Explore the tragic history of the psychiatric lobotomy and its legacy in modern medicine. Dr. Walter Freeman about to perform a transorbital lobotomy By Stuart M. Caplen, MD For a brief period in the mid-20th century, severing nerve connections in the frontal lobe was considered a breakthrough treatment for schizophrenia, depression, and violent behavior. Psychosurgery, or more specifically, frontal lobotomy, was performed on tens of thousands of patients. Proponents believed that the procedure allowed severely depressed or violent psychotic patients to leave crowded asylums. Critics argued that the procedure was unethical, pointing out that it frequently left patients apathetic and emotionally blunted, carried a significant mortality rate, and left some patients in a vegetative state. History In prehistoric times, trephination, the practice of drilling holes into the skull, was thought to have been performed by shamans or healers to treat conditions such as epilepsy, headaches, or other cerebral illnesses by allowing the demons supposedly causing them to escape. The first relatively modern psychosurgical procedure prior to the lobotomy was performed in 1888 by Swiss psychiatrist Dr. Gottlieb Burckhardt. He resected portions of the temporal and parietal lobes in six patients displaying severe psychiatric symptoms and aggressive behavior. His work was not well received by his colleagues at the time, and he stopped performing the procedure. At a 1935 scientific conference, Dr. John F. Fulton of Yale, with his colleague Dr. Carlyle Jacobsen, presented an experiment involving bilateral frontal cortex resections on chimpanzees. The surgery caused the animals to become less aggressive leaving them “devoid of emotional expression” and incapable of the “frustrational behavior” typically seen in the species. Dr. António Egas Moniz, a professor of neurology at the University of Lisbon, and his colleague, neurosurgeon Dr. Almeida Lima, attended that conference, and later became the leading proponents of psychosurgery. (Moniz is also known as the “father of cerebral angiography.”) Severe mental illness in the late 19th and early 20th centuries had no effective treatments, leaving patients confined to psychiatric hospitals for long periods of time. The use of straitjackets and isolation in cells with padded walls was common, and the number of institutionalized psychiatric patients continued to increase dramatically. In 1937, the U.S. had “more than 450,000 patients institutionalized in 477 asylums, with nearly one-half of them hospitalized for five years or longer.” Austrian neurologist Sigmund Freud developed psychoanalysis near the end of the 19th century, but talk therapy offered limited benefit to patients with severe psychotic disorders. During the 1930s, physicians also experimented with insulin shock therapy and, later, electroconvulsive therapy (ECT). Although ECT proved effective for some psychiatric disorders, particularly severe depression, it failed to help many patients with chronic psychosis. In this desperate therapeutic environment, physicians had few effective options for treating severe psychosis, and psychosurgery appeared to offer a promising solution. In 1935, Moniz and Lima started performing frontal leucotomies (later called lobotomies), which destroyed the white matter connections between the prefrontal cortex and the thalamus. Initially, they used alcohol injections but soon turned to surgical procedures, ultimately presenting results on 20 psychiatric patients. They reported that their patients were calmer, easier to manage, and less emotionally reactive after surgery. In 1949, Moniz was awarded the Nobel Prize in Physiology or Medicine “for the discovery of the therapeutic value of leucotomy in certain psychoses.” (In 2005, some relatives of lobotomy patients petitioned the Nobel Committee to revoke the prize, although the request was denied.) In the United States, neurosurgeon Dr. James W. Watts and neurologist Dr. Walter Freeman started performing frontal lobotomies using burr holes on the sides of the skull to access the brain. In 1942, they published a report on 200 patients who had undergone the procedure, and noted that 63% improved, 23% were unchanged, and 14% either deteriorated or died from the surgery. Many patients were considered improved because they became calmer and less aggressive, although these changes often came at the cost of initiative, personality, and emotional responsiveness, as well as a significant risk of death. One of their most famous failures was Rosemary Kennedy, John F. Kennedy’s sister. She was lobotomized in 1941 at the age of 23, in an attempt to treat an intellectual disability combined with mood swings and rebellious behavior. Following the procedure, she lost much of her ability to walk and speak and required lifelong care. Dr. Walter Freeman – “Ice Pick” Surgery and the “Lobotomobile“ Freeman later developed the transorbital leucotomy (transorbital frontal lobotomy), where he accessed the brain through the top of the eye socket. He initially used an ordinary ice pick and later an instrument he invented, called the orbitoclast, to destroy the connections between the frontal lobe and the thalamus. This did not require opening the skull as a traditional frontal lobotomy did. He frequently administered electroconvulsive therapy to his patients prior to the procedure to induce unconsciousness, rather than as a psychiatric treatment. Freeman’s lack of sterile technique (he frequently did not wear surgical gloves or masks) and the crude nature of the surgery eventually alienated Watts, while also drawing criticism from other neurosurgeons. As a significant percentage of his patients either showed no change, got worse, or died, the medical community became disenchanted with the procedure. Freeman, however, was undeterred and remained an enthusiastic advocate of the procedure. He drove his customized van around the country performing the procedure in hospitals and occasionally even in hotel rooms. The van was later dubbed the “lobotomobile“ by critics and the press. Dr. Walter Freeman in his van, later known as the “Lobotomobile” Freeman bragged he could finish the procedure in less than 10 minutes. He performed over 3,500 lobotomies in his career, sometimes up to 25 in a day, with some sources attributing approximately 490 patient deaths from his surgeries. While some desperate families expressed gratitude at the time, Freeman ultimately left many people permanently incapacitated or dead. Frontal and prefrontal lobotomies became widely used procedures, and between 1936 and 1956, an estimated 60,000 lobotomies were performed in the U.S. and Europe. The procedure gained popularity because it offered overcrowded psychiatric hospitals a way to reduce violent or disruptive behavior at a time when few effective treatments existed. The End of the Lobotomy In 1952, the first successful antipsychotic medication, chlorpromazine, was released in Europe and was available two years later in the U.S., marking the beginning of an era of effective pharmacologic treatment that would ultimately replace lobotomies. Additional antipsychotic drugs followed in subsequent years. However, Freeman continued to perform transorbital frontal lobotomies until he was finally banned from operating in 1967, following the death of what turned out to be his last patient. Summary In an era when little could be done for severe mental illness, lobotomy appeared to many physicians to be a miraculous solution. However, it often produced devastating consequences, including profound personality changes, cognitive impairment, and death. One of the controversies surrounding lobotomy was that “improvement” was measured by patient compliance and calmness rather than preservation of personality, independence, or quality of life. Fortunately, the development of effective psychiatric medications provided safer alternatives and brought this controversial chapter in medical history to an end. If you liked this article, you may also find these other FibonacciMedicine history of medicine articles interesting: The History of the Black Death and How a Medieval Pandemic Still Affects Us Today The History of Tuberculosis and How Colorado Became the “World’s Sanitarium” The History of Malaria The Discovery of Radium and the Start of the “Radium Cure Craze” Era The History of Mercury as Medicine How Gila Monsters and Gut Hormones Changed Modern Medicine - The History of GLP-1 Drugs The History of Insulin and Type 1 Diabetes The History of “Snake Oil” and “Snake Oil Salesmen” The “Transfusion Affair” that Shook the Paris Medical Establishment The Milk Transfusion Era The History of Nitroglycerin, an Explosive with Medical Benefits The History of Heroin, the “Non-addictive” Substitute for Morphine The Story of the Most “Kissed” Face in the World “Gentlemen this is no humbug” - The First Use of General Anesthesia in Surgery and the Battle for Recognition that Ensued The History of the Coney Island Incubator Babies The Tobacco Smoke Enema, One of the First CPR Techniques? Benjamin Franklin, Mesmerism, and the First Use of Placebos in Science The Fascinating Mystery of “The Toxic Lady” The Dancing Plague of 1518 Penicillin, the Accidental Antibiotic The History of Leeches in Medicine and the Era of the “Leech Mania” The History of the “Whale Cure” for Rheumatism The History of Antiseptic Surgery The History of the Electrocardiogram (EKG/ECG) The History of Phrenology; Just Another Bump in the Road? The Creation of the Gin and Tonic; a Medical Odyssey The History of Cocaine The History of the Iron Lung Dr. Robert Liston and the 300% Mortality Surgery The First Medical Text - The Edwin Smith Surgical Papyrus References Faria MA Jr. Violence, mental illness, and the brain - A brief history of psychosurgery: Part 1 - From trephination to lobotomy. Surg Neurol Int. 2013;4:49. Published 2013 Apr 5. Retrieved from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3640229/ Robison RA, Taghva A, Liu CY, Apuzzo ML. Surgery of the mind, mood and conscious state: an idea in evolution. World Neurosurg. 2012;77:662–86. doi: 10.1016/j.wneu.2012.03.005. [DOI] [PubMed] [Google Scholar] Lobotomy: The brain op described as ‘easier than curing a toothache’. BBC. 29 January 2021. Retrieved from: https://www.bbc.com/news/stories-55854145 Liester MB. A Dark Chapter in Psychiatry: The Lobotomobile. Psychology Today. Updated May 16, 2025. https://www.psychologytoday.com/us/blog/the-leading-edge/202505/a-dark-chapter-in-psychiatry-the-lobotomobile Lobotomy. Encyclopedia Britannica. June 12, 2026. Retrieved from: https://www.britannica.com/science/lobotomy Medically reviewed by Han S. MedicalNewsToday What is a lobotomy? Uses, history, and more. Updated on August 12, 2025. Retrieved from: https://www.medicalnewstoday.com/articles/what-is-a-lobotomy#history Weiner E. Nobel Panel Urged to Rescind Prize for Lobotomies. August 10, 2005. Retrieved from: https://www.npr.org/2005/08/10/4794007/nobel-panel-urged-to-rescind-prize-for-lobotomies Prentice C. Walter Freeman. Claire Prentice, Author and Journalist. https://claireprentice.org/__peopleandplaces/

