Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Fournier's Gangrene

Episode Date: June 13, 2023

Most people have probably heard of gangrene, a condition that causes tissue to become necrotic. But Fournier’s Gangrene is a more . . . targeted version, specifically affecting the perineum, or taint. Justin and Dr. Sydnee discuss who Dr. Fournier was and how he (deservedly or not) put his name on this very specific infection.Music: "Medicines" by The Taxpayers https://taxpayers.bandcamp.com/

Saw bones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books! One, two, one, two, three, four! Hello everybody and welcome to Sawbo. for the mouth. Wow. Hello everybody and welcome to Salbo's, a marital tour of

this guy at medicine. I'm your co-host Justin McElroy. And I'm Sydney McElroy. And the cat is aggressively attacking my foot and just like like, lick. Well, she was just like

licking me and now she's like eating me. Sorry, okay, she is. Stop brewing the show for everybody. You can have my slipper. You can here, look, I see my slipper to you. There, good, take the slipper. Take the slipper, take the slipper.

We have a pot, she doesn't even enjoy podcasting. Like she doesn't appreciate that we have to do that. If you're part of this family, you have to enjoy podcasting. That's right, that's right. That one is a lot more. Or at least respect podcasting. Yeah, it's very podcasting. Don't lick your way through it. Okay.

Sorry, it really hurts. Okay. So it's inviting the back of my calf. Well, we've removed the cat from the room now. That is that is what it is come to. Don't worry. Her other cat friend is right out there with her. The two of them can play with each other and stop liking my leg. Okay. Justin. Yes. I was recently asked a question out in the real world, not the podcast world, the real world. And I- We were recording a podcast at the time, it should be noted.

Yeah, actually we were, we were doing a live podcast episode. But I was asked a question by someone afterwards that I didn't know the answer to. And then, and I thought I should look that up and then I didn't look it up because I just forgot about it because a lot of other things happened. And then one of our listeners emailed in, thank you Heather, with this same question.

And I reminded me, I gotta look that up. I gotta figure out the answer to this sort of odd question. So here's what it is. You may have seen, you know, we do ads in this country for prescription drugs on TV. Just us in Australia, right? Is that what I always forget if it's Australia or New Zealand. And I think we say it wrong 50% of the time. It's Australia. I bet you anything.

Anyway, sorry about that to everyone from Australia and New Zealand. If I've offended you by just like getting confused, you're both great. And we love you. That's great. One's bigger, one smaller, who's counting? I don't know. I love to go to both. Yeah. Love to go love you. That's great. One's bigger, one's smaller, who's counting? I don't know. I'd love to go to both. Yeah. Love to go to both.

There you go. Anyway, I decided to research a question that derives from one of these ads. And in these ads for medications, it's not uncommon for them to show people happy. They've taken this medicine and their lives are so much better and they're like, they're living their best life now, right? But then they list like a whole bunch of really horrible side effects really quickly, right? Right. It's always like they're riding a bike and then you're like, make us death. Yes, exactly.

Make us seizure and heart attack. Well, some people had noticed a particularly strange one in a commercial for a medication called Giardians. Giardians, diabetes medication also has some effects on your kidneys and your blood pressure probably and things like that. I think Giardians is a bad name. All these names are just made up nonsense anyway.

Giardians, that sounds like you're trying to get an audience with somebody named Giardian. Giardians to me sounds like the parasite GiD, which gives you terrible diarrhea. And so, or the, the peppers from Chicago, the Jardy, they have that is kind of like that too. I don't know what those are called. Anyway, GRD knows, the peppers. So I don't know, I'm not, GR, GRD, an area, No, no. GR, GRD in area. GRD in area.

GRD in area. GRD in area. Okay, we're gonna get emails about that now. Okay, so this is all about the darts. This is all about the darts, because I don't like pickled stuff. Giardians, one of the side effects that they list is that it can cause a life threatening infection

of your perineum. it can cause a life-threatening infection of your perineum. That is your may I say, pain, I think. Yes, well, I knew you would. And the question to me was, why just that? Like, why just that? Why just maybe more precisely, why just there? Why do they, yeah, why is that,

well, no, it has, I mean, there are a lot of other side effects possible that they list, but like, why specifically would it cause an infection of that part of your body? As opposed to any other part of your body, what is it about this medicine you take that would make that become infected? And what do you mean life threat? Like a serious infection? A final life threatening.

