 

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): <ol> <li>Swain, K. ‘Extraordinarily arduous and fraught with danger’: syphilis, Salvarsan, and general paresis of the insane. Lancet Psychiatry 5, (2018).</li> </ol> <ol> <li>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).</li> </ol> <ol> <li>Forrai, J. Syphilis - Recognition, Description and Diagnosis. (2011). doi:10.5772/24205</li> </ol> <ol> <li>Parascandola, J. From mercury to miracle drugs: syphilis therapy over the centuries. Pharm Hist 51, 14–23 (2009).</li> </ol> <ol> <li>Eisler, C. Who Is Dürer’s ‘Syphilitic Man’? Perspect Biol Med 52, 48–60 (2009).</li> </ol> <ol> <li>Rothschild, B. M. History of Syphilis. Clin Infect Dis 40, 1454–1463 (2005).</li> </ol> <ol> <li>Schwartz, R. S. Paul Ehrlich’s Magic Bullets. New Engl J Medicine 350, 1079–1080 (2004).</li> </ol> <ol> <li>Fee, E. The wages of sin. Lancet 354, SIV61 (1999).</li> </ol> <ol> <li>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).</li> </ol> <ol> <li>Mahoney, J., Arnold, R., Sterner, B. L., Harris, A. &amp; Zwally, M. Penicillin Treatment of Early Syphilis: II. Jama 251, 2005–2010 (1984).</li> </ol> <ol> <li>Waugh, M. Role played by Italy in the history of syphilis. Sex Transm Infect 58, 92–95 (1982).</li> </ol> <ol> <li>Thorburn, A. Fritz Richard Schaudinn, 1871-1906: protozoologist of syphilis. Sex Transm Infect 47, 459–461 (1971).</li> </ol> <ol> <li>CROSBY, A. W. The Early History of Syphilis: A Reappraisal. Am Anthropol 71, 218–227 (1969).</li> </ol> <ol> <li>Clark, E. G. &amp; 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).</li> </ol> <ol> <li>MUNGER, R. S. Guaiacum, the Holy Wood from the New World. J Hist Med All Sci IV, 196–229 (1949).</li> </ol> <ol> <li>Thomas, E. &amp; r, W. Rapid Treatment of Early Syphilis with Multiple Injections of Mapharsen. J Nerv Ment Dis 99, 88 (1944).</li> </ol> <ol> <li>WIEDER, L., FOERSTER, O. &amp; FOERSTER, H. MAPHARSEN IN THE TREATMENT OF SYPHILIS: FURTHER EXPERIENCES. Arch Dermatol Syph 35, 402–413 (1937).</li> </ol> <ol> <li>THON, L. SHOULD THE INTERNIST KNOW SYPHILIS? J Amer Med Assoc 97, 994–996 (1931).</li> </ol> <ol> <li>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).</li> </ol> <ol> <li>COLE, H., GERICKE, A. &amp; SOLLMANN, T. THE TREATMENT OF SYPHILIS BY MERCURY INHALATIONS: HISTORY, METHOD AND RESULTS. Arch Dermatol Syph 5, 18–33 (1922).</li> </ol> <ol> <li>Mason, U. Observation: Use and Abuse of Salvarsan. J Natl Med Assoc 3, 340–3 (1911).</li> </ol> <ol> <li>Fleming, A. &amp; Colebrook, L. ON THE USE OF SALVARSAN IN THE TREATMENT OF SYPHILIS. Lancet 177, 1631–1634 (1911).</li> </ol> <ol> <li>Evans, A. The Treatment of Syphilis by Salvarsan (Dioxy-diamido-arseno-benzol). Brit Med J 1, 617 (1911).</li> </ol> <ol> <li>Boeck, W. History, Theory and Practice of Syphilisation. New Engl J Medicine 73, 20–25 (1865).</li> </ol> <ol> <li>Veale, H. Remarks on Syphilis and Its Treatment. Edinb Medical J 10, 10–26 (1864).</li> </ol> <ol> <li>LaFond RE and Lukehart SA, Biological Basis for Syphilis. Clinical Microbiology Reviews 2006.</li> </ol> <ol> <li>Secher L et al, Treponema pallidum in peripheral nerve tissue of syphilitic chancres. Acta dermato-venereologica 1982.</li> <li> Hollander DH, Turner TB, The role of temperature in experimental treponemal infection. American journal of syphilis, gonorrhea, and venereal diseases, 1954</li> </ol> <ol> <li>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.</li> </ol> <ol> <li>Kampmeier RH, Syphilis therapy: an historical perspective. Journal of the American Venereal Disease Association 1976.</li> </ol> <ol> <li>Pachner AR, Spirochetal Diseases of the CNS. Neurologic clinics, 1986.</li> </ol> <ol> <li>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.