When Milk was Infused into Ill Patients Discover the bizarre history of milk transfusions, a 19th-century medical practice used to treat cholera and blood loss before the rise of saline and blood typing. By Stuart M. Caplen, MD While blood transfusions from animals to humans were specifically banned in France in 1668 (see the “Transfusion Affair” article), in 1825, James Blundell performed the first documented human-to-human blood transfusion in Europe. This procedure was practiced for over 50 years, mostly in England, with poor results at times. One issue was preventing the blood from coagulating. Another was that many of the subjects of uncrossed-matched blood transfusions suffered from incompatibility reactions as the concept of different blood types was not discovered until 1901. As the numbers of adverse reactions increased, human blood transfusions fell somewhat into disrepute and were rarely performed in the late 1800s. Substitutes for blood transfusion for ill patients were sought and this brought about an era of popularity for milk transfusions. It was thought that the fatty particles in milk were converted to white blood cells by the body and later turned into red blood cells. The first documented intravenous injections of milk to treat humans was performed in 1854, in Toronto, Canada, by Drs. James Bovell and Edwin Hodder during a cholera epidemic. Their first patient was a 40-year-old man who markedly improved after injection of 12 ounces of warmed cow’s milk, which came from a cow that had been brought to the hospital. A second patient also had good results. However, five other patients who later got the milk transfusions died, but the doctors still wanted to continue the practice. Dr. Hodder later noted: “Dr. Bovell and myself then applied to the corporation (of the city of Toronto) for a good cow, and a few articles indispensable for the comfort and well-being of the patient; these were refused, and we thereupon sent in our resignation.” Milk transfusions were not performed again until 1873 when Dr. Joseph Howe in New York City transfused goat’s milk into a tuberculosis patient. The patient immediately suffered vertiginous dizziness after two treatments with 1.5 ounces of intravenous milk. He died the next day. Howe tried milk transfusion on another tuberculosis patient who also suffered vertigo, as well as back pain and shortness of breath. He died four hours after the procedure. Howe performed the procedure a third time in 1878 in front of colleagues at New York Charity Hospital. After an infusion of four ounces of goat's milk the woman's condition appeared to have improved. The most ardent U.S. supporter of milk transfusions was Dr. T. G. Thomas, a New York City gynecologist. In 1875, he transfused cow’s milk into a woman with a uterine hemorrhage. After six ounces of milk were administered, she “complained that her head felt like bursting.” She developed a rapid heart rate and fever, but she improved over the next week. During the next three years he transfused another seven patients with milk and authored an article supporting the practice. Thomas believed that blood transfusions were problematic due to the blood coagulating and that milk was similar in composition to chyle (lymphatic fluid). He predicted a “brilliant and useful future for intravenous lacteal injection and wrote, “The injection of milk into the circulation in place of blood is a perfectly feasible, safe, and legitimate procedure.” More doctors in the U.S. and England started performing milk transfusion procedures on their patients. In 1878, a Dr. Brinton from New York wrote that, ‘‘I think that this procedure will, in a few years, entirely supersede the transfusion of blood.” Transfusion de sang de chèvre (transfusion of goat’s blood)-1892 By 1879, medical opinion was starting to change. French doctors Moutard-Martin and Richet wrote “its injection is a useless and dangerous operation and one which should be absolutely proscribed.” A Dr. Helmuth, in the U.S., concluded that milk transfusion was much more dangerous than blood transfusion. In 1880, Dr. Howe, who had first experimented with milk infusions seven years prior, trialed a human breast milk infusion on a woman with a lung infection. After two ounces were administered the woman stopped breathing but was resuscitated. At that point Howe concluded that milk infusions, regardless of the source, were unsuccessful treatments. By 1880, the procedure of milk infusion had fallen into disfavor, and it was finally abandoned as isotonic* saline solutions became available. The safe transfusion of blood from human-to-human would wait until the beginning of the next century after blood types were discovered and typed and cross-matched blood became available. * (An isotonic solution contains approximately the same concentration of water and solutes as blood plasma causing no net movement of water in or out of cells. Isotonic solutions used today include 0.9% normal saline and Lactated Ringer’s solution.) If you liked this article, you may also be interested in learning what happened when blood transfusions from animals to humans was attempted in The “Transfusion Affair” that Shook the Paris Medical Establishment . Here are more fascinating topics in the FibonacciMedicine history of medicine series: The History of the Black Death and How a Medieval Pandemic Still Affects Us Today The History of Tuberculosis and How Colorado Became the “World’s Sanitarium” The History of Malaria The Discovery of Radium and the Start of the “Radium Cure Craze” Era The History of Mercury as Medicine How Gila Monsters and Gut Hormones Changed Modern Medicine - The History of GLP-1 Drugs The History of Insulin and Type 1 Diabetes The History of “Snake Oil” and “Snake Oil Salesmen” . The History of Nitroglycerin, an Explosive with Medical Benefits The History of Heroin, the “Non-addictive” Substitute for Morphine The Story of the Most “Kissed” Face in the World “Gentlemen this is no humbug” - The First Use of General Anesthesia in Surgery and the Battle for Recognition that Ensued The History of the Coney Island Incubator Babies The Tobacco Smoke Enema, One of the First CPR Techniques? Benjamin Franklin, Mesmerism, and the First Use of Placebos in Science The Fascinating Mystery of “The Toxic Lady” The Dancing Plague of 1518 Penicillin, the Accidental Antibiotic The History of Leeches in Medicine and the Era of the “Leech Mania” The History of the “Whale Cure” for Rheumatism The History of Antiseptic Surgery The History of the Electrocardiogram (EKG/ECG) The History of Phrenology; Just Another Bump in the Road? The Creation of the Gin and Tonic; a Medical Odyssey The History of Cocaine The History of the Iron Lung Dr. Robert Liston and the 300% Mortality Surgery The First Medical Text - The Edwin Smith Surgical Papyrus References Gaillard TG. The intra-venous injection of milk as a substitute for the transfusion of blood : illustrated by seven operations. D. Appleton & Company. 1878. https://backend.production.deepblue-documents.lib.umich.edu/server/api/core/bitstreams/3cd64451-2e45-49e0-872c-714ff87d80d1/content Oberman HA. Early History of Blood Substitutes-Transfusion of Milk. Transfusion. Mar.-Apr. 1969. Retrieved from: https://backend.production.deepblue-documents.lib.umich.edu/server/api/core/bitstreams/3cd64451-2e45-49e0-872c-714ff87d80d1/content Painting by Jules Adler. Transfusion de sang de chèvre. Musée d'Histoire de la Médecine, Paris. 1892. Retrieved from: https://www.researchgate.net/figure/Jules-Adler-1865-1952-Transfusion-de-sang-de-chevre-1892-Oil-on-canvas-1295cm-x_fig1_320372828

Crispy & Easy Chicken Caprese Panini Recipe Creative Cooking for the Health-Conscious Gourmet FibonacciRECIPES | Culinary Medicine by Mary B Grosvenor, MS, RD When summer heat sets in, simple meals that keep the kitchen cool are the way to go. This fancy but easy sandwich relies on a rotisserie chicken so the only cooking involved is 4 minutes on a panini press. It provides plenty of protein and a variety of veggies spiced up with an easy to make pesto mayonnaise. You can even make it on the stove top if you don’t have a panini press. Ingredients 4 Ciabatta rolls 12 oz Rotisserie chicken, sliced 4 oz Fresh mozzarella, sliced 1 Tomato, sliced 2 cups fresh spinach, washed & trimmed 4 tsp Butter or margarine ½ tsp salt ¼ tsp ground black pepper 1 Tbsp prepared basil pesto, 3 Tbsp mayonnaise 1 tsp capers, drained Instructions Prepare pesto mayo by mixing pesto, mayo, and capers, stir well and set aside. Preheat panini press. Prepare Open ciabatta rolls and spread the inside of the bottom half with some pesto mayonnaise. Then layer each with ¼ of the chicken, cheese, tomato and spinach. Sprinkle with salt and pepper. Spread the outside of the top half with butter. Put halves of the roll together. Cook Place sandwiches butter side down on panini grill. Spread butter on the exposed top side of the roll. Close grill and cook for 2 minutes. Flip the sandwich and cook for 2 minutes more. Notes If you don’t have a panini press, heat a fry pan, place the sandwich in the pan and place another weighted pan or skillet on top of the sandwich to compress it while cooking. You won’t get grill marks but still have delicious panini Makes 4 sandwiches Nutrition Information per sandwich 360 Calories, 20 g fat, 9 g saturated fat, 5 mg cholesterol, 35g carbohydrate, 2g fiber, 35 g protein, 415 mg potassium, 700 mg sodium Editor’s Note: This recipe provides for a low-calorie, low-cholesterol, high protein, low carb meal!

A Savory, Herb-Marinated Portobello Mushroom Burger Recipe for Grill Season Creative Cooking for the Health-Conscious Gourmet FibonacciRECIPES | Culinary Medicine by Lori A. Smolin, PhD and Mary B Grosvenor, MS, RD Portobello mushrooms make for a juicy, low-calorie, plant-based alternative to a beef hamburger. They fit nicely on a toasted bun and are delicious topped with pesto, mustard, avocado and any other burger toppings. * Ingredients 4 Portobello mushrooms Marinade 4 T Balsamic vinegar 2 T Soy sauce 2 T Olive oil, plus more for brushing 2 Cloves garlic, minced ½ tsp oregano ½ tsp thyme Fixings 4 Brioche burger buns 4 tsp Dijon mustard 1 Avocado, peeled and sliced ¼ cup prepared basil pesto 1 Tomato, sliced 1 cup fresh spinach leaves Instructions Preheat grill. Remove mushroom stems and clean caps with a brush or damp towel. In a small bowl whisk together vinegar, soy sauce, olive oil, garlic, oregano, and thyme. Place mushrooms, gills up, in a shallow baking dish and drizzle marinade over them, turn to ensure both sides are soaked. Let stand at room temperature for 20 to 30 minutes. Place mushrooms on the grill and reserve marinade. Cook 5 to 10 minutes per side until they are flattened and tender, brushing frequently with marinade. Brush cut side of buns with oil and toast on grill. Spread mustard on the toasted bun. Add avocado and smash with a fork. Top with pesto, tomato slices, spinach leaves and salt and pepper as desired. Notes: For a vegan meal, choose a vegan pesto and burger bun. *You can vary the toppings: try melted cheese, ketchup, caramelized onions, or aioli. Makes 4 Servings (1 Burger) Nutrition Information per serving Calories 416, Total Fat 23.3g, Saturated fat 4 g, Cholesterol 15 mg, Total Carbohydrate 48g, Fiber 4.5g, Protein 15g, Sodium 1162mg, Potassium 1091mg Editor’s Note: This recipe is appropriate for a low-cholesterol, low saturated fat vegetarian dietary regimen. It also provides for a good source of fiber. Read the article "The Magic of Mushrooms" FibonacciRECIPES has many recipes with mushrooms - just type "mushroom" in the search bar.

