Does smoking cause lung cancer? How could you ever know? The second in a three-part series on causality, I’m joined by Dr. Shoshana Herzig to discuss how Austin Bradford Hill and Richard Doll set out to try and answer this question -- and along the way revolutionized the way we think about what causes disease. In this episode, we’ll talk about the first double-blinded randomized controlled trial, the long shadow of tuberculosis, and why epidemiology is beautiful. Plus, a brand new #AdamAnswers about chest compressions!

Please support Bedside Rounds by filling out the listener demographic survey: https://survey.libsyn.com/bedsiderounds

Sources:

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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.

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41. Penn CW, Avoidance of Host Defences by Treponema pallidum in Situ and on Extraction from Infected Rabbit Testes, Microbiology 1981.

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45. 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

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51. Bleich HL et al, The Role of Regional Body Temperature in the Pathogenesis of Disease, The New England Journal of Medicine, 1981

52. Vander Veer JB et al, The Prolonged Use of an Oral Mercurial Diuretic in Ambulatory Patients with Congestive Heart Failure. Circulation 1950

53. Cox DL et al, The outer membrane, not a coat of host proteins, limits antigenicity of virulent Treponema pallidum. Infection and immunity, 1992.

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55. Clarkson TW, THE MECHANISM OF ACTION OF MERCURIAL DIURETICS IN RATS; THE METABOLISM OF 203Hg‐LABELLED CHLORMERODRIN. British Journal of Pharmacology and Chemotherapy, 1965

56. 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

57. Belum GR et al, The Jarisch–Herxheimer reaction: Revisited. Travel Medicine and Infectious Disease, 2013

58. 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.

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60. 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.

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62. 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

63. Spiller HA, Rethinking mercury: the role of selenium in the pathophysiology of mercury toxicity. Clinical Toxicology 2017

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66. Lant AF, Modern diuretics and the kidney. Journal of Clinical Pathology, 1981

67. Kamath SU et al, Mercury-based traditional herbo-metallic preparations: a toxicological perspective, Archives of Toxicology 2012.

68. 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

69. Wöβmann W et al, Mercury intoxication presenting with hypertension and tachycardia. Archives of Disease in Childhood, 1999

70. 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.

71. Edwards AM, From tooth to hoof: treponemes in tissue‐destructive diseases. Journal of Applied Microbiology, 2003

72. Wolgemuth CW, Flagellar motility of the pathogenic spirochetes. Seminars in Cell & Developmental Biology 2015.

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74. Rice KM et al, Environmental Mercury and Its Toxic Effects. Journal of Preventive Medicine and Public Health 2014.

75. Drusin LM, Electron microscopy of Treponema pallidum occurring in a human primary lesion. Journal of bacteriology 1969.

76. 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.

77. Borenstein LA et al, Contribution of rabbit leukocyte defensins to the host response in experimental syphilis. Infection and immunity 1991.

78. Cabot RC et al, Case 51-1976 — Bicentennial CPC — Syphilis, Diarrhea and Death in the 1820's. The New England Journal of Medicine 1976.

79. Hobman JL and Crossman LC, Bacterial antimicrobial metal ion resistance. Journal of Medical Microbiology 2015

80. Gelpi A and Tucker JD, After Venus, mercury: syphilis treatment in the UK before Salvarsan. Sexually Transmitted Infections 2015.

81. MacHaffie et al, A study of the effectiveness of mercurial diuretics in treatment of cardiac decompensation. The American Journal of Cardiology 1958

82. Aberer W et al, Ammoniated mercury ointment: outdated but still in use. Contact Dermatitis 1990

83. Farhi D, Dupin N, Origins of syphilis and management in the

immunocompetent patient: Facts and controversies. Clinics in Dermatology (2010) 28, 533–538

84. 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/

85. 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.

86. 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.

87. Simpson WM, “Artificial fever therapy of syphilis,” JAMA. 1935;105(26):2132-2140.

88. 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

89. Wagner-Jauregg J, “The history of malaria treatment of general paralysis.” Am J Psychiatry. 1946;02: 577-582

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93. Tsaraklis A, Preventing syphilis in the 16th century: the distinguished Italian anatomist Gabriele Falloppio (1523-1562)  and the invention of the condom. Le Infezioni in Medicina, n. 4, 395-398, 2017.

What was behind the mysterious increase in lung cancer deaths at the turn of the 20th century? The first of a three-parter investigating the cigarette-smoking link and causality, this episode looks at that early debate, which largely focused on environmental pollution. Along the way, we’re going to talk about toxic vapors -- and not Miasma theory, but the actual literal Great Smog of London in 1952 that killed over 10,000 people -- as well as the birth of the case-control study, Nazi attempts at tobacco control programs, and the rather prosaic beginnings of a debate that rages to this day. Plus a new #AdamAnswers about the medical cause of Game of Thrones greyscale featuring Dr. Jules Lipoff!

Sources:

• Bell, M. L., Davis, D. L. & Fletcher, T. A retrospective assessment of mortality from the London smog episode of 1952: the role of influenza and pollution. Environ Health Persp 112, 6–8 (2003).
• Brunekreef B, Air Pollution and Life Expectancy: Is There a Relation? Occupational and Environmental Medicine, Vol. 54, No. 11 (Nov., 1997), pp. 781-784.
• Des Voeux HC, Smoke and Fog, The Lancet, 1679-1680 (1904).
• Logan WPD, Mortality in the London Fog Incident, 1952. The Lancet, 336-338 (1953).
• Heirdorn KC, The Weather Doctor's Weather Almanac: The Infamous London Smog of 1952, 2012.
• HOFFMAN, F. L. CANCER AND SMOKING HABITS. Ann Surg 93, 50–67 (1931).
• Morabia, A. Quality, originality, and significance of the 1939 “Tobacco consumption and lung carcinoma” article by Mueller, including translation of a section of the paper. Prev Med 55, 171–177 (2012).
• Ochsner, A. My first recognition of the relationship of smoking and lung cancer. Prev Med 2, 611–614 (1973).
• Ochsner, A. & bakey. Primary pulmonary malignancy: treatment by total pneumonectomy; analysis of 79 collected cases and presentation of 7 personal cases. Ochsner J 1, 109–25 (1999).
• Parascandola, M. Two approaches to etiology: the debate over smoking and lung cancer in the 1950s. Endeavour 28, 81–86 (2004).
• Press, D. J. & Pharoah, P. Risk Factors for Breast Cancer. Epidemiology 21, 566–572 (2010).
• Proctor, R. Angel H Roffo: the forgotten father of experimental tobacco carcinogenesis. B World Health Organ 84, 494–495 (2006).
• Proctor, R. N. The anti-tobacco campaign of the Nazis: a little known aspect of public health in Germany, 1933–45. Bmj 313, 1450 (1996).
• Proctor, R. On playing the Nazi card. Tob Control 17, 289–290 (2008).
• Winkelstein, W. Vignettes of the History of Epidemiology: Three Firsts by Janet Elizabeth Lane-Claypon. Am J Epidemiol 160, 97–101 (2004).
• Proctor R, The history of the discovery of the cigarette–lung cancer link: evidentiary traditions, corporate denial, global toll. Tobacco Control. 21:2 (2013).

