Blowing Smoke Up Your Arse: Drowning, Resuscitation, and Public Health in Eighteenth-Century Venice.

This article examines resuscitation practices in the second half of the eighteenth century, especially the new use of tobacco smoke enema machines on people who had been extracted from water with no signs of life. Drownings accounted for a small number and proportion of urban deaths, yet governments promoted resuscitation techniques at considerable expense in order to prevent such deaths. The visibility of drowning in religious, urban, and civic life encouraged engagement with new approaches. Analyzing the deployment of resuscitation practices illuminates three key features of premodern public health interventions: the focus of governments on the logistics of these interventions, the participation of physicians and surgeons at all levels of the professional hierarchy, and the importance of communication.

Cien años después, recordando cómo BMJ y JAMA comunicaron la pandemia de gripe de 1918-1919 / One hundred years later, recalling how BMJ and JAMA reported the 1918-1919 influenza pandemic

RESUMEN La pandemia de gripa que en 1918-1919 asoló el planeta, es sin duda el evento de enfermedad masivo de mayor virulencia y letalidad que la especie humana ha sorteado a lo largo de la historia. Este ensayo se centró en evaluar, a partir de lo publicado en la literatura médica de dos de las más importantes revistas de la época, (BMJ) The British Medical Journal y (JAMA)The Journal of the American Medical Association, la interpretación que desde la medicina se hizo de este fenómeno y de la respuesta que en términos de tecnología diagnóstica y terapéutica se dio por parte de los médicos. Se encontró que el arsenal de conocimientos, diagnóstico y terapéutica de la época ofrecía muy pocas herramientas para abordar el manejo clínico y frenar los contagios y mortalidad. No obstante, las dificultades que debieron sortear los clínicos y autoridades sanitarias de la época se constituyeron en un sólido aliciente para que en poco tiempo se avanzara significativamente en la comprensión y manejo de las enfermedades infecciosas, particularmente de etiología viral.

ABSTRACT The influenza pandemic that ravaged the planet in 1918-1919 is, undoubtedly, the most virulent and lethal infectious disease that the human species has ever overcome. This essay was to evaluate the medical interpretation of this phenomenon and the response given by doctors in terms of diagnostic and therapeutic technology based on the data published in the medical literature of two of the most important journals of the time, BMJ (The British Medical Journal) and JAMA (The Journal of the American Medical Association). It was found that the arsenal of knowledge, diagnosis and therapeutics of the time offered very few tools to address clinical management and curb contagion and mortality. However, the difficulties that clinicians and health authorities had to overcome were a solid incentive to make significant progress in the understanding and management of infectious diseases, particularly of viral etiology, in a short period of time.

A pandemia de gripe que devastou o planeta em 1918-1919 é, sem dúvida, o evento de doença maciça mais virulento e letal que a espécie humana passou ao longo da história. Este ensaio teve como objetivo avaliar, a partir do que foi publicado na literatura médica de duas das mais importantes revistas da época, (BMJ) The British Medical Journal e (JAMA) The Journal of American Medical Association,a interpretação que a medicina fez desse fenômeno e a resposta que os médicos deram em termos de tecnologia diagnóstica e terapêutica. Verificou-se que o arsenal de conhecimento, diagnóstico e terapia da época oferecia pouquíssimas ferramentas para abordar o manejo clínico e impedir infecções e mortalidade. No entanto, as dificuldades que os médicos e as autoridades de saúde da época tiveram que superar foram um sólido incentivo para que, em pouco tempo, fossem feitos progressos significativos no entendimento e tratamento de doenças infecciosas, particularmente de etiologia viral.(AU)

Origins in the USA in the 1980s of the warning that smokeless tobacco is not a safe alternative to cigarettes: a historical, documents-based assessment with implications for comparative warnings on less harmful tobacco/nicotine products.