Of like that area of my body. And so a lot of people, I think had that question like, why? Because that sounds really scary. Yeah. And I didn't know the answer. So anyway, I'm good to tell you the answer. Don't worry by the end of this episode.

Yeah. But I wanted to, I'm dangling that over your head. You have to hang in there. And by the way, if you want to play along at home, write down why you think Jardians would cause an infection specifically of your perineum. Any guesses?

Because I didn't have one. Just email it to said right now. Need it. Anyway, and I will tell you by the end of the episode. So I'll both the maximum fund out of work. Just send in your guesses. And don't look it up. I'm gonna tell you.

I'm gonna tell you, don't look it up. Don't cheat yourself. So anyway, I thought this would be a good time to talk about infections of this part of the body, specifically what we usually call fornyays gangrene. So that's what our episode will be about today. Fornyays gangrene and why could Jardines and their other medicines like it that also have this, by the way, Jardines isn't the only one.

That class can do this. Why? I once helped care for a patient with four N.A.'s gangrene. It's not incredibly common. So I can only remember one case that I was involved in. Because as a family doctor, this is not something you would usually manage, because as we'll get into, it's really a surgical issue. And I don't do surgery.

However, I was a medical student at the time, so you get to rotate through everything. So I was helping care for a patient who had this really terrible condition. And it is something that you don't ever forget if you have helped somebody with, because it's so impactful. So who was fornier? And why did he want his name to be on a kind of gangrene? I think that's always an interesting thing.

He's an acidog. That one's easy. And this is gonna be weird for you. He's not really. He's not an acidog. Not an acidog. Or I don't know, for the time actually, for the time he probably was considered an acidog. He's not real. This is gonna be weird for you. He's not really. He's not a nasty dog. Not a nasty dog. Or I don't know, for the time actually, for the time he probably was considered a nasty dog.

Yeah. And I began to uncover another truth as I researched this that maybe fornier is gangrene should never have been named for fornier. Maybe fornier wasn't the first to talk about gangrene. And maybe that it was somebody else's gangrene first. And he robbed them of the opportunity. He stole the gangrene from them. He stole the gangrene from them. Not intentionally, perhaps, but anyway.

So let's talk about gangrenous infections of the peronium's grow to match. General genital areas. Yes, let's. Fournier gangrene is the name we use for basically any necrotizing infection of the groin area. And when I say necrotizing infection, I mean, like it kills tissue. mean, like, it kills tissue. It kills dying. Yes. It kills the tissue.

Tissue dies. You may have heard of necrotizing fasciitis or neck fasci, some people abbreviate it. And it's what, if you've ever seen like the news reports of a flesh eating bacteria, that's what we're talking about. So it's same idea. It's a couple different types of bacteria usually.

This is one we usually don't blame on one specific bug. It's what we call a polymicrobial infection, meaning multiple different microbes get involved. They have like a party and it's a synergistic effect that can cause pretty severe tissue damage and destruction really quickly too. That's one of the hallmarks of these necrotizing conditions is that they can progress really fast. So, recognizing them and responding to them quickly is absolutely imperative because the treatment is going to be cutting a lot of stuff away.

And the faster you respond to it, the less stuff you have to cut. The bacteria that can cause it, you can see some general skin stuff, like strep and staff, and then some other things that cause gain green more classically, like clostridium is one that causes gas gain green a lot. So you can see like a bunch of these bugs in there. It usually arises because there's been some trauma or surgery or something that somehow the flesh has been damaged there, right?

Either intentionally because you cut it for a surgery or unintentionally from a trauma. There are definitely some risk factors. It's something that we use to only associate really with men. And it would like even, I actually had the impression that forniase gangrene specifically was about like people with scrotums, like you had to, it had to infect the scrotum. But actually that entire growing area, if it is infected. So like it's gender, but there is no gender specific. There's no gender, do you think? That's true, Justin. Beautiful. Man. I've heard you really is everywhere. Everybody has a taint is like a book that people who are like really like the book banning people would like make up and pretend like we were teaching kindergarteners or something. You feel like that's a book that they would invent and pretend like look at this.