What killed Charles II of Spain, the inbred monarch whose autopsy famously showed a heart the size of a peppercorn, a head full of water, and a bloodless body? This episode addresses that medical mystery by not only delving deep into Charles’ unfortunate past, but by exploring some of the fundamental assumptions physicians have made about the nature of disease. Along the way we’ll walk about inbreeding coefficients, postmodern philosophy, and two thousand years of anatomy and autopsy. Plus a new #AdamAnswers about whether Vincent van Gogh’s love of the color yellow was caused by digitalis poisoning!

Sources:

• Alvarez G, Ceballos FC, Quinteiro C (2009) The Role of Inbreeding in the Extinction of a European Royal Dynasty. PLoS ONE 4(4): e5174. https://doi.org/10.1371/journal.pone.0005174
• Burchell HB, Digitalis poisoning: historical and forensic aspects. J Am Coll Cardiol. 1983 Feb;1(2 Pt 1):506-16.
• Burton JL, A Bite Into the History of the Autopsy: From Ancient Roots to Modern Decay. Forensic Sci. Med. Pathol. 1:4:277.
• Cerda JL. Charles II of Spain, «the bewitched». Rev. méd. Chile  [Internet]. 2008 Feb [cited 2019 Feb 11] ; 136( 2 ): 267-270.
  Cullen W, Nosology. Retrieved online at: https://books.google.com/books?id=3IgUAAAAQAAJ&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false
• Foucault, Michel. The Birth of the Clinic: An Archaeology of Medical Perception. New York: Vintage Books, 1975.
• Gargantilla Madera P. Enfermedades de los reyes de España, los Austrias : de la locura de Juana a la impotencia de Carlos II el Hechizado. Madrid 2005.
  Ghosh SK, “Giovanni Battista Morgagni (1682-1771): father of pathologic anatomy and pioneer of Modern Medicine, Anat Sci Int, 6 Sep 2016.
• Gruener A. Vincent van Gogh's yellow vision. Br J Gen Pract. 2013;63(612):370-1.
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• Lagay F, The Legacy of Humoral Medicine, Virtual Mentor. 2002;4(7):
• Lee TC. Van Gogh's Vision: Digitalis Intoxication? JAMA. 1981;245(7):727–729.
  Lesney MS, Flowers for the heart, ACS, March 2002, Vol. 5, No. 3, pp 46, 48
• López AG et al, Charles II: From Spell to Genitourinary Pathology. Arch. Esp. Urol. 2009; 62 (3): 179-185.
• Somberg J et al, Digitalis: Historical Development in Clinical Medicine, The Journal of Clinical Pharmacology, Volume 25, Issue 7
• Starkstein, S., & Berrios, G. (2015). The “Preliminary Discourse” to Methodical Nosology, by François Boissier de Sauvages (1772). History of Psychiatry, 26(4), 477–491.
  Viale G, The rete mirabile of the cranial base: a millenary legend. Neurosurgery. 2006 Jun;58(6):1198-208.

Florence Nightingale stands as one of the most important reformers of 19th century medicine -- a woman whose belief in the power of reason and statistical thinking would critically shape the both the fields of epidemiology and nursing. This episode discusses the fascinating story of Nightingale’s legacy -- how modern nursing was born out of the horrors of war, medical theories about poisonous air, the outsize influence of the average man, the first graph in history, and how a woman who died over a century ago presciently foresaw some of the most important scientific and social issues in medicine that are still with us today. Plus, a new #AdamAnswers about the doctor-nurse relationship.

Sources:

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

Mesmerism has had an outsize influence on medicine, despite the rapid rise and fall of its inventor Dr. Franz Mesmer and hostility from the medical establishment. This curious story covers the healing powers of magnets, secret societies in pre-Revolutionary France, fundamental questions about what makes someone alive, and one of the most fascinating medical investigations in history led by a dream team of Benjamin Franklin, Lavoisier, and Guillotine on behalf of King Louis XVI. Plus, a #AdamAnswers about the origin of the phrase “Code Blue.”

Sources:

• Damton R. Mesmerism and the End of the Enlightenment in France. Cambridge, MA: Harvard University Press, 1968.  
• Dyer R, Mesmerism, Ancient and Modern. Victorian Web.
• Franklin B et al, The Reports of the Royal Commission on Mesmer’s System of Animal Magnetism and other contemporary documents, James Lind Library, translated by Iml Donaldson. Retrieved online at https://www.rcpe.ac.uk/sites/default/files/files/the_royal_commission_on_animal_-_translated_by_iml_donaldson_1.pdf
• Lanska JT and Lanska DJ, Mesmer, Franz. Encyclopedia of the Neurological Sciences, 2014, pp 1106-1107.
• Lanska DJ and Lanksa JT, Franz Anton Mesmer and the Rise and Fall of Animal Magnetism: Dramatic Cures, Controversy, and Ultimately a Triumph for the Scientific Method. Brain, Mind and Medicine: Essays in Eighteenth-Century Neuroscience pp 301-320
• “Mesmerism,” Boston Med Surg J 1837; 17:185-187
• Normandin S, Visions of Vitalism: Medicine, Philosophy and the Soul in Nineteenth
  Century France, October 2005
• Shermer, M, Testing the Claims of Mesmerism: The First Scientific Investigation of the Paranormal Ever Conducted. Skeptic, retrieved online at https://www.skeptic.com/eskeptic/10-09-22/
• Sollberg, G. Vitalism and Vital Force in Life Sciences – The Demise and Life of a Scientific Conception
• Weckowicz TE and Liebel-Weckowicz HP, 7 Nineteenth Century: Vitalist-Mechanist and Psychic-Somatic Controversies. Advances in Psychology, Volume 66, 1990, Pages 109-152

Youtube videos of the Armonica:

• Adagio for Glass Armonica, Mozart: https://www.youtube.com/watch?v=QkTUL7DjTow
• Rutgers video on history of Armonica: https://www.youtube.com/watch?v=BdtLK9pAh5k

Bacteriophages -- viruses that target and kill bacteria -- were one of the most promising medical treatments of the early 20th century, and were used to treat all sorts of infections, from cholera to staph, and everything in between. But by the 1950s, they had all but died out in the West. This episode tells the story of the humble phage, from its discovery in the waters of the Ganges, love trysts ending in a KGB execution, and to a resurgence of this once forgotten therapy in the 21st century as an answer to antibiotic resistance.

