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

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

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

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

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

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

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

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

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

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

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

Before CT scans, EKGs, and even the humble x-ray, there was the stethoscope, arguably the first diagnostic test in the history of medicine. In this episode, we revisit Rene Laennec and the invention of the stethoscope -- a potent new way to localize, for the first time, disease inside the still-living human body. Plus a new #AdamAnswers on medical eponyms!

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

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

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

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

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

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

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

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