This is the future the liberals want everybody has a taint. If that is a book I I'd buy it. But anyway, so it's not, we tend to associate it with the male gender, but it's not necessarily. It's any infection of that region of the perineum and of specifically the groin area. So whatever you got down there, if it gets infected in this way, it can be four-years gangrene. It can occur in younger people, although we typically associate it with older age or the risk factor. Alcohol use is definitely a risk factor,

especially people who have alcohol use disorder, diabetes as a risk factor, immunosuppression of course increases your risk of lots of different things, malnourishment tends to be a risk factor. The treatment always involves surgery, that's the hallmark of it, any sort of, if the tissues dead,

we generally have to get rid of it. And if you cut away the infected part, it should stop spreading and you can stop it. Yes, we use antibiotics, but antibiotics alone are not gonna treat a necrotizing infection. You gotta have surgical, what we call, debridement. Can you rate the dead stuff, right?

Yes, debridement means cutting stuff away that you, that will either inhibit healing or is causing damage. So you can also like debris to wound if it's just got like little bits of dead tissue around the edges that not necessarily are spreading, but like are going to inhibit healing so that you've got a clean wound base that will encourage healing. So that's we debris. Back in 1883, Dr. Jean Alfred fornier was the first one to, we think, that we thought was the first one, to bring this to our attention.

And Dr. Fornier was actually an initially dermatologist in Paris, France, but he went on to become a venerealologist. A venerealologist. As in venereal disease. Studying it loud, you have to be a very specific sort of person. Maybe even a nasty dog for me. And a syphilologist. A syphilologist.

Syphilist. Is there a lot of these specialists in specific diseases? Because I don't feel like we've talked about this a lot. Is there like a... There used to be. Climidialogists. Not now. I mean, now you wouldn't be a syphilologist, right?

You would, if you were an infectious disease specialist, syphilis would be within your wheelhouse. Although, part of it too is that like, we didn't fully understand all these diseases. So you can see where syphilis specifically causes a lot of skin manifestations. There's a lot of symptoms that are evident on the skin. So you can see where a dermatologist would start to specialize in this because it's in there, it's on the skin. As time has worn on and we understand these things much better, you don't necessarily, I mean, sure a dermatologist could diagnose it, but also,

you know, an infectious disease doc, a family doc, an OBGYN, a lot of us, an internal medicine doc, don't wanna forget you guys, a lot of us could diagnose syphilis, or venereal disease, what we usually call a sexually transmitted infection, STI. But back then, it could be your whole life. It could be in my day, it's STD in my day.

It was STD, now it's STI. Now if I wonder around saying, I got an STD, the local teens are like, it seems okay to me. I don't think there's any problems there, Mr. McRoy. And then another one's like, you don't mean STI. Do you? Because we all hate those.

And then another teen is like, no cap. And then I leave. And what? I don't think they start telling talking to do the greeting cap. They start telling me to do the, no, it's, it's no cap that they hate STI. Oh, okay. Well, that's probably the thing. And then they asked me to do, do the gritty hit the gritty?

I think I believe it was a dance. There's popular there now. No idea what that means. I don't know. You're making me feel so old. I know. I feel old. And what you might mean is you have a Sid because my phone corrects Sid,

S-Y-D, which a lot of people will call me to STD, quite frequently. Yeah. Anyway, so he studied under a doctor record who was like, he was sort of an iconoclast in the venereal disease world. Yeah. Because he was one of the first people to say,

gonerian syphilis are two different diseases. And as we know, that was, we've talked about this on the show before. This was a big point of contention in the world of venerologists, which is our gonerian syphilis, just the same disease, but different, like, times in the course of the disease, right? Like, it looks different ways throughout its progression. Or are they two different things completely? And therefore, would need two different ways of treating and they can be transmitted differently

or whatever, right? So he was one of the first ones to say there are two different diseases. And everybody was like, boo, and then Dr. Fornier, he was like, I agree with him. And everybody was like, boo, and then eventually, we were like, you guys are right. So anyway, Fornier followed in his footsteps

because he studied under him, he also studied syphilis. That was his major area of focus. And he got some, he did a lot of work in that area. There's a lot of our understanding of syphilis that came from the work of these doctors. He studied it early on. And he got some stuff named after him in the syphilis world. Nice. There's something called for me, a sign.