Sources:

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

Tuberculosis has been humanity’s oldest and greatest killer. Starting at the turn of the nineteenth century, the White Plague was decimating entire generations in the crowded and unclean cities of Europe, North America, and across the globe. But as medical science learned more about the disease, doctors and reformers developed new ways to combat it, most notably specialized tuberculosis hospitals that sought to heal their patients with fresh air, rest, and a nutritious diet. This episode discusses the sanatorium movement and the gradual conquest of tuberculosis, long before effective antibiotic therapy existed. Along the way we’re going to talk about the King’s Evil, the dangers of rebreathed air, the healing powers of mountains, and the social determinants of health. Plus, a brand new #AdamAnswers about maternal placentophagy. All this and more on Episode 39 of Bedside Rounds, monthly podcast on the weird, wonderful, and intensely human stories that have shaped modern medicine, brought to you in partnership with the American College of Physicians. To claim CME and MOC credit, please go to www.acponline.org/BedsideRounds.

Sources:

• Adams, J. F. Alleyne. "The Segregation of Consumptives." The Boston Medical and Surgical Journal 157, no. 2 (1907): 35-40.
• Barberis I et al, The history of tuberculosis: from the first historical records to the isolation of Koch's bacillus, J Prev Med Hyg. 2017 Mar; 58(1): E9–E12.
• Bertolaccini et al, Surgical treatment of pulmonary tuberculosis: the phoenix of thoracic surgery? J Thorac Dis. 2013 Apr; 5(2): 198–199.
• CDC: World TB Day 2018, retrieved from: https://www.cdc.gov/tb/worldtbday/history.htm
• Cox GL. Sanatorium treatment contrasted with home treatment. After-histories of 4,067 cases. Br J Tuberc 1923; 17:27–30.
• Coyle CW et al, Placentophagy: Therapeutic Miracle or Myth? Arch Womens Ment Health. 2015 Oct; 18(5): 673–680.
• Daniel TM, Hermann Brehmer and the origins of tuberculosis sanatoria, Int J Tuberc Lung Dis. 2011 Feb; 15(2):161-2.
• Daniel TM, Jean-Antoine Villemin and the infectious nature of tuberculosis, Int J Tuberc Lung Dis 19(3):267–268
• Daniel TM, “The history of tuberculosis,” Respiratory Medicine (2006) 100, 1862–1870.
• Daniel VS and Daniel TM,, Old Testament Biblical References to Tuberculosis, linical Infectious Diseases, Volume 29, Issue 6, 1 December 1999, Pages 1557–1558.
• Davies RPO, Tocque K, Bellis MA, Rimmington T, Davies PDO. Historical declines in tuberculosis in England and Wales: improving social conditions or natural selection. Int J Tuberc Lung Dis 1999;3:1051–4.
• Dormandy T, The White: A History of Tuberculosis, 1999.
• Farr et al, “Human Placentophagy: A review,” AJOG, April 2018.
• Frith J, History of Tuberculosis. Part 1 – Phthisis, consumption and the White Plague. J Mil Vet Health, 22,2.
• Gaensler EA. The surgery for pulmonary tuberculosis. Am Rev Respir Dis 1982;125:73–84.
• Grigg RN. (1958), The arcana of tuberculosis. Am Rev Tuberc Resp Dis; 78:151-172.
• Hayman J, “Mycobacterium Ulcerans: An infection from Jurassic Time?” The Lancet, Nov 3, 1984.
• Holloway-Kew KL et al, Lessons from history of socioeconomic improvements: A new approach to treating multi-drug-resistant tuberculosis, Journal of Biosocial Science 46(5):1-21, October 2013.
• Jacobaeus HC. The Cauterization of Adhesions in Artificial Pneumothorax Treatment of Pulmonary Tuberculosis under Thoracoscopic Control. Proc R Soc Med 1923;16:45-62
• Morse D, Brothwell DR, Ucko PJ. Tuberculosis in ancient Egypt. Am Rev Respir Dis. 1964;90:524–541.
• Murray JF. Bill Dock and the location of pulmonary tuberculosis: how bed rest might have helped consumption. Am J Respir Crit Care Med 2003;168:1029–1033.
• Murray JF. Mycobacterium tuberculosis and the cause of consumption: from discovery to fact. Am J Respir Crit Care Med 2004;169: 1086–1088.
• Murray JF, Sanatoriums and climate, The Lancet Infectious Disease, Vol 16, Issue 7, P786, July 01, 2016.
• Murray JF. The white plague: down and out, or up and coming? J. Burns Amberson Lecture. Am Rev Respir Dis 1989;140:1788–1795.
• Murray JF et al, “Treatment of Tuberculosis. A Historical Perspective,” Annals of the American Thoracic Society. Vol. 12, No. 12 , Dec 01, 2015.
• Pomerantz M. Surgery for the management of mycobacterium tuberculosis and nontuberculous mycobacterial infections of the lung. In: Shields TW, Lo Cicero J, Ponn RB, et al. eds. General Thoracic Surgery, 6th ed. Lippincott Williams & Wilkins: Philadelphia, PA; 2005:1251-61.
• Tuberculosis Chemotherapy Centre, A concurrent comparison of home and sanatorium treatment of pulmonary tuberculosis in South India, Bull World Health Organ. 1959; 21(1): 51–144.
• Warren P, The evolution of the sanatorium: the first half-century, 1854-1904, Can Bull Med Hist. 2006;23(2):457-76.

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

The first population study in history was born out of a dramatic debate involving leeches, “medical vampires,” professional rivalries, murder accusations, and, of course, bloodletting, all in the backdrop of the French Revolution. The second of a multipart series on the development of population medicine, this episode contextualizes Pierre Louis’ “numerical method,” his famous trial on bloodletting, and the birth of a new way for doctors to “know”. Plus a brand new #AdamAnswers about Occam’s razor and Hickam’s Dictum. All this and more on Episode 38 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine! To claim CME and MOC credit, please go to www.acponline.org/BedsideRounds.