</li> </ol> <ol> <li>Taylor SH, Diuretics in cardiovascular therapy. Perusing the past, practising in the present, preparing for the future. Zeitschrift für Kardiologie, 1985.</li> </ol> <ol> <li>Ovchinnikov NM, [Treponema pallidum in peripheral nerves of rabbit syphiloma]. Vestnik dermatologii i venerologii, 1975.</li> </ol> <ol> <li>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</li> </ol> <ol> <li>Vogl A, The discovery of the organic mercurial diuretics, American Heart Journal, 1950</li> </ol> <ol> <li>Schwemlein GX et al, Penicillin and fever therapy in early syphilis, Journal of the American Medical Association, 1948.</li> </ol> <ol> <li>Stringham JS, On the Diuretic Effects of Mercury in a Case of Syphilis. The Medical and physical journal, 1807</li> </ol> <ol> <li>Evanson RL et al, Effect of mercurial diuretics on tubular sodium and potassium transport in the dog. The American journal of physiology, 1972</li> </ol> <ol> <li>Sell S and Salman J, Demonstration of Treponema pallidum in Axons of Cutaneous Nerves in Experimental Chancres of Rabbits, Sexually Transmitted Diseases, 1992</li> </ol> <ol> <li>Penn CW, Avoidance of Host Defences by Treponema pallidum in Situ and on Extraction from Infected Rabbit Testes, Microbiology 1981.</li> </ol> <ol> <li>Beutler B and Munford RS, Tumor Necrosis Factor and the Jarisch–Herxheimer Reaction, The New England Journal of Medicine 1996.</li> </ol> <ol> <li>Radolf JD et al, Treponema pallidum: doing a remarkable job with what it's got. Trends in Microbiology, 1999</li> </ol> <ol> <li>Tight RR, Perkins RL, Treponema pallidum infection in subcutaneous polyethylene chambers in rabbits. Infection and immunity, 1976</li> </ol> <ol> <li>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</li> </ol> <ol> <li>Azevedo BF et al, Toxic Effects of Mercury on the Cardiovascular and Central Nervous Systems. Journal of Biomedicine and Biotechnology 2012,</li> </ol> <ol> <li>Clarkson TW and Magos L, The Toxicology of Mercury and Its Chemical Compounds, Critical Reviews in Toxicology 2008.</li> </ol> <ol> <li>Fitzgerald TJ, The Th1/Th2-like switch in syphilitic infection: is it detrimental? Infection and immunity, 1992</li> </ol> <ol> <li>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</li> </ol> <ol> <li>Batterman RC, The status of mercurial diuretics for the treatment of congestive heart failure. American Heart Journal, 1951</li> </ol> <ol> <li>Bleich HL et al, The Role of Regional Body Temperature in the Pathogenesis of Disease, The New England Journal of Medicine, 1981</li> </ol> <ol> <li>Vander Veer JB et al, The Prolonged Use of an Oral Mercurial Diuretic in Ambulatory Patients with Congestive Heart Failure. Circulation 1950</li> </ol> <ol> <li>Cox DL et al, The outer membrane, not a coat of host proteins, limits antigenicity of virulent Treponema pallidum. Infection and immunity, 1992.</li> </ol> <ol> <li>Fildes P, The Mechanism of the Anti-bacterial Action of Mercury. Br J Exp Pathol, 1940</li> </ol> <ol> <li>Clarkson TW, THE MECHANISM OF ACTION OF MERCURIAL DIURETICS IN RATS; THE METABOLISM OF 203Hg‐LABELLED CHLORMERODRIN. British Journal of Pharmacology and Chemotherapy, 1965</li> </ol> <ol> <li>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</li> </ol> <ol> <li>Belum GR et al, The Jarisch–Herxheimer reaction: Revisited. Travel Medicine and Infectious Disease, 2013</li> </ol> <ol> <li>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.</li> </ol> <ol> <li>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</li> </ol> <ol> <li>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.</li> </ol> <ol> <li>Aronson IK and Soltani K, The enigma of the pathogenesis of the Jarisch-Herxheimer reaction. The British Journal of Venereal Diseases, 1976</li> </ol> <ol> <li>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</li> </ol> <ol> <li>Spiller HA, Rethinking mercury: the role of selenium in the pathophysiology of mercury toxicity. Clinical Toxicology 2017</li> </ol> <ol> <li>Sell S et al, Reinfection of chancre-immune rabbits with Treponema pallidum. I. Light and immunofluorescence studies. The American journal of pathology 1985.