BACKGROUND: Before the 1980s in the USA, smokeless tobacco carried no health warnings, was not judged to cause disease, and was a declining practice. In 1986, the federal government passed legislation requiring rotating warnings on "mouth cancer," "gum disease and tooth loss," and "This product is not a safe alternative to cigarettes." This paper explores the history of the establishment of these warnings with emphasis on the 'not a safe alternative' warning and the bases for claiming that smokeless was 'not safe' (absolute harm) versus 'not safer than cigarettes' (relative harm). METHODS: Results of searches of Truth Tobacco Industry Document archives and transcripts of legislative hearings were analyzed. Critical assessments were made of the evidence-base. RESULTS: New evidence of oral cancer causation emerged along with a much-publicized case of a teenager dying of oral cancer. Public health concerns also arose over a widespread, successful marketing campaign implying smokeless was a safe alternative to cigarettes. Industry wanted pre-emptive federal warnings, to prevent a diversity of pending state warnings. To avoid an addiction warning, the industry accepted a compromise 'not a safe alternative' warning, which had not been initially proposed and which the cigarette industry may have sought in order to constrain the smokeless tobacco industry. The evidence presented supported smokeless only as 'not safe' and not 'as harmful as cigarette smoking.' CONCLUSIONS: The comparative warning was a compromise to prevent an addiction warning and consistent with the preferences of cigarette companies. Prior surveys indicated that the public generally did not view smokeless tobacco as harmless, but they did generally report smokeless as less harmful than cigarettes despite expert interpretations to the contrary. As would not have been appreciated by public health supporters at the outset, subsequent research has shown that the 'not a safe alternative' message is misinterpreted by consumers to indicate that smokeless is 'not safer' than cigarettes-which was not established and has been disconfirmed by subsequent assessments of that question. Though many countries have banned smokeless tobacco (but not cigarettes), where smokeless is legally available accurate information on the nature of harms and differential harms needs to be developed.

High-Society Framing: The Brooklyn Eagle and the Popularity of Twilight Sleep in Brooklyn.

Twilight Sleep (TS) is an obstetric intervention during which a laboring woman enters a semiconscious state via injection. TS received enthusiastic support in Brooklyn, NY, in The Brooklyn Eagle (TBE) newspaper between 1914 and 1918. The purpose of this article is to analyze the framing of TS in TBE as the most popular obstetric intervention among wealthy, White socialites in Brooklyn during the period. The coverage in TBE prompted a nearly universally positive perception of TS among the newspaper's wider readership. After extensive historiographical research and rhetorical analysis of newspaper coverage of TS in TBE, we discovered a form of framing we call "high-society framing," rooted in both wealth and notoriety. We discuss four possible effects of high-society framing: The first is the ability of high-society framing to attract or repel the public regarding a health care issue, and the second is the impact of high-society framing on public perception of medical interventions, procedures, or pharmaceuticals. A third possible effect of high-society framing is that it can alter notions of necessity, and a fourth is that high-society framing can elicit a tacit acceptance of medical interventions, procedures, and pharmaceuticals, thus obfuscating risk. Finally, we argue that high-society framing has implications for the discussion of health care in present-day mediated discourses.

"Dark Victory" (prognosis negative): The beginnings of neurology on screen.

In "Dark Victory," released in theaters in 1939, the diagnosis and management of a progressive brain tumor was a central part of the screenplay, and this film marked the beginnings of the depiction of neurologic disease in cinema. Bette Davis' cinematic portrayal of a young woman dying from a brain tumor is close to the reality of denial, bargaining, a hope for a cure, and final acceptance. "Dark Victory" includes part of a neurologic examination (funduscopy, testing of strength, testing of stereognosis, and tendon reflexes). The film also alludes to decisions on what to tell the patient (better say nothing) and shows an implausible clinical course (an abrupt peaceful ending). The film is unusual in depicting the presentation of a brain tumor, but the cinematic portrayal of the vicissitudes of living with a brain tumor is often close to reality.

Historical aspects of immunization and vaccine safety communication.

It has been a long journey starting from the beginnings of variolation [3] leading up to the greatest success in the history of immunization: the eradication of smallpox [39]. Today, vaccines are an acknowledged important medical advance [40]. Nevertheless, immunization has been the subject of public controversy on several occasions [15, 24, 31]. This article shall provide a short overview of some aspects of the early stages of immunization in Western countries, including some examples of vaccine safety controversies in the past.