• Best M and Neuhauser D, “Pierre Charles Alexandre Louis: Master of the spirit of mathematical clinical science,” Qual Saf Health Care 2005;14:462–464.
• Duffin J, “Laennec and Broussias: The ‘Sympathetic’ Duel,” from La Berge A and Hannaway C, Paris Medicine: Perspective Past and Present.
• (1977) The French Revolution: A Revolution in Medicine, Too, Hospital Practice, 12:11, 127-138
• Hillard A, et al. “Occam’s Razor versus Saint’s Triad, N Engl J Med 2004;350:599-603.
• Lo Re V 3rd, Bellini LM, William of Occam and Occam's razor. Ann Intern Med. 2002 Apr 16;136(8):634-5.
• Kirk GW and Pemberton N. Leech, 2013
• Kirk GW and Pemberton N, Re-imagining Bleeders: The Medical Leech in the Nineteenth Century Bloodletting Encounter. Med Hist. 2011 Jul; 55(3): 355–360.
• La Berge A and Hannaway C, Paris Medicine: Perspective Past and Present.
• Louis PCA. Researches On The Effects Of Bloodletting In Some Inflammatory Diseases. Boston: Hilliard, Gray, 1836.
• Morabia A. PCA Louis and the birth of clinical epidemiology. J Clin Epidemiol 1996;49: 1327-33
• Morabia A, Pierre-Charles-Alexandre Louis and the evaluation of bloodletting. J R Soc Med. 2006 Mar; 99(3): 158–160.
• Niehyl PH. The English bloodletting revolution, or modem medicine before 1950. Bull Hist Med 1977; 51, pp. 464-483.
• Papavramidou N and Christopolou-Aletra H, Medicinal use of leeches in the texts of ancient Greek, Roman and early Byzantine writers. Intern Med J. 2009 Sep;39(9):624-7.
• “Suckers for Success,” Nature volume 484, page 416 (26 April 2012).
• “Walter Chatton,” Stanford Encyclopedia of Philosophy, retrieved from: https://plato.stanford.edu/entries/walter-chatton/
• Wardrop D, “Ockham’s Razor: sharpen or re-sheathe?” J R Soc Med. 2008 Feb; 101(2): 50–51.

For thousands of years, bloodletting was the standard of care for any number of medical conditions, but at the turn of the nineteenth century, often acrimonious debates about the practice would lead to a new method of medical knowledge. The first of a multi-part series on the birth of population medicine, this episode visits the controversies surrounding the death of George Washington and Benjamin Rush’s bleeding of Philadelphia during the 1793 yellow fever epidemic and asks the big question -- how do doctors truly “know” what actually helps their patients? Plus, a brand new #AdamAnswers about military metaphors in medicine. All this and more on Episode 37 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine!

Sources:

• Brickell J, Observations on the Medical Treatment of General Washington in His Illness, retrieved from https://books.google.com/books?id=YXA3AQAAMAAJ&pg=PA90&lpg=PA90&dq=craik+dick+washington+medical+repository&source=bl&ots=IZB72sSdaS&sig=kUY0JZHft1HbRrarR9RE4r-2w_A&hl=en&sa=X&ved=2ahUKEwju3PT439TcAhVOxVkKHZPHBVQQ6AEwA3oECAcQAQ#v=onepage&q&f=false
• Cohen B, The death of George Washington (1732-99) and the history of cynanche. J Med Biogr. 2005 Nov;13(4):225-31.
• Craik J and Dick E, The Medical Repository and Review of American Publications on
  Surgery, Third Quarter, 1805.
• Fuks A, “The Miliary Metaphors of Modern Medicine,” 2009.
• Harington J, Regimen Sanitatis Salernitanum (ca. 11th c.), retrieved from https://faculty.humanities.uci.edu/bjbecker/PlaguesandPeople/week3f.html
• Kopperman P, "Venerate the Lancet": Benjamin Rush's Yellow Fever Therapy
  in Context. Bulletin of the History of Medicine, Volume 78, Number 3, Fall 2004, pp.
  539-574
• Lane HP et al, “The war against dementia: are we battle weary yet?” Age and Ageing, Volume 42, Issue 3, 1 May 2013, Pages 281–283.
• Moed et al, “Cantharidin Revisited: A Blistering Defense of an Ancient Medicine,” JAMA Dermatology, October 2001.
• Morens DM, Death of a President, NEJM Dec 9, 1999
• Niehyl PH. The English bloodletting revolution, or modem medicine before 1950. Bull Hist Med 1977; 51, pp. 464-483.  
• North RL, “Benjamin Rush, MD: assassin or beloved healer?” Proc (Bayl Univ Med Cent). 2000 Jan; 13(1): 45–49.
• Parapia LA, History of bloodletting by phlebotomy. British Journal of Haematology Volume 143, Issue 4
• Rush, Benjamin. Observations Upon the Origin of the Malignant Bilious, or Yellow Fever in Philadelphia, and Upon the Means of Preventing It: Addressed to the Citizens of Philadelphia. Philadelphia: Printed by Budd and Bartram, for Thomas Dobson, at the Stone House, No. 41, South Second Street., 1799, retrieved from: https://iiif.lib.harvard.edu/manifests/view/drs:6483213$1i
• Wallenborn WM, George Washington’s Terminal Illness: A Modern Medical Analysis of the Last Illness and Death of George Washington, retrieved from: http://gwpapers.virginia.edu/history/articles/illness/

The southern United States was hit by a dramatic epidemic of a mysterious disease called pellagra in the early twentieth century. This episode discusses the cultural and scientific sources of the outbreak -- from the cotton fields of the south, to the cow pastures of rural Germany, to the river basins of Uganda -- and the incredible lengths a young doctor named Joseph Goldberger went through to try and put an end to this plague. Plus, a new #AdamAnswers about the source of the name “internal medicine.” All this and more on episode 36 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine!

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

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

Why do doctors love Sherlock Holmes so much? In this episode, we’ll explore this endearing, nerdy obsession with the good detective, from Holmes’ medical origins and influences, the parallels with medical reasoning, and how the Holmes stories still influence medicine to this day. Plus a new #AdamAnswers about the origin of the white coat. All this and more in Episode 35 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine!