Discover the fascinating story of penicillin, the accidental antibiotic that revolutionized medicine. Learn about its discovery, early trials, and the challenges faced in mass production. Medical Trivia by Stuart M. Caplen, MD The accidental discovery of penicillin was an event that changed the world, as infections that could not be treated previously were then curable. Even today, almost 100 years after its discovery, penicillin is still a first line drug for some infections such as strep throat and syphilis. On September 3, 1928, Alexander Fleming, a Professor of Bacteriology at St. Mary's Hospital in London, returned from vacation and noticed something odd in one of his petri dishes. There was some mold growing in a culture of Staphylococcus aureus that had a clear zone around it signifying that this accidental mold had inhibited the growth of the Staph bacteria. The mold was identified as a rare strain of Penicillium notatum. He later discovered that his ”mold juice” could kill a wide range of harmful bacteria. However, he was unable to isolate pure penicillin from the mold. In 1939, Howard Florey, Ernst Chain, and their colleagues at the Sir William Dunn School of Pathology at Oxford University started work on the purification of penicillin and were successful. In 1940, Florey demonstrated that penicillin could protect mice against infection from Streptococcal infections. In February 1941, an Oxford England policeman named Albert Alexander was the first person in the world to be treated with penicillin. As the story goes, he had scratched his mouth pruning roses* and developed abscesses and a life-threatening infection. He was started on intravenous penicillin and made a remarkable recovery. His monumental recovery did not last. His physicians ran out of penicillin, even after recycling the drug from his urine. He was unable to complete his course of treatment and succumbed to infection. It was not uncommon when penicillin first started being used to recover excreted penicillin from the patient’s urine and then reinfuse it, as the drug was so scarce and up to 70% of administered penicillin could be recovered. In March of 1942, Anne Miller, a woman with streptococcal sepsis after a miscarriage, became the first person to be cured by penicillin. She was severely ill in a Connecticut hospital and her doctor managed to obtain a tablespoon of penicillin, reportedly half of the entire store of penicillin in the U.S. at that time. After she recovered, her urine was sent back to Merck & Company pharmaceuticals for reconstitution and reuse of the penicillin for another patient. By 1943 there was enough penicillin made to treat thirty people in the U.S. By mid-1944 chemists and drug companies, with the support of the U.S. War Production Board, had discovered more effective ways to produce penicillin so even after supplying the military, they were able to start allowing civilian access to the drug. (* The classical history is that Alexander injured himself pruning roses. However, 70 years later it was discovered and confirmed by family that the injury had been from shrapnel during a German bombing raid.) ________________________________________________________________________________________________________ If you liked this article, here are more fascinating topics in the FibonacciMedicine history of medicine series: The History of the Black Death and How a Medieval Pandemic Still Affects Us Today The History of Tuberculosis and How Colorado Became the “World’s Sanitarium” The History of Malaria The Discovery of Radium and the Start of the “Radium Cure Craze” Era The History of Mercury as Medicine How Gila Monsters and Gut Hormones Changed Modern Medicine - The History of GLP-1 Drugs The History of Insulin and Type 1 Diabetes The History of “Snake Oil” and “Snake Oil Salesmen” The “Transfusion Affair” that Shook the Paris Medical Establishment The Milk Transfusion Era The History of Nitroglycerin, an Explosive with Medical Benefits The History of Heroin, the “Non-addictive” Substitute for Morphine The Story of the Most “Kissed” Face in the World “Gentlemen this is no humbug” - The First Use of General Anesthesia in Surgery and the Battle for Recognition that Ensued The History of the Coney Island Incubator Babies The Tobacco Smoke Enema, One of the First CPR Techniques? Benjamin Franklin, Mesmerism, and the First Use of Placebos in Science The Fascinating Mystery of “The Toxic Lady” The Dancing Plague of 1518 Penicillin, the Accidental Antibiotic The History of Leeches in Medicine and the Era of the “Leech Mania” The History of the “Whale Cure” for Rheumatism The History of Antiseptic Surgery The History of the Electrocardiogram (EKG/ECG) The History of Phrenology; Just Another Bump in the Road? The Creation of the Gin and Tonic; a Medical Odyssey The History of Cocaine The History of the Iron Lung Dr. Robert Liston and the 300% Mortality Surgery The First Medical Text - The Edwin Smith Surgical Papyrus ________________________________________________________________________________________________________ References: Sullivan B. Guns, not roses – here is the true story of penicillin’s first patient. The Conversation. March 11, 2022. Retrieved from: https://theconversation.com/guns-not-roses-heres-the-true-story-of-penicillins-first-patient-178463 Discovery and Development of Penicillin. American Chemical Society. 1999. Retrieved from: https://www.acs.org/education/whatischemistry/landmarks/flemingpenicillin.html Rothman L. This Is What Happened to the First American Treated with Penicillin. Time. March 14, 2016. Retrieved from: https://time.com/4250235/penicillin-1942-history/ Czepiel KL. Daily Nutmeg, New Haven. March 16, 2022. Retrieved from: https://dailynutmeg.com/blogs/blog/penicillin-new-haven-medical-history-redux

The Speed Surgeon: Robert Liston’s Innovative Practice and Infamous Blunder Medical Trivia by Stuart M. Caplen, MD Dr. Robert Liston Dr. Robert Liston (or Mr. Robert Liston, as surgeons were referred to in England) was born on October 28, 1794, and became one of the leading surgeons in London. He had a 10% mortality rate compared to other surgeons, where 40% was the average. He was ahead of his time, and long before it became standard practice, he washed his hands and instruments, wore clean aprons, and shaved surgical sites. Later in his career, he was the first surgeon in Europe to use general anesthesia, and he was also known for inventing new surgical techniques and instruments. Prior to the use of anesthesia, the fastest surgeons were considered the best, as it decreased the time the patient was in pain and the amount of blood loss. Liston was one of the fastest, performing amputations in as little as 30 seconds. In fact, his catchphrase in the operating room to medical students holding stopwatches was, “Time me, gentlemen, time me!”. Unfortunately, that hubris and speed occasionally got him and his patients into trouble. His most infamous operation was one that resulted in three fatalities. During one of his trademark high-speed limb amputations, he managed to also cut off some of his assistant’s fingers and slashed the coat of a nearby spectator. According to reports, both the patient and the assistant later died from infection, and the observer, who apparently thought he had been stabbed, dropped dead from shock right in the operating room. Thus, Dr. Liston, despite all his success, also became known for having the only recorded 300% mortality surgery in history. If you liked this article, here are more fascinating topics in the FibonacciMedicine history of medicine series: The History of the Black Death and How a Medieval Pandemic Still Affects Us Today The History of Tuberculosis and How Colorado Became the “World’s Sanitarium” The History of Malaria The Discovery of Radium and the Start of the “Radium Cure Craze” Era The History of Mercury as Medicine How Gila Monsters and Gut Hormones Changed Modern Medicine - The History of GLP-1 Drugs The History of “Snake Oil” and “Snake Oil Salesmen” The History of Insulin and Type 1 Diabetes The “Transfusion Affair” that Shook the Paris Medical Establishment The Milk Transfusion Era The History of Nitroglycerin, an Explosive with Medical Benefits The History of Heroin, the “Non-addictive” Substitute for Morphine The Story of the Most “Kissed” Face in the World “Gentlemen this is no humbug” - The First Use of General Anesthesia in Surgery and the Battle for Recognition that Ensued The History of the Coney Island Incubator Babies The Tobacco Smoke Enema, One of the First CPR Techniques? Benjamin Franklin, Mesmerism, and the First Use of Placebos in Science The Fascinating Mystery of “The Toxic Lady” The Dancing Plague of 1518 Penicillin, the Accidental Antibiotic The History of Leeches in Medicine and the Era of the “Leech Mania” The History of the “Whale Cure” for Rheumatism The History of Antiseptic Surgery The History of the Electrocardiogram (EKG/ECG) The History of Phrenology; Just Another Bump in the Road? The Creation of the Gin and Tonic; a Medical Odyssey The History of Cocaine The History of the Iron Lung Dr. Robert Liston and the 300% Mortality Surgery The First Medical Text - The Edwin Smith Surgical Papyrus _______________________________________________________________________________________ Rich's Picks As an Amazon Associate FibonacciMD earns from qualifying purchases. The intense focus and breakneck speed required to perform a 30-second amputation would surely demand a surgeon's full attention. While Liston didn't have access to modern energy, you can fuel your own focus while reading history's most fascinating tales with a robust cup of Bulletproof Breakfast Blend Coffee. [https://amzn.to/47YytXH] The history of medicine is full of dramatic life-or-death tales. For another gripping survival tale, read The Wager by David Grann. A gripping historical non-fiction account of survival and high-stakes drama. [https://amzn.to/4rclx9I] If you enjoy immersing yourself in rich historical settings like 19th-century London, the Tudor period explored in the historical fiction novel Dark Fire by C.J. Sansom offers a similarly fascinating look at a pivotal time in British history. [https://amzn.to/3X0uCVd] Resources Andrew J. Jones AJ, Nesbit Jr. RR, Holsten SB. Time me, gentlemen! The bravado and bravery of Robert Liston. The American College of Surgeons. 2016 Retrieved from: https://www.facs.org/media/nggpiakr/05_liston.pdf Dzikiewicz K, Howes Fellow PG. Dr. Liston and the Surgery That Killed Three People. December 03, 2018. Retrieved from: https://www.storagetwo.com/blog/2018/12/dr-liston-and-the-surgery-that-killed-three-people Hawk AJ. ArtiFacts: Built for Speed-Robert Liston's Surgical Technique. Clin Orthop Relat Res. 2021;479(4):679-680. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083913/ initially posted 5/2024

