Bedside Rounds

The podcast dives into the harrowing past of surgical practices before anesthesia, where patients endured torturous procedures. It details the journey of ether from recreational use to a groundbreaking medical discovery. Listeners will learn about the historical application of mandrake and other herbal anesthetics, and the painful legacy of bladder stone surgeries. The narrative contrasts grim realities with transformative moments in 1846, showcasing the monumental shift in pain relief and surgical techniques.

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

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

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

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

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

In this engaging discussion, Tony Breu, a hospitalist and pathophysiology expert, delves into the intriguing history of syphilis, from its arrival in Naples in 1495 to the profound impact it had on modern medicine. He shares fascinating topics, including the historical use of mercury in treatments, experiments involving malaria, and the evolution of germ theory. Listeners will be captivated by bizarre past practices and ethical dilemmas surrounding syphilis treatments, as well as the disease's surprising resurgence in contemporary public health.

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

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

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