Sources:

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

The physical exam has become a ritual of the modern doctor’s appointment, with pokes, prods, and strange tools. How did this become a normal thing to do? In this episode, I’ll discuss how the physical exam went from the medieval examination of a flask of urine to basically what we have today in just a few decades in early 19th century France, and how the exam is still developing in the 21st century. Plus, a brand new #AdamAnswers about why Americans insist on using the Hermes’ Staff as a symbol for medicine. All this and more in episode 34 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine!

Sources:

• Antic T, DeMay RM. “The fascinating history of urine examination,” Journal of the American Society of Cytopathology (2014) 3, 103e107
• Ghasemzadeh N and Zafari AM, “A Journey into the History of the Arterial Pulse,” Cardiology Research and Practice Volume 2011 (2011).
• McGee S, Evidence Based Physical Diagnosis 4th edition. Amazon link: https://www.amazon.com/Evidence-Based-Physical-Diagnosis-Steven-McGee/dp/0323392768
• Nicolson M, Commentary: Nicholas Jewson and the disappearance of the sick man from medical cosmology, 1770–1870. Int J Epidemiol 2009;38:622–33)
• Jewson ND. The disappearance of the sick-man from medical cosmology, 1770–1870, Sociology , 1976, vol. 10 (pg. 225-44)
• Robertson WE. Physical diagnosis from the time of Rontgen. Ann Med Hist. 1934;6:255–63
• Rodgers MM, “Piorry on Pleximetry and Auscultation,” Boston Med Surg J 1852; 46:151-152
• Tan SY and Hu M, “Josef Leopold Auenbrugger (1722 - 1809): father of percussion. Singapore Med J 2004 Vol 45(3):103
• Walker HK, “The Origins of the History and Physical Examination,” Clinical Methods: The History, Physical, and Laboratory Examinations.Boston: Butterworths; 1990.
• Wallis F, Signs and Senses: Diagnosis and Prognosis in Early Medieval Pulse and Urine Texts. Social History of Medicine Vol. 13 No. 2 pp. 265-278.
• Wilcox RA et al, “The Symbol of Modern Medicine: Why One Snake Is More Than Two,” Ann Intern Med. 2003;138:673-677.
• Verghese et al, A History of Physical Examination Texts and the Conception of Bedside Diagnosis.
• Voswinkel P, From uroscopy to urinalysis. Clinica Chimica Acta 297 (2000) 5–16

Alexis St. Martin and William Beaumont have one of the strangest relationships in the history of medicine -- a young French-Canadian fur trapper with a hole in his stomach from an errant shotgun blast and the American army physician who cared for him, and then made his own career by turning Alexis into a human guinea pig. Through the decades of their complicated relationship, they’d revolutionize our understanding of the physiology of the stomach, put American medicine on the map, and start a conversation about the ethics of human experimentation that goes on to this day. Plus there’s a new #AdamAnswers about whether or not your body temperature and fevers can “run low”. All this and more on the latest episode of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine.

Sources:

• Beaumont W. Experiments and Observations of the Gastric Juice and the Physiology of Digestion. Plattsburgh, NY: FP Allen; 1833.
• Mackowiak PA et al, “A critical appraisal of 98.6 degrees F, the upper limit of the normal body temperature, and other legacies of Carl Reinhold August Wunderlich.” JAMA. 1992 Sep 23-30;268(12):1578-80.
• Mackowiak PA, “Feel the heat: a short history of body temperature,” BMJ. 2017;359:j5697
• Markel H, “How William Beaumont and Alexis St. Martin Seized the Moment of Scientific Progress,” JAMA, August 19, 2009—Vol 302, No. 7.
• Myers NA and Durham Smith E, “A Debt to Alexis: The Beaumont-St Martin Story,” Aust NZ J Surg (1991) 67, 534-539.
• Numbers RL, “William Beaumont and the Ethics of Human Experimentation,” Journal of the History of Biology, Vol. 12, No. 1 (Spring, 1979), pp. 113-135.
• Obermeyer Z et al, Individual differences in normal body temperature: longitudinal big data analysis of patient records. BMJ. 2017; 359: j5468.
• Osler W, “William Beaumont: A Pioneer American Physiologist,” JAMA Vol XXXIX No 20, Nov 15, 1902.

The Four Humors are probably the longest-lasting idea in the history of medicine, even though they’ve been more or less completely abandoned for the past century or so. In this episode, we’ll explore how the ancient Greek idea of disease coming from imbalances in body fluids touched every aspect of medicine for two millennia, well into the modern era. And we’ll discuss how humoral explanations likely hampered adoption of the first clinical trial in history, James Lind’s famous scurvy study. Plus we have a brand new #AdamAnswers about germ theory. Listen to all this and more in Episode 32 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine!

Sources:

• Arikha N, Passions and Tempers: A History of the Humors. 2007.
• Baron JH, “Sailors' scurvy before and after James Lind--a reassessment,” Nutr Rev. 2009 Jun;67(6):315-32.
• Bartholomew M, “James Lind and scurvy: a revaluation,” Journal for Maritime Research. Published online: 08 Feb 2011.
• Lind J. A Treatise of the Scurvy in Three Parts. Containing an Inquiry into the Nature, Causes and Cure of that Disease, together with a Critical and Chronological View of what has been published on the subject. London: Miller, 1753
• NLM’s Turning the Pages on the Edwin Smith Papyrus (https://www.nlm.nih.gov/news/turn_page_egyptian.html)
• Nutton V, Ancient Medicine.
• Nutton V, “The Fatal Embrace: Galen and the History of Ancient Medicine”. Science in Context 18(1), 111–121 (2005).
• Shoja MM et al, “Wrong theories on the origin of blood vessels: Polybus and De Natura Hominis.” Int J Cardiol. 2008 Jun 6;126(3):313-5.
• Sutton G, “Putrid gums and 'dead men's cloaths': James Lind aboard the Salisbury.” J R Soc Med. 2003 Dec;96(12):605-8.
• Trohler U, “Lind and Scurvy: 1747-1795,” J R Soc Med. 2005 Nov; 98(11): 519–522.
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Malariotherapy -- infecting comatose syphilis patients with malaria to cure them of the disease -- was once the cutting edge of medicine, and earned its inventor Julius Wagner-Jauregg the Nobel Prize in Medicine or Physiology in 1927. In this episode, we’re going to talk about the fascinating story behind this remarkable treatment, from the murky beginnings of syphilis through its sordid sexual connotations, to the birth of modern psychiatry and Nazi experiments. Plus, there’s a brand new #AdamAnswers about whether or not ancient doctors thought hair served to store semen (seriously).  Listen to all this and more in Episode 31 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine.

