Contagious Horror: Infectious Themes in Fiction and Film.

Infectious diseases have been a preeminent part of literature since the earliest human writings. In particular, they have contributed greatly to the genre of horror-written or visual art intended to startle or scare. Horror fiction has emphasized infectious themes from the earliest Babylonian and Hebrew texts. In medieval times, stories of vampires and werewolves often had a contagious component, and pivotal works of Victorian horror centered around fear of infection and contamination. As film became prominent in the 20th Century, a strong emphasis on themes of plague and apocalypse developed. An analysis of the use of infection in horror fiction and film shows that it often represents a metaphor for societal concerns, and it is extremely useful in framing challenging issues for a wide audience.

Contagious rhythm: infectious diseases of 20th century musicians.

Infectious diseases have led to illness and death for many famous musicians, from the classical period to the rock 'n' roll era. By the 20th century, as public health improved and orchestral composers began living more settled lives, infections among American and European musicians became less prominent. By mid-century, however, seminal jazz musicians famously pursued lifestyles characterized by drug and alcohol abuse. Among the consequences of this risky lifestyle were tuberculosis, syphilis, and chronic viral hepatitis. More contemporary rock musicians have experienced an epidemic of hepatitis C infection and HIV/AIDS related to intravenous drug use and promiscuity. Musical innovation is thus often accompanied by diseases of neglect and overindulgence, particularly infectious illnesses, although risky behavior and associated infectious illnesses tend to decrease as the style matures.

Implementing CAP guidelines: impediments and opportunities.

CONTEXT: The implementation of guidelines for treatment of Community-Acquired Pneumonia (CAP) has been proposed as a quality improvement and cost-saving strategy, though the effectiveness of several recommendations has yet to be confirmed through clinical trials. We sought to analyze the development and implementation of guidelines at our hospital, and to identify particular successes and impediments. EVIDENCE ACQUISITION: Date sources included the Web sites of the Joint Commission on Accreditation of Healthcare Organizations, the Infectious Disease Society of America, and the American Thoracic Society. References from their guidelines were reviewed, and further citations were obtained using Ovid software to search for references within the last 15 years using "pneumonia guideline," "pneumococcal vaccination," and other relevant search terms. Our own hospital data was compiled, analyzed, and presented using Excel software. EVIDENCE SYNTHESIS: Significant improvement was seen during the 2-year study period when CAP guidelines were implemented at our hospital. However, we also identified several impediments, which will require further attention to achieve our quality improvement goals. CONCLUSIONS: Our implementation of CAP guidelines was challenging but overall instructive and contributory to patient care. We review further areas for improvement.

High prevalence of genital mycoplasmas among sexually active young adults with urethritis or cervicitis symptoms in La Crosse, Wisconsin.

Sexually active young adults in the small college town of La Crosse, Wisconsin, were evaluated for conventional sexually transmitted pathogens and tested for infections with mycoplasmas. The prevalence in 65 symptomatic men or women and 137 healthy volunteers (67 men and 70 women) was compared. Urine specimens from both cohorts were tested by ligase chain reaction for Chlamydia trachomatis or Neisseria gonorrhoeae. In addition, the urethral or cervical swabs from the symptomatic subjects were tested by PCR for Mycoplasma genitalium and cultured for Mycoplasma hominis and the ureaplasmas. The results confirmed a relatively low prevalence of gonorrhea among symptomatic men (12%) and chlamydia among symptomatic men (15%) and normal women (3%). In contrast, infections with mycoplasmas, especially the ureaplasmas (57%), were common and the organisms were the only potential sexually transmitted pathogen detected in 40 (62%) symptomatic subjects. Because of the high prevalence, we also evaluated urethral swabs from an additional 25 normal female volunteers and recovered ureaplasmas from 4 (16%) subjects. Additionally, the participants rarely used protection during sexual intercourse and some symptomatic subjects apparently acquired their infections despite using condoms regularly. The findings demonstrate a strong association between abnormal urogenital findings and detection of myoplasmas, particularly ureaplasmas, and suggest the infections will remain common.

J. Marion Sims, the father of gynecology: hero or villain?

J. Marion Sims (1813-1884) has been called the "Father of Gynecology" for his revolutionary approach to treating the diseases of women. He rose from humble origins to become a successful surgeon, teacher, and writer. His innovations included the first successful treatment for vesicovaginal fistula, the first gallbladder surgery, and the introduction of antiseptic principles in all areas of surgical treatment. The "Sims position" and "Sims speculum" are eponymic tributes to his accomplishments. In recent years Sims has, however, become a focus of controversy because of his experimental surgeries on slave women. His powerful personality and messianic attitude led him to minimize moral problems, and to bristle against opposition. Ethical principles of autonomy and beneficence are important criteria for evaluating Sims' research. An exploration of the nature of Sims' work and the atmosphere in which he practiced will illuminate the critical ethical questions surrounding Sims' use of slave women as experimental subjects.

"Commissioned by God": Mother Bickerdyke during the Civil War.

Mary Ann Bickerdyke, nurse, herbalist, and humanitarian, stood out as a singular figure during the American Civil War and afterward. She advocated nutrition and herbal medicines at a time when "heroic," if futile, treatments were often the rule. Her compassion toward ill soldiers was legendary and provided her with the nickname "Mother." Nevertheless, she did not hesitate to stand up to the bureaucratic and occasionally incompetent physician administrators who opposed her. Working in an arena typically off limits for women, she exceeded the bounds proscribed for her sex during the 19th century as a naturopathic physician, humanitarian, and social reformer.