Bedside Rounds

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

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

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

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

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

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

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

Discover the first recorded virtual plague, Corrupted Blood, in World of Warcraft, and how it led to real-world epidemiological research. Explore the devastating effects on player characters and the in-game economy. Uncover factors behind the initial outbreak, NPC involvement, and attention from researchers. Learn how World of Warcraft unintentionally modeled real disease behavior and its potential for future scientific exchange.

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