Sources:

• Crellato E et al, “The Hippocratic treatise ‘On glands’: the first document on lymphoid tissue on lymph nodes,” Leukemia. Retrieved online at https://www.nature.com/articles/2404618
• Farhi D, Dupin N, Origins of syphilis and management in 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/
• Gelder MG, “Biological Psychiatry in Perspective,” British Medical Bulletin. 1996;2 (No. 3H01-4G7)
• Howes OD et al, “Julius Wagner-Jauregg, 1857-1940,” American Journal of Psychiatry, April 2009 Volume 166 Number 4, Volume 166, Issue 4, April, 2009, pp. 409-409.
• Karamanou M et al, “Julius Wagner-Jauregg (1857-1940): Introducing fever therapy in the treatment of neurosyphilis.” Psychiatriki. 2013 Jul-Sep;24(3):208-12.
• Kent, ME and Romanelli F. Reexamining Syphilis: An Update on Epidemiology, Clinical
  Manifestations, and Management, The Annals of Pharmacotherapy. 2008 February, Volume 42
• Kreston R, “Pyromania! On Neurosyphilis and Fighting Fire with Fire,” Body Horrors blog on Discover. Retrieved online at: http://blogs.discovermagazine.com/bodyhorrors/2014/05/31/pyromania-syphilis-malaria/#.WnTvHKinE2x
• Martin TW, “Paul’s argument from Nature for the Veil in 1 Corinthians 11:13-15: A Testicle Instead of a Head Covering,” Journal of Biblical Literature, Vol. 123, No. 1 pp 75-84.
• Rothschild, BM, “History of Syphilis Clinical Infectious Diseases.” 2005; 40:1454–63
• Simpson WM, “Artificial fever therapy of syphilis,” JAMA. 1935;105(26):2132-2140.
• Tampa M et al, “Brief History of Syphilis.” J Med Life. 2014 Mar 15; 7(1): 4–10.
• Tsay CJ, “Julius Wagner-Jauregg and the Legacy of Malarial Therapy for the Treatment of General Paresis of the Insane,” Yale J Biol Med. 2013;86(2): 245–254
• Wagner-Jauregg J, “The history of malaria treatment of general paralysis.” Am J Psychiatry. 1946;02: 577-582

Two hundred years ago, a few doctors, a matron, and 22 orphans set sail in a gutsy attempt to spread the new invention of vaccination across three continents in the world’s first attempt to eliminate smallpox. Learn about their epic journey, the Balmis-Salvany Expedition, as well as the medical context surrounding the invention of vaccination in “The Orphan Vaccine”. Plus, a new #AdamAnswers about why you always get sick when you first go on vacation. You can find all this and more in the latest episode of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine!

Sources:

• Domingo P, “Smallpox: The triumph over the most terrible of the ministers of death,” Annals of Internal Medicine, November 1997.
• Fenner F et al, “Smallpox and its Eradication,” World Health Organization, 1988,
• Franco-Paredes C, et al. “The Spanish Royal Philanthropic Expedition to Bring Smallpox Vaccination to the New World and Asia in the 19th Century”, Clinical Infectious Diseases, Volume 41, Issue 9, 1 November 2005, Pages 1285–1289
• Hammarsten JF et al, “Who discovered smallpox vaccination? Edward Jenner or Benjamin Jesty?” Trans Am Clin Climatol Assoc. 1979;90:44-55.
• Lipton RB et al, “Reduction in perceived stress as a migraine trigger: testing the ‘let-down headache’ hypothesis,” Neurology. 2014 Apr 22; 82(16): 1395–1401.
• Mark C and Rigau-Peres JG, “The World’s First Immunization Campaign: The Spanish Smallpox Vaccine Expedition, 1803-1813,” Bulletin of the History of Medicine, Volume 83, Number 1, Spring 2009, pp 63-94.
• Morgan AJ and Poland GA, “The Jenner Society and the Edward Jenner Museum: Tributes to a physician-scientist,” Vaccine, 295 (2011) D152-D154.
• Tuells J. “Francisco Xavier Balmis (1753–1819), a pioneer of international vaccination,” Journal of Epidemiology and Community Health, 2002, 56:11.

Did the famous composer Gustav Mahler work his fatal heart murmur into his final ninth symphony? To try and answer this question, I’m joined by Dr. Kevin Nordstrom of the Great Composers Podcast. We’ll delve into Mahler’s diseases, a history of heart sounds, musical theory, his obsession with mortality, and the unfortunate circumstances of his own death. Classical music and medicine, in one podcast! What more could you want? And included (at no extra charge!) is a new #AdamAnswers about the origins of respiratory therapy.

You can listen to Dr. Nordstrom’s Great Composers Podcast on iTunes or on his website.

Sources:

• Amenta C, “The Opening of Mahler's Ninth Symphony and the Bernstein "Heart-beat" Hypothesis by Charles Amenta,” Naturlaut 4(1): 17-18, 2005.
• Cardoso F and Leese AJ. “Did Gustav Mahler have Syndenham’s chorea?” Mov Disord. 2006 Mar;21(3):289-92.
• Christy NP et al, “Gustav Mahler and his illnesses,” Trans Am Clin Climatol Assoc. 1971; 82: 200–217.
• Ferretti J et al, “History of Streptococcal Research.” Streptococcus pyogenes : Basic Biology to Clinical Manifestations.
• Hannah IR and Silverman ME, “A history of cardiac auscultation and some of its contributors,” Am J Cardiol. 2002 Aug 1;90(3):259-67.
• Levy D, “Gustav Mahler and Emanuel Libman: bacterial endocarditis in 1911,” Br Med J (Clin Res Ed). 1986 Dec 20-27;293(6562):1628-31.
• Mangione S, “Mahler at 100: a medical history,” Hektoen International. http://hekint.org/2017/01/30/mahler-at-100-a-medical-history/

The story of smallpox blankets offered as gifts to indigenous peoples as a weapon of war is ubiquitous -- but is it based in truth? And did our increased medical understanding of smallpox lead to its use as a biological weapon?  In this episode, we confront these questions and explore the history of biological warfare, smallpox, and medicine. Listen to all this, a new #AdamAnswers, and more in this episode of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine.