Culinary Medicine by Lori A Smolin, PhD and Mary B Grosvenor, MS, RD Mushrooms pop up everywhere. We serve them on pizza, fold them into omelets, add them to salads and soups, and sauté them as sides. Although they are found in the produce section of the grocery store, they are technically not plants; they are a fungus.[1] While eating fungi may not sound very appetizing, mushrooms offer a multitude of culinary and health benefits. What are Fungi? Fungi, which includes mushrooms, yeasts, and molds, make up one of the six taxonomic kingdoms. Unlike the plant kingdom, fungi do not have chlorophyl, so they cannot convert sunlight into food energy via photosynthesis. Unlike most members of the animal kingdom, they do not take food into their bodies to digest and absorb it. Instead, fungi break down organic material in their environment and absorb nutrients through their cell walls. The mushrooms we eat are the fruiting bodies of certain fungi. They develop from an underground network of branching, thread-like filaments called mycelium. The primary role of mushrooms is to produce and release spores that allow fungi to reproduce and spread. 2] Mushrooms: Past and Present Mushrooms have been part of the human diet and culture for thousands of years.[3] Ancient civilizations ate them for strength, healing, and ritual 4] Today, about 25 species are widely accepted as human food. [3,5] Some are cultivated and some are foraged. Common cultivated varieties include button, cremini, portobello, shiitake, and oyster.[6] Mushrooms like morels, chanterelles, and maitakes are foraged because they only thrive in a damp, dark forest ecosystem. These sylvan species are considered a delicacy, often costing up to $100 per pound compared to about $4 per pound for button mushrooms. While it may be tempting to forage these pricey mushrooms, unless you have been trained to distinguish between edible and toxic varieties, it is better to stick to store-bought. Globally, thousands become ill every year after eating poisonous mushrooms, and more than 100 people die. [7] Nutrition and Health Mushrooms offer many nutritional benefits. They are a good source of protein, fiber, and micronutrients and are low in calories, fat, and sodium. A half-cup serving of cooked mushrooms has about three grams of protein, less than a serving of meat, beans, or fish but still an important dietary contribution. The protein they supply is easily digested and absorbed and provides all the essential amino acids.[8] Mushrooms are also a good source of riboflavin and niacin, and contain smaller amounts of other B vitamins and vitamins C and E. They are the only nonanimal source of vitamin D. Wild mushrooms are a good source because they are naturally exposed to UV light from the sun, but the cultivated variety only contain vitamin D if they have been treated with UV light, which is needed to synthesize this vitamin.[9] Mushrooms are also a good source of minerals, including calcium, magnesium, phosphorous, iron, zinc, potassium, copper, and selenium. [10] The bioactive compounds in mushrooms have health benefits that range from reducing the risk of cancer and cardiovascular disease to improving brain health. For example, higher mushroom consumption has been associated with a lower risk of cancer, particularly breast cancer.[11] One bioactive compound found in mushrooms is ergothioneine. It is a powerful anti-inflammatory and antioxidant that has been studied for its beneficial effects on the brain.[12] Consuming ergothioneine has been correlated with lower rates of dementia as well as cardiovascular disease.[10] Mushrooms also contain beta-glucans, which are a type of soluble fiber that helps lower blood cholesterol, modulate blood glucose levels, and stimulate immune function. Beta-glucans are prebiotics that improve the health of the gut microbiota, suppress the growth of pathogenic microbes, and protect against harmful environmental toxins and carcinogens. In addition, beta-glucans are antioxidants and have neuroprotective properties. [3] Mushrooms also contain chitin, an insoluble fiber that is found in insect exoskeletons and the shells of shrimp and crabs. Chitin supports colon health by increasing fecal bulk, which helps food move more efficiently through the gastrointestinal tract. Mushrooms in Our Meals Mushrooms are a versatile addition to many cuisines; they add a chewy texture and an umami flavor. Umami, the ineffable fifth taste (alongside sweet, sour, salty, and bitter) is often described as rich and savory. It comes from the amino acid glutamate. Umami is also found in cheese, meat, fish, and fermented soy products such as soy sauce and miso.[13] Button mushrooms are the most commonly consumed mushroom.[14] Their firm texture makes them ideal for topping pizza. Cremini mushrooms are button mushrooms that have been allowed to mature; they work well cooked into quiche or layered in lasagna. Shitake mushrooms are best without their woody stems; add them to your ramen or stir-fry. Oyster mushrooms crisp up nicely when roasted or air-fried and make an interesting addition to tacos. Buy fresh mushrooms when they are firm and have no dark spots. Use them within a few days of purchasing. Some mushrooms, such as button, cremini, and portobello, can be eaten raw. Simply clean them using a soft brush or damp towel, slice them and toss them on your salad or sandwich. Others, such as morels and shitakes, should be cooked. Cooking enhances digestibility and nutrient absorption and can eliminate harmful bacteria and certain toxins.[15] Cooking also brings out the meaty texture and aforementioned rich umami flavor.[13] Canned and dried mushrooms are also available. They have a much longer shelf life than fresh mushrooms and can be used in a variety of recipes. The taste and texture of mushrooms make them a good meat alternative. If you are trying to eat less meat, try a hearty portobello burger or substitute chopped mushrooms for some of the meat in your recipes. References [1] Alexopoulos, C. J. (1999, July 26). Fungus | Definition, Characteristics, Types, & Facts. Encyclopedia Britannica. https://www.britannica.com/science/fungus/Evolution-and-phylogeny-of-fungi? [2] Li H, Tian Y, Menolli N, Karunarathna S. C., Perez‐Moreno J., et al. Reviewing the world’s edible mushroom species: A new evidence‐based classification system. Comprehensive Reviews in Food Science and Food Safety. 2021;20(2):1982-2014. doi:https://doi.org/10.1111/1541-4337.12708 [3] Valverde ME, Hernández-Pérez T, Paredes-López O. Edible mushrooms: improving human health and promoting quality life. Int J Microbiol. 2015;2015:376387. doi:10.1155/2015/376387 [4] The Evolution and History of Psilocybin Mushrooms. Beckleyretreats.com. Published March 12, 2024. https://www.beckleyretreats.com/blog/the-history-of-psilocybin-usage [5] Mushrooms. (2024, June 19). Food Source Information. https://www.chhs.colostate.edu/fsi/food-articles/produce/mushrooms/ [6] Sachdev P. Health Benefits of Mushrooms. WebMD. Published September 12, 2022. https://www.webmd.com/diet/health-benefits-mushrooms [7] Xu J. Assessing global fungal threats to humans. mLife. 2022 Sep 22;1(3):223-240. doi: 10.1002/mlf2.12036. [8] Ayimbila F, Keawsompong S. Nutritional Quality and Biological Application of Mushroom Protein as a Novel Protein Alternative. Current Nutrition Reports. 2023;12(2). doi:https://doi.org/10.1007/s13668-023-00468-x [9] Mushrooms and Vitamin D – Mushrooms Canada. Mushrooms.ca. Published 2026. https://mushrooms.ca/vitamin-d/ [10] Singh A, Saini RK, Kumar A, Chawla P, Kaushik R. Mushrooms as Nutritional Powerhouses: A Review of Their Bioactive Compounds, Health Benefits, and Value-Added Products. Foods. 2025;14(5):741. doi:https://doi.org/10.3390/foods14050741 [11] Ba DM, Ssentongo P, Beelman RB, Muscat J, Gao X, Richie JP. Higher Mushroom Consumption Is Associated with Lower Risk of Cancer: A Systematic Review and Meta-Analysis of Observational Studies. Adv Nutr. 2021 Oct 1;12(5):1691-1704. doi: 10.1093/advances/nmab015. [12] Paul, B. D. Ergothioneine: A Stress Vitamin with Antiaging, Vascular, and Neuroprotective Roles? Antioxidants & Redox Signaling 2022, 36 (16–18), 1306–1317. https://doi.org/10.1089/ars.2021.0043. [13] Rotondo, C. Wild, Weird and Delicious: The Mushroom Varieties You Should Know. Serious Eats. https://www.seriouseats.com/all-about-mushrooms-11823669 (accessed 2026-07-14). [14] White Button Mushrooms | Mushroom Varieties 101. Mushroom Council. https://www.mushroomcouncil.com/mushroom-101/varieties/white-button/ (accessed 2026-07-14). [15] Can You Eat Raw Mushrooms? Store Bought vs. Foraged, Best Cooking Methods, and More - American Association of Naturopathic Physicians. Naturopathic.org. https://naturopathic.org/news/675582/can-you-eat-raw-mushrooms-store-bought-vs.-foraged-best-cooking-methods-and-more.htm (accessed 2026-07-14).