That is one of the, probably my least favorite part of the entire Disney Resort is syphilis world. I wish they would tear it down, honestly. I don't see who it's helping. The drinks are disgusting. If I can, it is, it is no love lost there. So this is the one thing you and DeSantis agree on. The one thing that's funny is that I agree on shut down syphilis world. JPEG wanted to expand it, but I'm classic. So the congenital syphilis, which means if you acquire syphilis while you're in utero, and you're born with syphilis, it can lead to something called forniase sign, which are the scars in your mouth. And then there's something called forniase tibia,

which is when you get this like thickening and bowing. Again, this is from Ken Jennerle, syphilis and birth of the tibia. So he got some other stuff named after him other than the gangrene that we're talking about. And forni, actually, he followed records so closely, like he worked with him and studied under him and like followed in his footsteps so much that he actually married his daughter. Really? I think that's an interesting side note. Like he studied under him, married his daughter and went on to carry on his legacy of funeral diseases. He would also connect syphilis with like neurological things

that it could cause, which again, at the time, nobody knew what, you can't see the syphilis spire key yet, right? Right, because it's done by the magnification. So nobody knows what it is. And so the idea that there is something that causes these skin things and also this thing on your genitals. And also, these neurological symptoms was a pretty wild assertion.

But, he said that this thing called tabies dorsalus, which is the term we use for this slow degeneration of the nerves in the spinal cord that can cause a bunch of different neurological symptoms. When he said that, like this is from syphilis, all the neurologists at the time were like, what? No! How could you? Like these people were really mad at each other.

Like when you would say something that someone didn't agree with, it was like, a big deal. It was a huge deal. And like, Sharko, who we've talked about before, Dr. Sharko, who was the leading neurologist, like the neurologist of the time period and who a bunch of stuff is named after Sharko,

was like, this is a travesty. That's taken from me. Pop their Batman villain, Sharko. But he was like, I am the neurologist and I know if sy's a neuro, if syphilis can cause neurological issues. How dare you? I'm a sharko.

And they would get, and they would get really mad, and then they would like make fun of each other, and like bright papers and things to deride each other, and like, you know, make little snarky comments at conferences, and be like, well, that sounds like a dermatologist. Like, you know, and things like that about each other. So anyway, scientists can be mean. That's my whole point. Especially, I mean, Shaco, I expect Shaco to be mean. Sometimes we get, and I say this as a scientist, this is not me throwing shade on scientists,

because I am, I consider myself one. Although, I will tell you that I've been told that, sharing shade on scientists, because I am, I consider myself one. Although, I will tell you that I've been told that, I'm sorry, you're an MD, that's not a side test. Wow. I've been told that. I guess gatekeeping isn't just for sure, Co. Which, I mean, I get, no, I feel it,

because like, I research isn't my thing, and I generally am more of like a, oh no, I don't want to study it, I just want to do it. Just let me do it and see what happens. And that is like, the antithesis of the scientific method, right? I got it, too. The scientific method is not do it and see what happens. It's like do it in a very regulated fashion and get IRB approval. And I don't want to write anything up. I just want to do it.

Anyway, so I mean, I get it. But yeah, and when you get really locked into an area of study and you know it so well, when someone comes in to rock your scientific world It can be really jarring and back then we didn't have all the answers and everybody wanted to be the one to find the answer And get their name on the thing Even now you see these kinds of battles. So that's a legacy. So anyway, this is who fornie is what is a legacy It's a rash on a scene. Hey, you never get this. So now you know who fornie is.

But in 1883, he's going to tell us about a new condition and he's going to slap his name on there. And I'm going to give Justin a chance to laugh. And then I'm going to tell you about fornie's gangrene after we go to the building department. Let's go. Let's go. My fellow graduates, for 500 episodes, my podcast, the JV Club with Janet Barney has gathered