</li> </ol> <ol> <li> Grant SS and Hung DT, Persistent bacterial infections, antibiotic tolerance, and the oxidative stress response, Virulence 2013</li> </ol> <ol> <li>Lant AF, Modern diuretics and the kidney. Journal of Clinical Pathology, 1981</li> </ol> <ol> <li>Kamath SU et al, Mercury-based traditional herbo-metallic preparations: a toxicological perspective, Archives of Toxicology 2012.</li> </ol> <ol> <li>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</li> </ol> <ol> <li>Wöβmann W et al, Mercury intoxication presenting with hypertension and tachycardia. Archives of Disease in Childhood, 1999</li> </ol> <ol> <li>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.</li> </ol> <ol> <li>Edwards AM, From tooth to hoof: treponemes in tissue‐destructive diseases. Journal of Applied Microbiology, 2003</li> </ol> <ol> <li>Wolgemuth CW, Flagellar motility of the pathogenic spirochetes. Seminars in Cell &amp; Developmental Biology 2015.</li> </ol> <ol> <li>Solomon HC and Kopp I, Fever Therapy. The New England Journal of Medicine 1937.</li> </ol> <ol> <li>Rice KM et al, Environmental Mercury and Its Toxic Effects. Journal of Preventive Medicine and Public Health 2014.</li> </ol> <ol> <li>Drusin LM, Electron microscopy of Treponema pallidum occurring in a human primary lesion. Journal of bacteriology 1969.</li> </ol> <ol> <li>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.</li> </ol> <ol> <li>Borenstein LA et al, Contribution of rabbit leukocyte defensins to the host response in experimental syphilis. Infection and immunity 1991.</li> </ol> <ol> <li>Cabot RC et al, Case 51-1976 — Bicentennial CPC — Syphilis, Diarrhea and Death in the 1820's. The New England Journal of Medicine 1976.</li> </ol> <ol> <li>Hobman JL and Crossman LC, Bacterial antimicrobial metal ion resistance. Journal of Medical Microbiology 2015</li> </ol> <ol> <li>Gelpi A and Tucker JD, After Venus, mercury: syphilis treatment in the UK before Salvarsan. Sexually Transmitted Infections 2015.</li> </ol> <ol> <li>MacHaffie et al, A study of the effectiveness of mercurial diuretics in treatment of cardiac decompensation. The American Journal of Cardiology 1958</li> </ol> <ol> <li>Aberer W et al, Ammoniated mercury ointment: outdated but still in use. Contact Dermatitis 1990</li> </ol> <ol> <li>Farhi D, Dupin N, Origins of syphilis and management in the</li> </ol> immunocompetent patient: Facts and controversies. Clinics in Dermatology (2010) 28, 533–538 <ol> <li>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: <a href="http://jmvh.org/article/syphilis-its-early-history-and-treatment-until-penicillin-and-the-debate-on-its-origins/" rel="nofollow" target="_blank"> http://jmvh.org/article/syphilis-its-early-history-and-treatment-until-penicillin-and-the-debate-on-its-origins/</a></li> </ol> <ol> <li>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.</li> </ol> <ol> <li>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.</li> </ol> <ol> <li>Simpson WM, “Artificial fever therapy of syphilis,” JAMA. 1935;105(26):2132-2140.</li> </ol> <ol> <li>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</li> </ol> <ol> <li>Wagner-Jauregg J, “The history of malaria treatment of general paralysis.” Am J Psychiatry. 1946;02: 577-582</li> </ol> <ol> <li>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.</li> </ol> <ol> <li>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.</li> </ol> <ol> <li>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)</li> </ol> <ol> <li>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.</li> </ol>