Plague doctors from Italy (left) and France (right) By Stuart M. Caplen, MD The Black Death, or plague, was one of the worst pandemics in human history. Beginning in the 14th century, it is estimated to have killed at least one-third of Europe’s population or more than 25 million people. Caused by the bacterium Yersinia pestis, the plague profoundly changed human history. History of the Black Death Plague has been around for thousands of years, with DNA of Yersinia pestis being found in the teeth of skeletons from Siberia dating back about 5,500 years ago. A separate, later Bronze Age strain, which is directly ancestral to the one that caused the Black Death, has also been confirmed in remains from approximately 3,800 years ago. Historians identify three separate pandemics. The first, known as the Justinian plague, is thought to have originated in Central Asia, although its exact origin remains debated. It reached Constantinople in 541 CE, before spreading throughout Europe, North Africa, and Asia for the next 200 years. The second pandemic, known as the Black Death, reached Sicily in 1347, likely transported from Asia aboard merchant ships carrying infected rodents and fleas. From there it swept across Europe, aided by crowded cities, poor sanitation, large rat populations, and extensive trade routes creating ideal conditions for rapid transmission. It is estimated that between 1347 and 1352, more than 25 million Europeans died from the disease. The pandemic subsided for a time at the end of the 14th century, but outbreaks recurred in Europe over the next 400 years. The continued outbreaks still took a serious toll, with at least half of the population of Genoa and Naples dying in the 1656-1657 outbreak, and 2.5 million deaths in France between 1600 and 1670. Tens of thousands more died in repeated outbreaks in other European cities. The plague toll was so severe that the population of Western Europe did not recover to pre-1347 levels until the 16th century. The third plague pandemic began in China around 1855 and spread via steamship trade routes to the Americas, Australia, and other parts of Asia in the late 1800s and early 1900s. India was especially hard hit, with an estimated 12 million deaths from the late 1800s to the early 1900s. Historical Beliefs and Public Health Measures Ancient physicians such as Hippocrates (460-370 BCE) and Galen (129-210 CE) promoted the miasma theory, which held that "bad air" caused disease. That concept shaped medical practice and doctors in the 17th century wore distinctive bird-like protective masks during plague epidemics. The beak of the mask was filled with aromatic herbs, flowers, spices, and other fragrant materials in an attempt to protect themselves from the “bad air” or miasma. A plague doctor would inspect suspected cases and then isolate the patients and their families in their homes. The same theory caused authorities in some cities to close public baths, believing warm water opened the skin's pores and allowed miasma to enter the body. Victims’ clothes and possessions were burned in an attempt to prevent further transmission. Dedicated plague hospitals were built in Europe to isolate the sick. Port cities started imposing a 30-day isolation period, which was later extended to 40 days in several Italian ports. The term quarantine derives from the Italian quaranta giorni, meaning "forty days." How the Black Death Affected Society The sheer number of people falling ill and dying reshaped 14th-century society. The plague led to shortages of farm workers and skilled craftsmen, which caused many feudal landowners to go bankrupt. The shrinking labor force forced them to pay wages to workers instead of simply providing room and board. This improved the lot of peasants and artisans and opened new paths to social mobility. The pandemic also cost the Italian states much of their former power and international standing. Life in this period was undoubtedly frightening for those who lived through it. Previously healthy people became ill in massive numbers, and entire towns were abandoned after survivors fled from the infected. Social structures broke down. Many priests died, and those that survived frequently refused to administer last rites out of fear of infection. This fear led to scapegoating with some Europeans blaming Jewish communities for poisoning wells and spreading the plague, sparking antisemitic pogroms in which Jews were killed or beaten. The Flagellant movement grew in popularity during the Black Death, as many turned to extreme religious movements. A common belief at the time was that the pandemic was a divine punishment for sin, and the Flagellants believed that self-flagellation or whipping themselves with knotted cords, sometimes embedded with metal tips, was a way to seek absolution. They also came to believe their presence alone could heal the sick. During the Black Death, it was difficult for peasants to access a priest, and the Flagellants often filled that gap. In 1349, Pope Clement VI ordered the suppression of the Flagellant movement because of their increasingly heretical beliefs. The Plague Yersinia pestis is the bacterium that causes plague. It is spread by infected fleas that feed on rodents, most commonly black rats in urban settings. The fleas infect the rats, which in turn infect more feeding fleas. In Xenopsylla cheopis (the Oriental rat flea), Yersinia pestis blocks the flea's digestive tract, forcing the starving insect to repeatedly bite and regurgitate bacteria into new hosts. Humans can become infected by getting bitten by infected fleas, direct contact with sick or dead animals, or inhaling infectious respiratory droplets expelled from a human or animal with pneumonic plague. Black rats live near humans, and when the rats die, the fleas can readily transfer to human hosts. Fleas can travel on clothing or bedding, carrying the disease to new locations. Axillary buboes in bubonic plague There are three forms of plague: bubonic, pneumonic, and septicemic. Bubonic plague, the most common form, presents three to seven days after exposure with high fever, headaches, abdominal and limb pain. The bacteria multiply in the lymph nodes near the flea bite, causing pus-filled, painful swellings called buboes. Septicemic plague is rarer, accounting for approximately 10-15% of cases where the bacteria invade the bloodstream, reproduce, and cause an overwhelming systemic infection. Pneumonic plague is the least common form and causes a rapidly progressive, severe pneumonia. It can be spread by infected humans through respiratory droplets released by coughing, or less commonly through infected animals. Discovery of the Cause In 1894, during a Hong Kong outbreak, Alexandre Yersin from the Pasteur Institute identified the causative bacterium which was later named Yersinia pestis in his honor. Four years later, French physician Paul-Louis Simond demonstrated that fleas from infected rats could transmit the disease to healthy rats. In 1927, Ricardo Jorge, a Portuguese physician, expanded understanding of the disease when he reported that wild rodents, including gerbils, squirrels, and marmots, can also serve as long-term plague reservoirs. Plague in the Modern Era In the United States, an average of about seven cases of plague are reported each year, while globally several hundred to a few thousand cases occur annually. Prior to the introduction of antibiotics, plague was frequently fatal, with an overall mortality rate of approximately 66% among reported U.S. cases. Mortality was considerably higher for the septicemic and pneumonic forms than for the bubonic form. Modern antibiotic therapy has reduced overall mortality to approximately 11%. Early treatment with antibiotics can prevent progression of the disease. Close contacts may also be given prophylactic antibiotics to prevent disease. Recommended antibiotics include streptomycin, gentamicin, fluoroquinolones, doxycycline, and chloramphenicol. There has been a search for a plague vaccine, not only to prevent natural disease, but also to combat the potential bioweaponization of pneumonic plague. During the 1990s, a plague vaccine was marketed but was discontinued in 1999 due to both severe side effects, and because it only had limited protection against pneumonic plague. In 2026, scientists published their findings that two experimental vaccines they developed provided 80%-100% protection against pneumonic plague in mice, which is a promising advance. Genetic Legacy It is postulated that the large number of deaths during the Black Death drove natural selection for individuals with genotypes that offered some immunity to the disease. Researchers have since found that the same gene that confers protection from plague (ERAP2) may increase susceptibility of descendants to Crohn’s disease and possibly to rheumatoid arthritis. It appears that an evolutionary advantage that saved lives during the Black Death may also be a health risk for some of their modern descendants. Summary: The Lasting Impact of the Black Death The Black Death terrorized people living in the Middle Ages, causing millions of deaths across multiple episodes that stretched over hundreds of years. It changed society by reshaping labor compensation, class mobility, religious life, the power of nations, and helped establish the concepts of isolation and quarantine. For centuries it was thought that bad air, or miasma, was the cause and it was not until the late 1800s that the actual etiology of the plague was identified. The advent of effective antibiotics and better infection control measures has reduced the number of deadly infections. Fears that pneumonic plague could be used as a bioweapon, have spurred research into finding an effective vaccine. Promisingly, in 2026, two experimental vaccines were successfully tested in mice. f you liked this article, you may also enjoy reading about another plague where people danced for days, The Dancing Plague of 1518 You may also find these other FibonacciMedicine history of medicine articles interesting: The History of Tuberculosis and How Colorado Became the “World’s Sanitarium” The History of Malaria The Discovery of Radium and the Start of the “Radium Cure Craze” Era The History of Mercury as Medicine How Gila Monsters and Gut Hormones Changed Modern Medicine - The History of GLP-1 Drugs The History of Insulin and Type 1 Diabetes The History of “Snake Oil” and “Snake Oil Salesmen” The “Transfusion Affair” that Shook the Paris Medical Establishment The Milk Transfusion Era The History of Nitroglycerin, an Explosive with Medical Benefits The History of Heroin, the “Non-addictive” Substitute for Morphine The Story of the Most “Kissed” Face in the World “Gentlemen this is no humbug” - The First Use of General Anesthesia in Surgery and the Battle for Recognition that Ensued The History of the Coney Island Incubator Babies The Tobacco Smoke Enema, One of the First CPR Techniques? Benjamin Franklin, Mesmerism, and the First Use of Placebos in Science The Fascinating Mystery of “The Toxic Lady” Penicillin, the Accidental Antibiotic The History of Leeches in Medicine and the Era of the “Leech Mania” The History of the “Whale Cure” for Rheumatism The History of Antiseptic Surgery The History of the Electrocardiogram (EKG/ECG) The History of Phrenology; Just Another Bump in the Road? The Creation of the Gin and Tonic; a Medical Odyssey The History of Cocaine The History of the Iron Lung Dr. Robert Liston and the 300% Mortality Surgery The First Medical Text - The Edwin Smith Surgical Papyrus References Picture- Schultz I, European Plague Doctor Garb Was Black, Beaked, and Very Bleak , Atlas Obscura, April 2, 2020. Retrieved from: https://www.atlasobscura.com/articles/plague-doctor-clothes Glatter KA, Finkelman P. History of the Plague: An Ancient Pandemic for the Age of COVID-19. Am J Med. 2021;134(2):176-181. Retrieved from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7513766/ Zimmer C. A Deadly Outbreak of Plague, Nearly 5,000 Years Before the Black Death. June 17, 2026. The New York Times. Retrieved from: https://www.nytimes.com/2026/06/17/science/oldest-plague-siberian-skeletons.html Bubonic plague: the first pandemic. Science Museum. 