History and evolution of warning labels for automotive friction products.

There have been claims over the years that asbestos-containing product manufacturers did not sufficiently warn end users early enough regarding the potential health hazards associated with their products (1930s-1990s). To address this issue, we compared the content of the warnings associated with asbestos-containing friction products (brakes, clutches, and gaskets) manufactured by the US automotive industries to what was expected by regulatory agencies during the time period in which an understanding of asbestos health hazards was being developed. We ended our evaluation around 1990, since asbestos-containing manufacturer supplied automotive products were functionally removed from commerce by 1985 in the United States. We assessed the warnings issued in users' manuals, technical service bulletins, product packaging materials, and labels placed on products themselves. Based on our evaluation, regulatory agencies had no guidelines regarding specific warning language for finished friction products, particularly when a product contained encapsulated asbestos fibers (i.e., modified by a bonding agent). Even today, federal regulations do not require labeling on encapsulated products when, based on professional judgment or sampling, user exposure is not expected to exceed the OSHA PEL. We concluded that, despite limited regulatory guidance, the US automotive industry provided adequate warnings with regards to its friction products.

Revisión documental de experiencias de actividad comunitaria en atención primaria de salud / Documental review of community health promotion experiences in primary health care

ObjetivoDescribir las actividades comunitarias (AC) publicadas o inscritas en redes de promoción de la salud en las que ha participado Atención Primaria (AP).DiseñoEstudio descriptivo, mediante revisión documental de experiencias.Fuentes de datosArtículos, actividades en redes de intercambio de experiencias on-line, comunicaciones y proyectos premiados.Selección de experienciasSe incluyeron AC en las que AP y la comunidad atendida participaban en su inicio, desarrollo y/o evaluación, sin ser acciones puntuales.Extracción de datosSe recogieron las siguiente variables: fuente, año del registro del documento, CCAA, Municipio, número y nombre de los centros de salud implicados, población diana, objetivos, participación de la comunidad, y de sectores sanitarios y no sanitarios, perspectiva teórica, y métodos de evaluación.ResultadosSe identificaron 472 actividades que cumplían criterios, con participación de 300 centros de salud de la mayoría de CCAA. El 71,8% registradas en redes on-line, y el 19,3% en artículos. Las poblaciones diana más frecuentes fueron población general (22,2%), jóvenes (18,2%) y madres y padres (10,2%). El 58,2% tenía como objetivos: capacitar a la comunidad para optar por comportamientos más saludables, transmitir información sanitaria a la población, o fomentar el autocuidado. En el 33,3% no participó ningún agente además de AP. Del resto, participaron sectores no sanitarios en el 53,8%, entidades cívicas 26,9% y administraciones 24,2%.ConclusionesLa mayoría de las AC documentadas se encuentran en redes y su presencia por CCAA es desigual. La participación de otros sectores diferentes de AP en las actividades identificadas es baja(AU)

ObjectiveDescribe the community activities (CA) published or registered in health promotion networks in which Primary Health Care (PHC) has taken part.DesignDescriptive study, by documental review of experiences. Data source: articles, activities in exchange networks, presentations and funded projects.Selected experiencesThe AC included were those where PHC and the local community were involved in its inception, development and/or evaluation, but not solitary actions with no continuity.Data extractionThe following variables were collected: Source and year of the document; region; municipality; name and number of health centres involved; target population; objectives; involvement of the community, the health and the non-health sectors; theoretical perspective and evaluation methods.ResultsA total of 472 activities were found that met criteria, involving 300 health centres in most of the autonomous regions. Of those, 71.8% were registered in networks, and 19.3% were registered in articles. The most frequent target populations were: the general population (22.2%), youth (18.2%) and parents (10.2%). More than half (58.2%) had one or more of the following objectives: to empower the community to choose healthy behaviours; transmit health information to the population, or encourage self-care. In 33.3% of the activities there were no other sectors involved besides Primary Care. Of the remainder, non-health sectors participated in 53.8%, civic bodies in 26.9%, and government administration in 24.2%.ConclusionsMost of the CA are documented in networks and their presence is uneven by region. The involvement of sectors other than PHC in the activities identified is low(AU)