45 - The French Disease at 500

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

5 - Beachside Rounds

Liam Conway-Pearson

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. 

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: <ul> <li>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.</li> <li>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.</li> <li>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. </li> <li>Jennifer Manley, “Measles and Ancient Plagues: A Note on New Scientific Evidence,” Classical World 107, no. 3 (Spring 2014): 393-397. </li> <li>J. F. Gilliam, “The Plague under Marcus Aurelius,” The American Journal of Philology 82, no. 3 (July 1961): 225-251.</li> <li>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).</li> <li>Joseph B. Fullerton and Mark E. Silverman, “Claudius Galen of Pergamum: Authority of Medieval Medicine,” Clinical Cardiology 32, no. 11 (January 2008): E82-E84.</li> <li>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.</li> <li>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.</li> <li>Kyle Harper, The Fate of Rome (Princeton NJ: Princeton University Press, 2017), 23-118.</li> <li>Mike Duncan, The History of Rome, Podcast Audio, 2007-2013. <a href="https://thehistoryofrome.typepad.com/the_history_of_rome/archives.html" rel="noopener nofollow" target="_blank"> https://thehistoryofrome.typepad.com/the_history_of_rome/archives.html</a></li> <li>R. J. Littman and M. L. Littman, “Galen and the Antonine Plague,” The American Journal of Philology 94, no. 3 (Autumn 1973): 243-255.</li> <li>R. P. Duncan-Jones, “The Impact of the Antonine Plague,” Journal of Roman Archaeology 9 (1996): 108-136.</li> <li>“Smallpox,” CDC, last modified June 7, 2016, <a href="https://www.cdc.gov/smallpox/transmission/index.html" rel="noopener nofollow" target="_blank"> https://www.cdc.gov/smallpox/transmission/index.html</a>.</li> <li>Vivian Nutton, “The Chronology of Galen’s Early Career,” The Classical Quarterly 23, no. 1 (May 1973): 158-171.</li> <li>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. </li> <li>Catherine Thėves, Eric Crubėzy, and Philippe Biagini, “History of Smallpox and Its Spread in Human Populations,” Microbiology Spectrum 4, no. 4 (April 2015): </li> <li>Walter Scheidel, “A Model of Demographic and Economic Change in Roman Egypt after the Antonine Plague,” Journal of Roman Archaeology 15 (2002): 97-114.</li> </ul>

53 - The Antonine Plague (guest episode with Liam Conway-Pearson)

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. 

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: <ul> <li>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</li> <li>Fagin CM, Collaboration between nurses and physicians: no longer a choice. Academic Medicine. 67(5):295–303, May 1992.</li> <li>Fee E and Garofalo ME, Florence Nightingale and the Crimean War, Am J Public Health. 2010 September; 100(9): 1591.</li> <li>Garofalo ME and Fee E, Florence Nightingale (1820–1910): Feminism and Hospital Reform. Am J Public Health. 2010 September; 100(9): 1588.</li> <li>Halliday Stephen, Death and miasma in Victorian London: an obstinate belief. BMJ. 2001 Dec 22; 323(7327): 1469–1471.</li> <li>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.</li> <li>Jahoda G, Quetelet and the emergence of the behavioral sciences. Springerplus. 2015; 4: 473.</li> <li>Keith JM, Florence Nightingale: statistician and consultant epidemiologist. Int Nurs Rev. 1988 Sep-Oct; 35(5):147-50.</li> <li>Kopf EW, Florence Nightingale as statistician.. Res Nurs Health. 1978 Oct; 1(3):93-102.</li> <li>Kramer M, Schmalenberg C. Securing “good” nurse–physician relationships. Nurs Manage 2003;34(7):34-8.</li> <li>McDonald L Florence Nightingale and the early origins of evidence-based nursing Evidence-Based Nursing 2001;4:68-69.</li> <li>McDonald L, Florence Nightingale, statistics and the Crimean War, J. R. Statist. Soc. A (2014)177, Part 3, pp. 569–586.</li> <li>McDonald L, Florence Nightingale at First Hand, London and New York: Continuum, 2010.</li> <li>Oyler L, “It’s Really Sickening How Much Florence Nightingale Hated Women,” Vice Broadly, retrieved online at <a href="https://broadly.vice.com/en_us/article/kb4jd3/its-really-sickening-how-much-florence-nightingale-hated-women" rel="nofollow" target="_blank"> https://broadly.vice.com/en_us/article/kb4jd3/its-really-sickening-how-much-florence-nightingale-hated-women</a></li> <li>“Rank for Nurses,” The American Journal of Nursing, Vol. 20, No. 3 (Dec., 1919), pp. 241-24.</li> <li>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.</li> <li>Soine AH, From Nursing Sisters to a Sisterhood of Nurses: German Nurses and Transnational Professionalization, 1836-1918, Published Dissertation, August 2009.</li> <li>Stein LI. The doctor–nurse game. Arch Gen Psychiatry 1967;16(6):699-703.</li> <li>Stein LI, et al. The doctor–nurse game revisited. N Engl J Med 1990;322(8):546-9.</li> <li>Young D A B. Florence Nightingale's fever BMJ 1995; 311 :1697.</li> </ul>

42 - The Lady with the Lamp

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! 

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!

48 - Micrographia (FIXED AUDIO)

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. &amp; Hill, B. A. Lung Cancer and Other Causes of Death in Relation to Smoking. Brit Med J 2, 1071 (1956). Doll, R. &amp; 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. &amp; 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. &amp; 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). 