Sources:

• Barras V and Groub G, “History of biological warfare and bioterrorism,” Clin Microbiol Infect 2014.
• Carus W, “The history of biological weapons use: what we know and what we don’t,” Health Security, Vol 13, No4, 2015.
• Fenner F et al, “Smallpox and its Eradication,” World Health Organization, 1988, Chapters 5 and 6.
• Mayor A, “The Nessus Shirt in the New World: Smallpox Blankets in History and Legend,” J Am Folklore, Vol. 108, No. 427 (Winter, 1995), 54-77.
• Mear C, “The origin of the smallpox outbreak in Sydney in 1789,” Journal of the Royal Australian Historical Society, June, 2008.
• Skwarecki B, “What is the scariest disease?” PLoS Blogs, retrieved at https://gizmodo.com/what-is-the-scariest-disease-1653943826
• Theves C, et al, “The rediscovery of smallpox,” Clin Microbiol Infect 2014; 20: 210-218.
• Ranlet P, “The British, the Indians, and Smallpox: What actually happened at Fort Pitt in 1763?”, Pennsylvania history: 427-442.
• Warren C, “Smallpox at Sydney Cove -- who, when, why?” J Aust Studies, 30 Oct 2013

The United States is in the midst of an epidemic of addiction and overdose deaths due to opiate painkillers. Its causes are varied, but there’s no question that physicians share a large part of the blame. Little discussed is that this is actually the second time this has happened. Almost a century ago, a remarkably similar epidemic struck the country. In this episode, called “The First Opiate Epidemic,” I discuss what happened, the parallels to today, and the lessons we can learn from our forebearers. Learn about all this and a new #AdamAnswers in this month’s Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine!

Sources:

• Courtwright DT. Dark Paradise: A History of Opiate Addiction in America. Harvard University Press, 2001.
• Meldrum ML, “The ongoing opiod prescription epidemic: historical context,” Am J Public Health. 2016 August; 106(8): 1365–1366.
• Courtwright DT, “Preventing and treating narcotic addiction -- a century of federal drug control,” N Engl J Med 2015; 373:2095-2097.
• Adams JFA, “Substitutes for opium in chronic diseases,” Boston Med Surg J 1889; 121:351-356.
• Macht DI, “The history of opium and some of its preparations and alkaloids,” JAMA. 1915;LXIV(6):477-481.
• Hamilton GR and Baskett TF, “In the arms of Morpheus: the development of morphine for postoperative pain relief,” Can J Anesth. 2000;47:4, 367-374.
• Weiner JP, “A shortage of physicians or a surplus of assumptions?” Health Aff January 2002 vol. 21 no. 1 160-162.
• Gudbranson BA et al, Reassessing the Data on Whether a Physician Shortage Exists. JAMA. 2017;317(19):1945-1946.
• Kirch DG and Petelle K, Addressing the Physician Shortage: The Peril of Ignoring Demography. JAMA. 2017;317(19):1947-1948.

In 2005, a mysterious plague called Corrupted Blood hit the online denizens of World of Warcraft, ripping through cities and decimating player characters. After the smoke cleared, it became clear that this virtual plague shared many characteristics with real-world diseases and almost immediately attracted the attention of researchers. In this Summer Short, I go over the details of the in-game Corrupted Blood incident, and the very real-world epidemiological research that followed. Learn about all this and more on the latest short of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine.

Sources:

• Bohannon J. Slaying monsters for science. Science  20 Jun 2008.
• Messner S. How Blizzard coped with World of Warcraft's blood plague and other early disasters. PC Gamer.
• Henderson M. Analysis: Absence of risk limits parallels with real life. Times Online. October 28, 2008
• Oultram S. Virtual plagues and real-world pandemics: reflecting on the potential for online computer role-playing games to inform real world epidemic research. BMJ.
• Lofgren E, Fefferman N. The untapped potential of virtual game worlds to shed light on real world epidemics. Lancet Infect Dis 2007;9:625–9.

The invention of dialysis -- essentially artificial kidneys for people with kidney failure -- revolutionized medicine. It also started a debate about medical rationing and ethics that rages to this day. Producer Cam Steele brings us a story about the God Squad, the group of lay people and doctors tasked with deciding who lived and who died in the early days of dialysis, and how it has informed every debate about medical rationing since. Learn about all this and more, plus a new #AdamAnswers in the latest episode of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine.

Sources:

• Blagg CR, Development of ethical concepts in dialysis: Seattle in the 1960s. Nephrology, 1998.4, 235-238
• Scheunemann L and White D, The Ethics and Reality of Rationing in Medicine, Chest, 140; 6. December 2011
• White DB et al, Who should receive life support during a public health emergency? Using ethical principles to improve allocation decisions. Ann Intern Med. 2009 January 20; 150(2): 132–138.
• Jonson AR, The God Squad and the Origins of Transplantation Ethics and Policy, Journal of Law, Medicine, and Ethics.
• Levine C, The Seattle “God Committee”: A Cautionary Tale; Nov 30 2009.
• Blagg, CR. The Early Years of Chronic Dialysis: The Seattle Contribution. Am J Nephrol 1999;19:350–354
• Persad, et al. Principles for allocation of scarce medical interventions, Lancet 2009; 373: 423–31.
• Bryson, et al. Addiction and Substance Abuse in Anesthesiology. Anesthesiology. 2008 Nov; 109(5): 905–917.
• Hughes, et al. Resident Physician Substance Use, By Specialty. Am J Psychiatry 1992; 149: 1348-1354.

The eclipse is coming! Get out your eclipse glasses (or your camera obscura, if you didn't prepare like me), and enjoy a review of the medical literature on eclipses with our guest Dr. Avi O'Glasser in our first summer short. Beyond solar retinopathy (a very good reason to not look into the sun), are there health effects on humans? Is there anything to the widespread belief of an eclipse being a bad omen? Find out all this and more in our first Bedside Rounds Summer Short. And thanks so much to Dr. O'Glasser!

References:

• http://www.asrs.org/patients/retinal-diseases/special-safety-edition-2017-great-american-eclipse
• A New Way to Look Up. Solar Retinopathy Risks and Methods of Prevention Prior to the 2015 Solar Eclipse
• Public health warnings of solar retinopathy risk in European newspapers prior to the 2006 solar eclipse. (http://www.oftalmo.com/seo/archivos/maquetas/C/1C6CE602-7C96-3DE8-336A-00001A483D3C/articulo.pdf)
• EFFECT OF ECLIPSE OF THE SUN IN 1999 ON THE PSYCHIC STATE OF PEOPLE http://www.prolekare.cz/en/general-practitioner-article/effect-of-eclipse-of-the-sun-in-1999-on-the-psychic-state-of-people-25088

Intravenous or IV fluids are a ubiquitous treatment in medicine, and one of the most cost-effective treatments that we have, costing less than a cup of coffee in the developing world. But it wasn’t always this way. In this episode, called Salt Water, we go back to the second great cholera epidemic, where a young doctor developed IV fluids to help fight this mysterious disease, only to see his invention abandoned for over half a century. We also have a new #AdamAnswers about bloodletting. So join us for another rollicking adventure of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine!