25 April 2019. Retrieved from: https://www.sciencemuseum.org.uk/objects-and-stories/medicine/bubonic-plague-first-pandemic Britannica Editors. Black Death. Encyclopedia Britannica. 2026, May 10. Retrieved from: https://www.britannica.com/event/Black-Death Mucha MA. The Black Death: When Europe’s Worst Fear Became Reality. DePaul University. 10/28/2024. Retrieved from: https://dpuhonors.com/2024/10/28/the-black-death-when-europes-worst-fear-became-reality/ Lawson AD. The Black Death Hysteria and Rise of the Flagellants. The Historians Magazine. February 10, 2026. Retrieved from: https://thehistoriansmagazine.com/blogs/modern/the-black-death-hysteria-and-rise-of-the-flagellants Recommended antibiotic treatment for plague. CDC. Retrieved from: https://www.cdc.gov/plague/resources/Recommended-antibiotics-for-plague-web-site-rev-Jan2018-P.pdf Nelson CA, et al. Antimicrobial Treatment and Prophylaxis of Plague: Recommendations for Naturally Acquired Infections and Bioterrorism Response. MMWR Recomm Rep 2021;70(No. RR-3):1–27.Retrieved from: https://www.cdc.gov/mmwr/volumes/70/rr/rr7003a1.htm Photo- Meyer KF. CDC-Public Health Image Library. 1962. Retrieved from: https://wwwn.cdc.gov/phil/Details.aspx?pid=2061 Hendrix EK et al. Live attenuated vaccines alone or in combination with an adenovirus-based vaccine protect mice lacking IFN-γ against pneumonic plague. Sci. Transl. Med. Vol. 18,No. 859. 22 Jul 2026. Retrieved from: https://www.science.org/doi/10.1126/scitranslmed.ads0514 Irving M. We May Finally Have a Vaccine Against The Plague, With Two New Vaccines Showing 100% Effectiveness in Mice. Science Alert. 23 July 2026. Retrieved from: https://www.sciencealert.com/new-plague-vaccines-100-effective-against-the-deadly-disease-in-mice Klunk, J., Vilgalys, T.P., Demeure, C.E. et al. Evolution of immune genes is associated with the Black Death. Nature 611, 312–319 (2022). Retrieved from: https://www.nature.com/articles/s41586-022-05349-x Doctrow B. How the Black Death shaped human evolution. NIH. November 8, 2022. Retrieved from: https://www.nih.gov/news-events/nih-research-matters/how-black-death-shaped-human-evolution#:~:text=%E2%80%9CWhen%20a%20pandemic%20of%20this%20nature%E2%80%94killing%2030,a%20known%20risk%20factor%20for%20Crohn's%20disease. Doucleff M. Black Death survivors gave their descendants a genetic advantage — but with a cost. NPR. Updated October 21, 2022. 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Discover the health benefits of blueberries, from heart and brain support to rich anthocyanin nutrients in every bite. Culinary Medicine By Mary B Grosvenor, MS, RD and Lori A Smolin, PhD For decades blueberries have topped the list of superfoods. While the term “superfood” has no scientific definition, it generally refers to a food that provides high levels of nutrients or other compounds that offer specific health benefits.[1,2] Blueberries fit the bill because they are nutrient dense and loaded with phytochemicals. They have been suggested to lower the risk of chronic disease and have been linked to improved memory and cognitive function. [3] Some, but not all, of blueberry’s benefits are linked to their blue color. Blueberry Beginnings Blueberries are native to North America where they were an important part of the indigenous diet and, in the 1600s, were quickly added to colonists’ diets. Until the early 1900s they could only be harvested from bushes growing wild in the northeastern United States and Canada. But then a curious cranberry farmer, named Elizabeth White, partnered with a botanist at the US Department of Agriculture (USDA) to learn how to cultivate wild berries.[4,5] Cultivation spread rapidly and by the mid-1900s, blueberries were being planted across North America. [6] Today, blueberries are a commercial crop that is grown on every continent except Antarctica.[7] Blueberry production and sales got a boost in the early 2000s when the USDA published a list that ranked foods based on a laboratory measurement of their antioxidant capacity – blueberries were high on the list. Consumers flocked to foods with high values and food and supplement companies started using these scores to increase sales; a higher score was advertised as a healthier food.[8] However, these laboratory values did not measure how the foods were absorbed or metabolized and therefore did not necessarily reflect a food’s antioxidant capacity or health benefit. In 2012, the USDA retracted their publication because the antioxidant values were being misused by producers to promote their products and by consumers to guide their choices. Despite this, blueberry sales continued to grow. Global production doubled between 2010 and 2019, rising to nearly one million metric tons per year.[7] Americans currently eat more than 2½ pounds of blueberries each year.[9] The Health Benefits of Blueberries In addition to adding a beautiful blue color to foods, blueberries are among the most nutrient-dense berries: a cup provides more than 10% of recommended intake of fiber and vitamins C and K. [10] They also provide smaller amounts of B vitamins, and vitamin E as well as iron, zinc, and copper. All of this for about 80 Calories. Blueberries also contain a variety of phytochemicals, most notably anthocyanins, which give them their blue color. As the fruit ripens, the anthocyanin content rises and the color intensifies.[11] These anthocyanins help reduce oxidative stress and inflammation in the body. The combination of nutrients and phytochemicals in blueberries has been suggested to reduce the risk of cardiovascular disease, type 2 diabetes, cancer, and neurological decline. [11] Blueberry, and total anthocyanin intake, promote cardiovascular health due to their antioxidant and anti-inflammatory effects as well as by lowering blood lipid levels, enhancing vascular function, and modulating glucose metabolism. [11] Blueberries help maintain stable blood sugar levels because they have a low glycemic index and a high fiber content. The anthocyanins in blueberries also impact diabetes risk. A higher intake is associated with reduced risk and less weight gain with aging. [11] Blueberries and their anthocyanins have been shown to inhibit the formation of cancer cells and control the progression of the disease.[12] Regular consumption of blueberries has been linked to improved memory, cognitive function, and a slower rate of age-related mental decline. [13] Eat More Blueberries Blueberries are a nutrient-rich food that is high in antioxidants, particularly anthocyanins. Adding them to a varied, healthy diet can help reduce the risk of chronic disease. [2] The versatility of blueberries makes them easy to include in your diet as a snack, a topping for your breakfast cereal, or a dessert. You can toss them into a smoothy, add them to yogurt, or bake them into pancakes, muffins, and pies. You can buy them fresh in the summer and frozen or dried year-round. It is probably best to choose wild or organic because cultivated blueberries often have high pesticide residues. [14] More information about the health benefits of blueberries Anthocyanins: Antioxidant Phytonutrients in Colorful Foods Eating to Reduce Inflammation Recipes with Blueberries Blueberry Oat Buckle Recipe Blueberry French Toast Recipe Chia Flax Oatmeal with Blueberries Recipe Farro Fruit Salad Recipe Yogurt Parfait Recipe Patriotic Appetizer Platter Recipe References [1] Staab J. What makes superfood so super? UC Davis. Published March 10, 2021. https://www.ucdavis.edu/food/news/what-makes-superfood-so-super [2] The Nutrition Source. Superfoods or Superhype? The Nutrition Source. Published March 19, 2018. https://nutritionsource.hsph.harvard.edu/superfoods/ [3] Ashique S, Mukherjee T, Mohanty S, et al. Blueberries in focus: Exploring the phytochemical potentials and therapeutic applications. Journal of agriculture and food research. 2024;18:101300-101300. doi:https://doi.org/10.1016/j.jafr.2024.101300 [4] The history of blueberries: From Native American staple to domesticated superfood: University of Illinois Extension. extension.illinois.edu. Published January 19, 2019. https://extension.illinois.edu/blogs/garden-scoop/2019-01-19-history-blueberries-native-american-staple-domesticated-superfood [5] USDA ARS. Insight into Blueberry’s Domestication https://www.ars.usda.gov/news-events/news/research-news/2011/historic-collection-at-nal-gives-insight-into-blueberrys-domestication/ [6] The History of Blueberries: From Wild Berries to Global Superfruit. Agriculture for Life. Published August 16, 2025. https://www.agricultureforlife.ca/post/the-history-of-blueberries-from-wild-berries-to-global-superfruit [7] Protzman E. Blueberries Around the Globe – Past, Present, and Future. USDA Foreign Agricultural Service. Published October 21, 2021. https://www.fas.usda.gov/data/blueberries-around-globe-past-present-and-future [8] Schauss AG. Should We Ditch the ORAC Antioxidant Test? Nutritionaloutlook.com. Published November 13, 2012. Accessed April 28, 2026. https://www.nutritionaloutlook.com/view/should-we-ditch-orac-antioxidant-test [9] Blueberry update 2025: Unlocking demand to match expanding supply - Rabobank. Rabobank. Published 2025. https://www.rabobank.com/knowledge/q011504896-blueberry-update-2025-unlocking-demand-to-match-expanding-supply [10] Leech J. 7 Proven Health Benefits of Blueberries. Healthline. Published October 9, 2018. https://www.healthline.com/nutrition/10-proven-benefits-of-blueberries#lower-blood-pressure [11] Kalt W, Cassidy A, Howard LR, et al. Recent research on the health benefits of blueberries and their anthocyanins. Advances in Nutrition. 2019;11(2). doi:https://doi.org/10.1093/advances/nmz065 [12] Ashique S, Mukherjee T, Mohanty S, et al. Blueberries in focus: Exploring the phytochemical potentials and therapeutic applications. Journal of agriculture and food research. 2024;18:101300-101300. doi:https://doi.org/10.1016/j.jafr.2024.101300 [13] Stull AJ, Cassidy A, Luc Djousse, et al. The state of the science on the health benefits of blueberries: a perspective. Frontiers in Nutrition. 2024;11. doi:https://doi.org/10.3389/fnut.2024.1415737 [14] O’Connor E, Mündel T, Barnes MJ. Nutritional Compounds to Improve Post-Exercise Recovery. Nutrients. 2022;14(23):5069. doi:https://doi.org/10.3390/nu14235069