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: <ul> <li>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.</li> <li>Daniels M and Bradford Hill A, Chemotherapy of Pulmonary Tuberculosis in Young Adults, Br Med J. 1952 May 31; 1(4769): 1162–1168.</li> <li>Dangers of Cigarette-smoking. Brit Med J 1, 1518 (1957).</li> <li>Doll, R. &amp; Hill, B. A. Lung Cancer and Other Causes of Death in Relation to Smoking. Brit Med J 2, 1071 (1956).</li> <li>Doll, R. &amp; Hill, B. A. Smoking and Carcinoma of the Lung. Brit Med J 2, 739 (1950).</li> <li>Hill, A. The Environment and Disease: Association or Causation? J Roy Soc Med 58, 295–300 (1965).</li> <li>HOFFMAN, F. L. CANCER AND SMOKING HABITS. Ann Surg 93, 50–67 (1931).</li> <li>Keating C, Smoking Kills: The Revolutionary Life of Richard Doll. 2009.</li> <li>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).</li> <li>Ochsner, A. &amp; 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).</li> <li>Ochsner, A. My first recognition of the relationship of smoking and lung cancer. Prev Med 2, 611–614 (1973).</li> <li>Parascandola, M. Two approaches to etiology: the debate over smoking and lung cancer in the 1950s. Endeavour 28, 81–86 (2004).</li> <li>Phillips, C. V. &amp; Goodman, K. J. The missed lessons of Sir Austin Bradford Hill. Epidemiologic Perspectives Innovations 1, 1–5 (2004).</li> <li>Proctor, R. Angel H Roffo: the forgotten father of experimental tobacco carcinogenesis. B World Health Organ 84, 494–495 (2006).</li> <li>Wynder, E. RE: “WHEN GENIUS ERRS: R. A. FISHER AND THE LUNG CANCER CONTROVERSY”. Am J Epidemiol 134, 1467–9 (1991).</li> </ul>

47 - The Criteria

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 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.

6 - The Number Needed to Treat

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 

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: <ul> <li>Antic T, DeMay RM. “The fascinating history of urine examination,” Journal of the American Society of Cytopathology (2014) 3, 103e107</li> <li>Ghasemzadeh N and Zafari AM, “A Journey into the History of the Arterial Pulse,” Cardiology Research and Practice Volume 2011 (2011).</li> <li>McGee S, Evidence Based Physical Diagnosis 4th edition. Amazon link: <a href="https://www.amazon.com/Evidence-Based-Physical-Diagnosis-Steven-McGee/dp/0323392768" rel="nofollow" target="_blank"> https://www.amazon.com/Evidence-Based-Physical-Diagnosis-Steven-McGee/dp/0323392768</a></li> <li>Nicolson M, Commentary: Nicholas Jewson and the disappearance of the sick man from medical cosmology, 1770–1870. Int J Epidemiol 2009;38:622–33)</li> <li>Jewson ND. The disappearance of the sick-man from medical cosmology, 1770–1870, Sociology , 1976, vol. 10 (pg. 225-44)</li> <li>Robertson WE. Physical diagnosis from the time of Rontgen. Ann Med Hist. 1934;6:255–63</li> <li>Rodgers MM, “Piorry on Pleximetry and Auscultation,” Boston Med Surg J 1852; 46:151-152</li> <li>Tan SY and Hu M, “Josef Leopold Auenbrugger (1722 - 1809): father of percussion. Singapore Med J 2004 Vol 45(3):103</li> <li>Walker HK, “The Origins of the History and Physical Examination,” Clinical Methods: The History, Physical, and Laboratory Examinations.Boston: Butterworths; 1990.</li> <li>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.</li> <li>Wilcox RA et al, “The Symbol of Modern Medicine: Why One Snake Is More Than Two,” Ann Intern Med. 2003;138:673-677.</li> <li>Verghese et al, A History of Physical Examination Texts and the Conception of Bedside Diagnosis.</li> <li>Voswinkel P, From uroscopy to urinalysis. Clinica Chimica Acta 297 (2000) 5–16</li> </ul>

34 - The Physical

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. 