Sources:

• Foex B. How the cholera epidemic of 1831 resulted in a new
  technique for fluid resuscitation. Emerg Med J 2003;20:316–318.
• Gill G. William O’Shaughnessy and the forgotten cure for cholera
  in the 1832 British epidemic.
• Letter from Lord Cavendish: Online at: http://mssweb.nottingham.ac.uk/elearning/view-text.asp?resource=HealthHousing&ref=pwh287&theme=3&view=text&page=1
• O'Shaughnessy, W.B. (1838–40). "Case of Tetanus, Cured by a Preparation of Hemp (the Cannabis indica.)". Transactions of the Medical and Physical Society of Bengal. 8: 462–469.
• Chan C, et al. Historical Epidemiology of the Second Cholera Pandemic: Relevance to Present Day Disease Dynamics. PLOS One: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0072498
• BB4: Diary of an Epidemic. Online at: http://www.bbc.co.uk/radio4/history/longview/longview_20030415.shtml
• Kresta R. The Origin of IV Fluids. Discover Magazine. Online at: http://blogs.discovermagazine.com/bodyhorrors/2016/05/31/intravenous-fluids-cholera/#.WX9z4JdtmUl
• Prasad V and Cifu A, Medical Reversal: Why We Must Raise the Bar Before Adopting New Technologies. Yale J Biol Med. 2011 Dec; 84(4): 471–478.

Further reading:

• r/AskHistorians thread: https://www.reddit.com/r/AskHistorians/comments/6nzbfz/if_bloodletting_was_rubbish_why_was_it_considered/
• Ending Medical Reversal by Cifu and Prasad. On Amazon at: https://www.amazon.com/Ending-Medical-Reversal-Improving-Outcomes/dp/1421417723

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

What makes a disease? And who gets to decide? Producer Cam Steele brings us a story that spans migrating uteruses in ancient Egypt, a disease that makes slaves want to run away in the antebellum south, and the accidental discovery of an erection pill while trying to treat heart disease. Join us in our journey to disassemble the concept of disease in Episode 24 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine!

Sources:

• Bynum B. Discarded Diagnoses. The Lancet. Volume 356, No. 9241, p1615, 4 November 2000.
• Conrad P. The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders.
• Drescher J. Out of DSM: Depathologizing Homosexuality. Behav Sci (Basel). 2015 Dec; 5(4): 565–575.
• Robison J. Look Me in the Eye: A Brief History of Nosology. Retrieved from: http://jerobison.blogspot.com/p/a-brief-history-of-nosology.html
• Shorter E. The history of nosology and the rise of the Diagnostic and Statistical Manual of Mental Disorders. Dialogues Clin Neurosci. 2015 Mar; 17(1): 59–67.
• Tasca C, et al. Women And Hysteria In The History Of Mental Health. Clin Pract Epidemiol Ment Health. 2012; 8: 110–119.

Music credits:

• Sad Marimba Planet by Lee Rosevere
• Pookatori and Friends by Kevin MacLeod
  

A darkened laboratory with an eerie green glow; a photograph of the bones of a woman’s hand published on the front pages of newspapers throughout the globe; mysterious rays that promise to change medicine forever but also cause horrific disease in their champions and pioneers. In this episode, called Bone Portraits, I tell the story of two men -- Wilhelm Roentgen, the discoverer of x-rays who would later win a Nobel Prize, and Clarence Dally, the first victim of x-ray radiation. Listen to the thrilling conclusion of our to part series on the dawn of diagnostic imaging! We’ve got all this, plus a double-header #AdamAnswers, in Episode 23 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine.

Sources:

• Mahroo, et al. 'Dilatation' and 'dilation': trends in use on both sides of the Atlantic. Br J Ophthalmol. 2014 Jun;98(6):845-6. doi: 10.1136/bjophthalmol-2014-304986. Epub 2014 Feb 25.
• King, Gilbert. “Clarence Dally — The Man Who Gave Thomas Edison X-Ray Vision.” Smithsonian.com, March 14, 2012.
• Goodman, et al. Medical Writing: A Prescription for Clarity. P37.
• Gagliardi, Raymond A. “Clarence Dally: An American Pioneer,”  American Journal of Roentgenology, November, 1991, vol. 157, no. 5, p. 922
• Dunlop, Orrin. Deleterious effects of X-rays on the human body. Electrical Review 1896;29:95
• Cheng, Tsung. Dilation vs. Dilatation. American Journal of Cardiology. February 15, 1994. Volume 73, Issue 5, Page 421
• Brown, Percy. American martyrs to radiology. Clarence Madison Dally (1865-1904). 1936.
• Obrien, Frederick. In Memoriam: Percy Brown, MD. Radiology. December 1950
  Volume 55, Issue 6
• Sansare K, et al. Early victims of X-rays: a tribute and current perception. Dentomaxillofac Radiol. 2011 Feb;40(2):123-5.

A mortally wounded American president and the quest to find his assassin’s bullet unexpectedly opened up a potentially new era of medical diagnostics in the late nineteenth century. In this episode, learn about the assassination of James Garfield and how the controversy surrounding his medical care led Alexander Graham Bell to develop an “induction balance” that could locate a piece of metal inside a human body. This is the first part of a two part series called “Sound and Light.” Also included -- a new #AdamAnswers about … hiccups! All this and more in Episode 22 of Bedside Rounds!

Sources:

• Bell AG. Upon the electrical experiments to determine the location of the bullet in the body of the late President Garfield; and upon a successful form of induction balance for the painless detection of metallic masses in the human body, Retrieved from: https://archive.org/details/uponelectricalex00bell
• Paulson G. Death of a president and his assassin--errors in their diagnosis and autopsies. J Hist Neurosci. 2006 Jun;15(2):77-91.
• Trunkey D, et al. Medical and surgical care of our four assassinated presidents. J Am Coll Surg. 2005 Dec;201(6):976-89. Epub 2005 Jun 16.
• Reyburn R. Clinical history of the case of James Abram Garfield. JAMA. 1894;XXII(13):460-464.
• Steger M et al. Systemic review: the pathogenesis and pharmacological treatment of hiccups. Aliment Pharmacol Ther. 2015 Nov;42(9):1037-50

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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