A wholesome blueberry oat buckle recipe packed with antioxidant-rich berries, fiber-boosting grains, and the signature sunken fruit top of a classic American breakfast cake. Creative Cooking for the Health-Conscious Gourmet FibonacciRECIPES | Culinary Medicine by Mary B Grosvenor, MS, RD and Lori A. Smolin, PhD This breakfast cake combines juicy blueberries with hearty oats and wheat. As it bakes, the berry juices bubble through the batter, creating the cake's signature buckled surface. The result is a wholesome treat with a crisp crust and bursts of blueberry in every bite. Ingredients 1¼ cups flour ½ cup rolled oats 1 tsp baking powder ¼ tsp baking soda ½ tsp salt 3 Tbsp butter, room temperature 2 cups blueberries 3 Tbsp vegetable oil ¾ cup white sugar 2 eggs 2 tsp vanilla extract 1 tsp apple cider vinegar 2/3 cup low-fat buttermilk 2 Tbsp turbinado or raw sugar Instructions Preheat oven to 350°F. Grease a 9” round cake pan. Combine flour, oats, baking powder, baking soda, and salt in a small bowl and set aside. Place butter, oil, and white sugar in a mixing bowl and beat for 2 minutes with an electric mixer. Add eggs, one at a time, mixing until smooth. Stir in vanilla and vinegar. Slowly add dry ingredients and buttermilk to the mixture, alternating between the two. Use a spoon to fold in 1 cup of blueberries. Spread batter into prepared pan. Top with the remaining cup of blueberries and sprinkle with turbinado sugar. Bake for 35 to 40 minutes, until toothpick inserted into the center comes out clean. Cool for 20 minutes before serving. Makes 12 Servings Nutrition Information per serving Calories 222, Total Fat 8g, Saturated Fat 2.5g, Cholesterol 32mg, Total Carbohydrate 33g, Dietary fiber 1.6g, Protein 4.6g, Potassium 100mg, Sodium 268mg Editor’s note: This recipe is low in saturated fat and relatively low in calories Learn more about the health benefits of blueberries in "Blueberries: Colorful and Mighty" and "Anthocyanins: Antioxidant Phytonutrients in Colorful Foods" More health conscious FibonacciRECIPES you might like: Patriotic Appetizer Platter Recipe Blueberry French Toast Recipe Chia Flax Oatmeal Recipe (with blueberries) Farro Fruit Salad Recipe (with blueberries) Yogurt Parfait Recipe

CO exposure can be accidental or intentional as part of a suicide attempt. Refresh your memory about carbon monoxide poisoning. Carbon Monoxide Poisoning by Stuart M. Caplen, MD, Cheng-Hung Tai, MD and Charles L. Fishman, MD Exposure to carbon monoxide (CO), a colorless, odorless gas, can cause significant toxicity and is the most common cause of fatal poisoning in the United States. Exposure can be accidental or intentional as part of a suicide attempt. Carbon monoxide (CO) poisoning occurs after exposure to high levels of this gas. Common, nonspecific, presenting symptoms include headache, nausea/vomiting, dizziness, confusion, malaise, and loss of consciousness Changes in mental status are initially a brief confused/delirious state, but poisoning can progress to coma and even death. The classic description of "cherry-red lips" in acute CO poisoning is neither sensitive nor specific. CO, the byproduct of hydrocarbon combustion, is present in automobile and heating system exhaust. This gas binds to hemoglobin much more avidly than does oxygen. The resulting compound, carboxyhemoglobin, replaces oxyhemoglobin and diminishes oxygen transport, resulting in poor oxygen delivery in the body and, ultimately, tissue hypoxia. Myocardial ischemia, arrhythmias, and delayed neurologic sequelae (cognitive/neurologic deficits, personality changes, other movement disorders) are commonly noted after significant CO poisoning. Signs and Symptoms As CO poisoning can present subtly, a high level of suspicion and good history-taking may help make the diagnosis. This is particularly true in mild cases where presentation is nonspecific and the cause is not obvious. A history of other people or pets having similar symptoms or a history of using devices that produce CO can be helpful. Mild CO poisoning can present with headache, flu-like symptoms without fever, or nausea/vomiting. Chronic CO poisoning may cause more insidious symptoms, such as trouble concentrating, personality changes, or memory loss. More severe intoxication can cause chest pain, ataxia, seizures, syncope, focal neurologic deficits, confusion, visual disturbances, retinal hemorrhages, bullous skin lesions, dyspnea, coma, and respiratory or cardiac arrest. CO poisoning should be considered in comatose patients with an unexplained elevated anion gap metabolic acidosis or lactic acidosis. If the patient has been in a fire and has lactate levels >10 mmol/L, coexisting cyanide poisoning should be considered. The cherry-red color change of skin and oral mucosa classically described for CO poisoning is rarely seen in living patients. Causes and Risk Factors CO is produced during house or building fires; use of wood/charcoal/propane/gas heaters or stoves, natural gas-powered motors, generators and furnaces, gasoline powered generators and motors, and industrial equipment; and from car and boat exhaust. CO poisoning typically occurs indoors in a poorly ventilated space. However, a leaky or clogged exhaust system on a vehicle or boat can produce symptoms outdoors. Methylene chloride is a substance used in Christmas bubble lights, varnishes, and paint strippers. It is converted by the liver to CO and can cause prolonged toxicity when inhaled or ingested. Diagnostic Evaluation A careful history and physical examination is critical in diagnosing CO poisoning. Pulse oximetery can not distinguish between carboxyhemoglobin and oxyhemoglobin and is not reliable in detecting patients exposed to CO. If CO poisoning is suspected after history and physical, an arterial blood sample should be checked for an elevated carboxyhemoglobin level; testing of venous blood is less reliable. The American College of Emergency Physicians (ACEP) poisoning policy recommends an electrocardiogram and cardiac biomarker levels to identify acute myocardial injury. Lactate levels have been found to correlate to symptom severity in CO poisoning. Pulse oximetry is unreliable in diagnosing CO poisoning. The wavelengths for COHb and oxyhemoglobin are similar, and standard pulse oximetry cannot differentiate between them. As a result in CO poisoning, even if the patient is severely hypoxemic, a pulse oximetry oxygen saturation reading may be falsely normal. There are noninvasive portable pulse CO oximetry monitors that can measure COHb levels. A study of one model found a false-positive rate of 9%; although underpowered to detect the true false-negative rate, the sample had an 18% false-negative rate. ACEP guidelines recommend not using noninvasive pulse CO oximetry to diagnose CO toxicity in patients with suspected acute CO poisoning; blood COHb testing should be the standard. In arterial blood gas testing, the partial pressure of oxygen that reflects dissolved oxygen in the blood may be normal in CO poisoning. In some blood gas machines, the oxyhemoglobin level is calculated but not measured and may be inaccurately reported as normal in CO poisoning. Directly measured COHb levels should be ordered. There is good correlation between arterial and venous COHb levels; therefore, venous blood can be used for that testing. COHb levels will frequently correlate with the symptoms; however, treatment decisions should be based on the clinical picture in conjunction with the CO level. If a patient has received 100% oxygen, or a significant time has passed between exposure and arriving at the hospital, COHb levels may be lowered by the time the blood level is drawn and may not reflect the severity of the exposure. In the case of patients exhibiting significant neurologic sequelae, a computed tomography scan of the head to rule out other causes may be considered. Adverse effects The affinity of hemoglobin for CO is 200 times that of oxygen. CO displaces oxygen from the hemoglobin molecule and binds to hemoglobin to form carboxyhemoglobin (COHb), resulting in hypoxemia. The half-life of COHb in room air averages 240-320 minutes and can vary depending on the amount of respiration. On 100% oxygen, the half-life is about 80 minutes. In methylene-chloride exposure, the half-life can be up to 13 hours due to continued CO production. COHb shifts the oxygen dissociation curve to the left; hemoglobin will hold on to oxygen molecules more tightly than normal rather than delivering it to the tissues, which exacerbates the tissue hypoxemia already caused by the CO. CO results in a relative uncoupling of oxidative phosphorylation and causes lactic acidosis. It also causes release of guanylate cyclase and nitric oxide, which can cause hypotension. A cellular inflammatory process involving white blood cells and release of free radicals can also occur. The hypoxia, hypotension, and inflammation can lead to cell injury or death. The basal ganglia and globus pallidus are extremely sensitive to the effects of CO toxicity. In pregnant women, even mild CO poisoning can affect the fetus, potentially causing fetal demise or congenital malformations, since fetal hemoglobin has a stronger affinity for CO than does adult hemoglobin. Adverse outcomes Survivors of CO poisoning can suffer from long-term neurocognitive sequelae, including impaired memory, cognitive dysfunction, depression, anxiety, or vestibular and motor deficits. About one-third of patients may have subtle memory deficits or show personality changes after CO poisoning. Pearl to Know CO is produced in the body during the normal breakdown of heme. Normal physiologic CO levels are about 1% in nonsmokers, whereas smokers can have levels up to 10%. Treatment Options The immediate treatment for CO poisoning is high-flow oxygen therapy, usually via face mask. For patients exposed to smoke inhalation, cyanide toxicity should also be considered. An electrocardiogram and cardiac enzyme determination should be obtained to rule out any myocardial ischemia. In the case of patients exhibiting significant neurologic sequelae, a computed tomography scan of the head to rule out other causes may be considered. Initial treatment of CO toxicity consists of standard patient stabilization depending on severity of condition. There is some evidence that controlling hyperglycemia in severe CO poisoning may improve outcomes. All suspected CO-toxicity patients should be treated with 100% oxygen, as it significantly decreases the half-life of COHb from an average of 240-320 minutes to < 80 minutes. Hyperbaric oxygen therapy reduces the COHb half-life to about 24 minutes. History and the event should direct the initiation of treatment. COHb levels greater than 10% is abnormal in any person and COHb levels greater than 15% is significantly abnormal. High flow oxygen should be initiated. In mild cases of CO poisoning, administration of 100% oxygen until symptoms abate and avoidance of repeated exposure to the source of the CO might be adequate therapy. Hyperbaric therapy has been used in moderate-to-severe CO poisoning to try to prevent neurologic sequalae. However, a Cochrane review found conflicting and generally weak evidence on the usefulness of hyperbaric oxygen to prevent neurologic injury. The ACEP CO poisoning policy concluded that it is unclear whether hyperbaric therapy is superior to normobaric oxygen therapy for improving long-term neurocognitive outcomes. If used, hyperbaric oxygen therapy should be initiated within the first 6 hours after exposure. The indications for hyperbaric oxygen therapy are as follows: loss of consciousness. confusion/altered mental status, seizure, or new focal neurologic deficit carboxyhemoglobin level > 25%. carboxyhemoglobin level > 15% (pregnant patients). metabolic acidosis with pH < 7.10. signs of end-organ damage (e.g. acute myocardial ischemia). Extracorporeal membrane oxygenation (ECMO) has been used in CO poisoning with good results in several case reports and an animal study. It may be considered when hyperbaric therapy is not available, but further studies are needed to assess its actual effectiveness. Patients with self-inflicted CO poisoning should undergo psychiatric evaluation prior to hospital discharge. Resources and further reading Baran DA, Stelling K, McQueen D, Pearson M, Shah V. Pediatric veno-veno extracorporeal membrane oxygenation rescue from carbon monoxide poisoning, Pediatr Emerg Care. 2018 Apr 25 (epub ahead of print). Baud F, Barriot P, Toffis V, et al. Elevated blood cyanide concentrations in victims of smoke inhalation. N Engl J Med. 1991;325:1761-1766. Buckley NA, Juurlink DN, Isbister G, Bennett MH, Lavonas EJ. Hyperbaric oxygen for carbon monoxide poisoning. Cochrane Database Syst Rev. 2011;(4):CD002041. 