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! <ul> <li>Bean WB,  “Origin of the Term Internal Medicine,” N Engl J Med 1982; 306:182-183</li> <li>Blevins SM and Bronze MS, Robert Koch and the ‘golden age’ of bacteriology, Int J of Inf Dis, Vol 14, #9, Sep 2010.</li> <li>Bloomfield AL, “The origin of the term ‘internal medicine,” JAMA, April 4, 1959.</li> <li>Bressani R et al, Corn Nutrient Losses, Chemical Changes in Corn during Preparation of Tortillas, J Agr and Food Chem, 6, 10, 770-774.</li> <li>Brim CJ. Job's Illness: Pellagra. Archives of Dermatology and Syphilology. 1942;45:371-6.</li> <li>Carpenter KJ, The relationship of pellagra to corn and the low availability of niacin in cereals, Experientia Suppl. 1983;44:197-222.</li> <li>Clay K et al, Rise and Fall of Pellagra in the American South.</li> <li>Elmore JG and Feinstein AR, Joseph Goldberger: An Unsung Hero of American Clinical Epidemiology, Ann Intern Med. 1994;121:372-375.</li> <li>Goldberger J. The transmissibility of pellagra: Experimental attempts at transmission to human subjects. Public Health Rep. 1916;31:3159–73</li> <li>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.</li> <li>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.</li> <li>Goldberger J, Waring CH, Willets DG, et al. The Treatment and Prevention of Pellagra. Washington, DC: Government Printing Office; 1914.</li> <li>Goldberger J, Wheeler GA. Experimental pellagra in the human subject brought about by a restricted diet. Public Health Rep. 1915;30(46):3336–3339.</li> <li>Harris HF: Ankylostomiasis in an individual presenting all of the typical symptoms of pellagra. Am Med 1902; 4:99-100, retrieved from:</li> <li><a href="https://babel.hathitrust.org/cgi/pt?id=uc1.c3312358;view=1up;seq=107;size=125" rel="nofollow" target="_blank">https://babel.hathitrust.org/cgi/pt?id=uc1.c3312358;view=1up;seq=107;size=125</a></li> <li>Lavinder CH, Pellagra, The American Journal of Nursing, Vol. 13, No. 10 (Jul., 1913), pp. 746-754.</li> <li>MacNeal WJ, The Alleged Production of Pellagra by an Unbalanced Diet, JAMA. 1916;LXVI(13):975-977.</li> <li>Middleton J, Pellagra and the blues song ‘Cornbread, meat and black molasses’. J R Soc Med. 2008 Nov 1; 101(11): 569–570.</li> <li>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.</li> <li>Morabia A (2006). Joseph Goldberger’s research on the prevention of pellagra. JLL Bulletin: Commentaries on the history of treatment evaluation.</li> <li>Niles GM. Pellagraphobia: A word of caution. JAMA. 1912;58:1341.</li> <li>Roberts CS, Goldberger and the Mal de la Rosa, Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition.</li> <li>Roberts SR, SAMBON'S NEW THEORY OF PELLAGRA AND ITS APPLICATION TO CONDITIONS IN GEORGIA, JAMA. 1911;LVI(23):1713-1715.</li> <li>Searcy GH: An epidemic of acute pellagra. Transactions of the Medical Association of Alabama, 1907, pp 387-393</li> <li>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.</li> </ul>

36 - Filth Parties

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 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.

7 - The Medicine of the Empire Strikes Back

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 &amp; 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. 

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 <a href="http://www.acponline.org/BedsideRounds" rel="nofollow" target="_blank">www.acponline.org/BedsideRounds</a>. Sources: <ul> <li>Adams, J. F. Alleyne. "The Segregation of Consumptives." The Boston Medical and Surgical Journal 157, no. 2 (1907): 35-40.</li> <li>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.</li> <li>Bertolaccini et al, Surgical treatment of pulmonary tuberculosis: the phoenix of thoracic surgery? J Thorac Dis. 2013 Apr; 5(2): 198–199.</li> <li>CDC: World TB Day 2018, retrieved from: <a href="https://www.cdc.gov/tb/worldtbday/history.htm" rel="nofollow" target="_blank">https://www.cdc.gov/tb/worldtbday/history.htm</a></li> <li>Cox GL. Sanatorium treatment contrasted with home treatment. After-histories of 4,067 cases. Br J Tuberc 1923; 17:27–30.</li> <li>Coyle CW et al, Placentophagy: Therapeutic Miracle or Myth? Arch Womens Ment Health. 2015 Oct; 18(5): 673–680.</li> <li>Daniel TM, Hermann Brehmer and the origins of tuberculosis sanatoria, Int J Tuberc Lung Dis. 2011 Feb; 15(2):161-2.</li> <li>Daniel TM, Jean-Antoine Villemin and the infectious nature of tuberculosis, Int J Tuberc Lung Dis 19(3):267–268</li> <li>Daniel TM, “The history of tuberculosis,” Respiratory Medicine (2006) 100, 1862–1870.</li> <li>Daniel VS and Daniel TM,, Old Testament Biblical References to Tuberculosis, linical Infectious Diseases, Volume 29, Issue 6, 1 December 1999, Pages 1557–1558.</li> <li>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.</li> <li>Dormandy T, The White: A History of Tuberculosis, 1999.</li> <li>Farr et al, “Human Placentophagy: A review,” AJOG, April 2018.</li> <li>Frith J, History of Tuberculosis. Part 1 – Phthisis, consumption and the White Plague. J Mil Vet Health, 22,2.</li> <li>Gaensler EA. The surgery for pulmonary tuberculosis. Am Rev Respir Dis 1982;125:73–84.</li> <li>Grigg RN. (1958), The arcana of tuberculosis. Am Rev Tuberc Resp Dis; 78:151-172.</li> <li>Hayman J, “Mycobacterium Ulcerans: An infection from Jurassic Time?” The Lancet, Nov 3, 1984.</li> <li>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.</li> <li>Jacobaeus HC. The Cauterization of Adhesions in Artificial Pneumothorax Treatment of Pulmonary Tuberculosis under Thoracoscopic Control. Proc R Soc Med 1923;16:45-62</li> <li>Morse D, Brothwell DR, Ucko PJ. Tuberculosis in ancient Egypt. Am Rev Respir Dis. 1964;90:524–541.</li> <li>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.</li> <li>Murray JF. Mycobacterium tuberculosis and the cause of consumption: from discovery to fact. Am J Respir Crit Care Med 2004;169: 1086–1088.</li> <li>Murray JF, Sanatoriums and climate, The Lancet Infectious Disease, Vol 16, Issue 7, P786, July 01, 2016.</li> <li>Murray JF. The white plague: down and out, or up and coming? J. Burns Amberson Lecture. Am Rev Respir Dis 1989;140:1788–1795.</li> <li>Murray JF et al, “Treatment of Tuberculosis. A Historical Perspective,” Annals of the American Thoracic Society. Vol. 12, No. 12 , Dec 01, 2015.</li> <li>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 &amp; Wilkins: Philadelphia, PA; 2005:1251-61.</li> <li>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.</li> <li>Warren P, The evolution of the sanatorium: the first half-century, 1854-1904, Can Bull Med Hist. 2006;23(2):457-76.</li> </ul>

39 - The White Plague

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. 

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.

Summer Shorts #3 - Insulin Drama

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!

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!

12 - P.I.M.P.

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. 

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: <ul> <li>Courtwright DT. Dark Paradise: A History of Opiate Addiction in America. Harvard University Press, 2001.</li> <li>Meldrum ML, “The ongoing opiod prescription epidemic: historical context,” Am J Public Health. 2016 August; 106(8): 1365–1366.</li> <li>Courtwright DT, “Preventing and treating narcotic addiction -- a century of federal drug control,” N Engl J Med 2015; 373:2095-2097.</li> <li>Adams JFA, “Substitutes for opium in chronic diseases,” Boston Med Surg J 1889; 121:351-356.</li> <li>Macht DI, “The history of opium and some of its preparations and alkaloids,” JAMA. 1915;LXIV(6):477-481.</li> <li>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.</li> <li>Weiner JP, “A shortage of physicians or a surplus of assumptions?” Health Aff January 2002 vol. 21 no. 1 160-162.</li> <li>Gudbranson BA et al, Reassessing the Data on Whether a Physician Shortage Exists. JAMA. 2017;317(19):1945-1946.</li> <li>Kirch DG and Petelle K, Addressing the Physician Shortage: The Peril of Ignoring Demography. JAMA. 2017;317(19):1947-1948.</li> </ul>

27 - The First Opiate Epidemic

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 &amp; 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. 