2: Carbon monoxide acute exposure guideline levels. In: National Research Council (US) Committee on Acute Exposure Guideline Levels. Acute Exposure Guideline Levels for Selected Airborne Chemicals: Volume 8. Washington (DC): National Academies Press (US); 2010. Maloney G. Carbon monoxide. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM, eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 8th edition. New York, NY: McGraw-Hill; 2016. Moon JM, Shin MH, Chun BJ. The value of initial lactate in patients with carbon monoxide intoxication: in the emergency department. Hum Exp Toxicol. 2011;30:836-843. Penney DG. Hyperglycemia exacerbates brain damage in acute severe carbon monoxide poisoning. Med Hypotheses. 1988;27:241-244. Rose JJ, Wang L, Xu Q, et al. Carbon monoxide poisoning: pathogenesis, management, and future directions of therapy. Am J Respir Crit Care Med. 2017;195:596–606. Simonsen C, Magnusdottir SO, Andreasen JJ, Rohde MC, Kjærgaard B. ECMO improves survival following cardiogenic shock due to carbon monoxide poisoning - an experimental porcine model. Scand J Trauma Resusc Emerg Med. 2018;26:103. Teerapuncharoen K, Sharma NS, Barker AB, Wille KM, Diaz-Guzman E. Successful treatment of severe carbon monoxide poisoning and refractory shock using extracorporeal membrane oxygenation. Respir Care. 2015;60:e155-e160. Weaver LK, Churchill SK, Deru K, Cooney D. False positive rate of carbon monoxide saturation by pulse oximetry of emergency department patients. Respir Care. 2013;58:232-240. American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Carbon Monoxide Poisoning; Wolf SJ, Maloney GE, Shih RD, Shy BD, Brown MD. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute carbon monoxide poisoning. Ann Emerg Med. 217;69:98-107. Ernst A, Zibrak JD. Carbon monoxide poisoning. N Engl J Med. 1998;339:1603-1608. O'Brien C, Manaker S. Carbon monoxide and smoke inhalation. Lanken PN, Hanson CW III, Manaker S, eds. In: The Intensive Care Manual. 1st ed. Philadelphia: WB Saunders; 2001. Tibbles PM, Perrotta PL. Treatment of carbon monoxide poisoning: a critical review of human outcome studies comparing normobaric oxygen with hyperbaric oxygen. Ann Emerg Med. 1994;24:269-276. initially published July 21, 2020

Two nutrition specialists take a look at meal kits. What are meal kits? Do they save time? And are they healthy? Culinary Medicine by Lori A Smolin, PhD and Mary B Grosvenor, MS, RD Looking forward to a home cooked meal but don’t have the time, energy, or culinary skills to pull it off? Enter meal kits. Home Fresh, Dinnerly, Purple Carrot, Blue Apron, and Green Chef are just a few of the over 150 meal kit subscription services that will deliver everything you need to prepare a home-cooked meal directly to your door.[1] Over the past decade, meal kits have become a multi-billion-dollar industry, with Covid lockdowns contributing to their growth. One survey reported that 17% of Americans had subscribed to a meal kit service, with a higher percentage of participation among millennials and gen-xers.[2] Consumers buy them to save time, add variety to their diet by trying new recipes, and eat healthier.[1] Do they deliver on all these fronts and how do they stack up in terms of their environmental impact and your food budget? Do meal kits save time? Meal kits make planning and preparing meals faster and more convenient. You can map out a week of meals by choosing from an extensive online menu. This eliminates the need to research new recipes and to go to the grocery store for ingredients. Meal kits shorten meal prep time by providing pre-portioned, precut, and sometimes partially prepared ingredients.[3] A study that reviewed one meal delivery service found that a typical recipe took 35 minutes to prepare.[4] So although these kits do not eliminate all food prep work and you still need to clean up, they take less time than traditional methods of home cooking. Do they increase variety? Variety is one of the hallmarks of a healthy diet. Meal kits provide a wide selection of meal choices. You can find everything from meat and potatoes to plant-based and ethnic dishes as well as meals that meet preferences for organic, vegan, vegetarian, low-calorie, paleo, keto, and other diet options.[1,5] Some services even provide meals modified to meet the dietary prescriptions of those with diabetes, high blood pressure, kidney disease, and other chronic conditions. In addition to offering a variety of meal choices, meal kits make it easy to try new and unfamiliar foods by simplifying meal selection and preparation and teaching cooking skills.[5] Customers report the opportunity to try new recipes as a benefit of subscribing to a meal kit service.[3] Are they healthy? A healthy diet is a varied diet high in fruits, vegetables, whole grains, and fiber and low in salt, added sugar, and saturated fat. This dietary pattern limits highly processed foods and helps maintain a healthy weight. It is well documented that cooking and eating meals at home is associated with a healthier diet, better health and well-being, and improved overall quality of life.[4,6] Because meal kits promote home cooking, they contribute to healthier eating.[3] By making cooking more enjoyable and encouraging the participation of family and friends, meal kit use has been shown to have mental and social benefits.[3,5] Recipes are generally high in vegetables; one study found a typical recipe included 3 different vegetables. [1,4] Meal kits promote the use of minimally processed foods by providing fresh ingredients. In addition, the controlled portions help consumers manage their weight ; a typical meal provides about 678 Calories— about a third of the calories in a 2000-Calorie diet.[4] There is, however, room for improvement. Surveys have found that meal kit meals are relatively high in fat and often exceed recommended amounts of sodium. Recommendations for a healthy diet suggest limiting total fat to 35% of calories and saturated fat to less than 10% of calories. An analysis of meal kits found a median of 38% of calories from fat with 11% from saturated fat. Sodium content ranged from 67 to almost 4000 mg/meal; the goal is 1500 to 2000 mg of sodium for an entire day. [5] What is their environmental impact? Food packaging makes up about two thirds of packaging waste in the US so one might expect that the environmental impact of meal kit delivery services to individual homes would be large. However, a study found the carbon footprint of meals cooked from regular store-bought groceries was 33% higher than for meal kit meals.[7] The primary reason for this environmental advantage is a reduction in food waste. Ingredients provided in meal kits are purchased in bulk and then pre-portioned resulting in minimal food waste in packaging plants as well as in consumers’ kitchens. Meal kits also streamline the traditional manufacture/retail supply chain, so food skips retailing in stores. This reduces food waste in the grocery store and that wasted when consumers’ purchase more than they need; it also lessens the environmental costs of driving to and from grocery stores. In addition, meal kit cold packs have lower emissions than grocery store refrigeration. Are they affordable? Cost is an important consideration when shopping for food, and meal kits are no exception. Although cheaper than eating out, meal kits may cost as much as 3 times more than shopping at the store and preparing meals at home.[8] They generally require you to sign up for regular deliveries, usually every week. Many are purchased on a monthly subscription averaging between $5 and $10/meal, depending on discounts and how many meals are ordered. While this may sound expensive, if having a meal kit subscription reduces the number of times you eat at a restaurant or have food delivered, you may actually be saving money. The bottom line: Meal kits are a convenient way to have a home cooked meal when you are short on time and/or cooking skills. They generally meet more of the recommendations for a healthy diet than restaurant meals, take out, or delivery options, and thus have the potential to improve diet quality, and ultimately benefit personal and public health.[7] Despite the fact that meal kits arrive with a lot of packaging, overall, they have a smaller carbon footprint than buying food from the grocery store and cooking it at home. They are more expensive than home cooked meals, but they are less expensive than restaurant or takeout meals. While not everyone can afford the extra up-front cost of these meals, for those who can they offer the possibility of consuming healthy meals with less time and effort. More information is available in our culinary medicine BLOG and in our APP. References Cho M, Bonn MA, Moon S, Chang H. Home chef meal kits: Product attributes, perceived value, and repurchasing intentions the moderating effects of household configuration. J Hosp Tour Manag. 2020; 45:192-202. doi:10.1016/j.jhtm.2020.08.011 Patel, R. The top 10 meal kit delivery business Statistics & trends 2023. https://www.upperinc.com/blog/meal-kit-delivery-business-statistics-trends/Accessed August 3, 2023 Fraser K, Love P, Campbell KJ, Ball K, Opie RS. Meal kits in the family setting: Impacts on family dynamics, nutrition, social and mental health. Appetite. 2022;169:105816. doi:10.1016/j.appet.2021.105816 Moores CJ, Bell LK, Buckingham MJ, Dickinson KM. Are meal kits health promoting? Nutritional analysis of meals from an Australian meal kit service. Health Promot Int. 2021;36(3):660-668. doi:10.1093/heapro/daaa095 Clamp J. NNEdPro Global Centre for Nutrition and Health. Meal kits: Can they deliver? June 2022. https://nutrition2me.com/wp-content/uploads/2022/05/NNEdPro.pdf. Accessed July 30, 2023. McKay FH. What’s in a commercial meal kit? Structured review of Australian meal kits. Public Health Nutr. 2023;26(6):1284-1292. doi:10.1017/S1368980023000265 Heard BR, Bandekar M, Vassar B, Miller SA. Comparison of life cycle environmental impacts from meal kits and grocery store meals. Resour Conserv Recycl. 2019;147:189-200. doi.org/10.1016/j.resconrec.2019.04.008. Forbes, Here’s how much money you save by cooking at home. https://www.forbes.com/sites/priceonomics/2018/07/10/heres-how-much-money-do-you-save-by-cooking-at-home/?sh=65e8719e35e5. Accessed July 25, 2023.