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: <ul> <li>Abedon ST, Bacteriophage prehistory: Is or is not Hankin, 1896, a phage reference? Bacteriophage. 2011 May-Jun; 1(3): 174–178.</li> <li>Blair JE and Williams REO, “Phage Typing of Staphylococci,” Bull Org mond. Ste, 1961, 24, 771-784.</li> <li>Davis BM and Waldor MK, Filamentous phages linked to virulence of Vibrio cholera, Current Opinion in Microbiology 2003, 6:35-42.</li> <li>d’Herelle F, “Bacteriophage as a treatment in acute medical and surgical infections,” Bull N Y Acad Med. 1931 May; 7(5): 329–348.</li> <li>d'Herelle F.  Sur un microbe invisible antagoniste des baccilles dysenteriques.  CR Acad Sci Paris 1917,163,173-5.</li> <li>Eaton MD, Bayne-Jones S. Bacteriophage Therapy. JAMA 1934; 103:1769-76; 1847-53; 1934-9.</li> <li>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</li> <li>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.</li> <li>Himmelweit F. Combined action of penicillin and bacteriophage on Staphylococci. Lancet. 1945;ii:104.</li> <li>Hicks DJ et al, “Developments in rabies vaccines,” Clin Exp Immunol. 2012 Sep; 169(3): 199–204.</li> <li>Kingwell K, Bacteriophage therapies re-enter clinical trials, Nature, Vol 14, Aug 2015, 515.</li> <li>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.</li> <li>Hargreaves KR and Clokie MRJ, Clostridium difficile phages: still difficult? Front Microbiol. 2014 Apr 28;5:184.</li> <li>La Fee S and Buschman H, Novel Phage Therapy Saves Patient with Multidrug-Resistant Bacterial Infection. Retrieved from: <a href="https://health.ucsd.edu/news/releases/Pages/2017-04-25-novel-phage-therapy-saves-patient-with-multidrug-resistant-bacterial-infection.aspx" rel="nofollow" target="_blank">https://health.ucsd.edu/news/releases/Pages/2017-04-25-novel-phage-therapy-saves-patient-with-multidrug-resistant-bacterial-infection.aspx</a></li> <li>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.</li> <li>Pearce J, Louis Pasteur and Rabies: a brief note, Journal of Neurology, Neurosurgery &amp; Psychiatry 2002;73:82.</li> <li>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.</li> <li>Strathdee S, How Sewage Saved My Husband's Life from a Superbug, TEDxNashville, retrieved from: <a href="https://www.youtube.com/watch?v=AbAZU8FqzX4" rel="nofollow" target="_blank">https://www.youtube.com/watch?v=AbAZU8FqzX4</a>.</li> <li>Summers WC, Bacteriophage Therapy, Annual Review of Microbiology, Vol. 55:437-451 (Volume publication date October 2001)</li> <li>Summers WC, The strange history of phage therapy. Bacteriophage. 2012 Apr 1; 2(2): 130–133.</li> <li>Taylor M.W. (2014) Introduction: A Short History of Virology. In: Viruses and Man: A History of Interactions. Springer, Cham</li> <li>Thiel, K. (2004). Old dogma, new tricks—21st Century phage therapy. Nature Biotechnology, 22(1), 31–36.</li> <li>Twort FW, An investigation on the nature of Ultra-Microscopic Viruses, The Lancet, Jan 10th, 1914. 101.</li> <li>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.</li> <li>Ujmajuridze et al, Adapted Bacteriophages for Treating Urinary Tract Infections. Front Microbiol. 2018; 9: 1832.</li> <li>Ventola CL, “The Antibiotic Resistance Crisis: Part 1: Causes and Threats,” P T. 2015 Apr; 40(4): 277–283.</li> </ul>

40 - Phage

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 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!

9 - Laennec's Cylinder

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&amp;ref=pwh287&amp;theme=3&amp;view=text&amp;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 

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: <ul> <li>Foex B. How the cholera epidemic of 1831 resulted in a newtechnique for fluid resuscitation. Emerg Med J 2003;20:316–318.</li> <li>Gill G. William O’Shaughnessy and the forgotten cure for cholerain the 1832 British epidemic.</li> <li>Letter from Lord Cavendish: Online at: <a href="http://mssweb.nottingham.ac.uk/elearning/view-text.asp?resource=HealthHousing&amp;ref=pwh287&amp;theme=3&amp;view=text&amp;page=1" rel="nofollow" target="_blank"> http://mssweb.nottingham.ac.uk/elearning/view-text.asp?resource=HealthHousing&amp;ref=pwh287&amp;theme=3&amp;view=text&amp;page=1</a></li> <li>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.</li> <li>Chan C, et al. Historical Epidemiology of the Second Cholera Pandemic: Relevance to Present Day Disease Dynamics. PLOS One: <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0072498" rel="nofollow" target="_blank"> http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0072498</a></li> <li>BB4: Diary of an Epidemic. Online at: <a href="http://www.bbc.co.uk/radio4/history/longview/longview_20030415.shtml" rel="nofollow" target="_blank"> http://www.bbc.co.uk/radio4/history/longview/longview_20030415.shtml</a></li> <li>Kresta R. The Origin of IV Fluids. Discover Magazine. Online at: <a href="http://blogs.discovermagazine.com/bodyhorrors/2016/05/31/intravenous-fluids-cholera/#.WX9z4JdtmUl" rel="nofollow" target="_blank">http://blogs.discovermagazine.com/bodyhorrors/2016/05/31/intravenous-fluids-cholera/#.WX9z4JdtmUl</a></li> <li>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.</li> </ul> Further reading: <ul> <li>r/AskHistorians thread: <a href="https://www.reddit.com/r/AskHistorians/comments/6nzbfz/if_bloodletting_was_rubbish_why_was_it_considered/" rel="nofollow" target="_blank"> https://www.reddit.com/r/AskHistorians/comments/6nzbfz/if_bloodletting_was_rubbish_why_was_it_considered/</a></li> <li>Ending Medical Reversal by Cifu and Prasad. On Amazon at: <a href="https://www.amazon.com/Ending-Medical-Reversal-Improving-Outcomes/dp/1421417723" rel="nofollow" target="_blank">https://www.amazon.com/Ending-Medical-Reversal-Improving-Outcomes/dp/1421417723</a></li> </ul>

25 - Salt Water

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