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So join us each week, and let us tell you that you are doing a good job. You can listen to one bad mother on maximum fun, or wherever you get your podcasts. Ha ha ha ha. Ha ha ha ha. Okay, Sid, I'm doing better now. Are you ready? Yeah, I stored up like 16 minutes of not laughing about. Okay, I'm back on top. So as you may imagine, because fornier was a veneerologist and a syphilologist, he spent

a lot of time, you know, examining people's genitals. That was definitely a big piece of what he would do. And as a result, he came across these conditions that he compiled into a series of five case reports. He actually, he was the doctor for four of these, and then one was something he gathered from another doc. But in these cases, the patients developed a really serious gangrene,

meaning like the death of a bunch of tissue in the perineum and the region around it, and the reason was unclear. He thought it was related to maybe like some sort of systemic disease. Maybe this is something that happens with diabetes. He thought maybe was related to maybe like some sort of systemic disease. Maybe this is something that happens with diabetes. He thought maybe syphilis did this, which, you know, of course he did. He was a syphilologist. It's sort of like that. When all you got is a... I wrote a new one for this. Oh, what is it? What do you got? When

all you've got is a syphilologist, everything looks like a spire key. Three people who are listening just like our up off the they just a lot of things like losing it like yes, get it on a t-shirt, make it at least three of them. Well, four, you'll want one. And then I'd say it's more than I know our audience. More than three of you appreciated that joke. More than three of you, that joke more than three of you But they turned it off when I was laughing so much about taints So it's just the three that are left. You should email Justin and tell him how much you appreciated my joke

Oh, thanks, but they don't have I only give a mere email address They don't have mine So this series of case reports that he wrote without like a define he basically said it's idiopathic meaning we don't know why But he wrote this case report and said, here is this condition. We don't know exactly what causes it, but we know that it is really serious. And you have to respond really quickly. And it can be fatal. The five cases that he had studied were all men. So he had linked it to, you know, possibly just being something men could get. And because he was the one who published it

and he was well known, he had renowned, right? So it was a big deal when he published something, a lot of people noticed it, a lot of people read it. He was a member of medical societies, all that kind of stuff that would draw it to widespread attention. And so the condition became known as forniase gangrene. The specific form of idiopathic gangrene

that we don't know what causes it, but it's a big deal when it happens. Got it. However, as often happens, history that is written sometimes only tells us a piece of the story. And when we go back and search more, we find other pieces of the story that weren't told

because maybe the people who were responsible for them didn't have quite the same status and standing as Dr. Fournier. So this was not the first time someone ever wrote about what we call Fournier's gangrene. There was some brief mentions. Back in 1848, there was a doctor Hebler who had wrote up this whole case report of something that he referred to as scrottle fire. Scrottle fire, woof. Which you would think that would have caught on.

Well at least it's a band name. You can go way back. And we've talked about the medieval Arab physician, Ibn Sina, who wrote many medical texts, sort of followed the like, Hippocratic tradition, and then expanded upon that. I'm wrote a lot of medical texts so that expanded our understanding of, you know, all of medicine at the time.

And he wrote a description that also matches what we think is Forty-A's gangrene. All sorts that occur in this region quickly become violent because these organs allow the corruption to spread rapidly. This is because these organs are lacking in air and are exposed to heat and humidity and are in close proximity to the waste passages. You know what those are.

I'm not even clear for that. So we talked about the most dangerous ones are those that affect the muscle at the root of the penis and the anus because they need adequate dryness. And this is very sensitive and painful, and it may become necessary to amputate the penis if it spreads. So he's writing about forniase gangrene. Right. You know, that is exactly.

That is exactly that it's called that. Yeah. Well, I mean, it wouldn't have been because this is way before forniase was born. Yeah. Or if it will be called that someday. Yes. Someday. Yeah. I don't think I don't think he could have forcing that.

And then throughout the 1700s, again, this is all prior to 1883 when Fournier publishes his series of case reports. We have some other things. There's a Dr. Borean who wrote of a man who was gourd in the crotch by an ox. And then after everything was repaired, developed this rapidly spreading severe infection. There's another case report from the 1700s of a post-castration infection. A, an adult man had had to have a castration

performed for, I believe there was a tumor. And afterwards, he developed this rapidly spreading infection. And that would appear to come from nowhere. So they weren't sure like what exactly went wrong here. The goring of the ox made a little more sense to people. And then what was interesting in a lot of these cases, by the way, is that as you read about them, they were using the same treatment for a lot of them,

not necessarily surgery, but they were actually using peruvian bark. You would basically make like a tincture. You would soak the bark, and then take the water and make a tincture, you would soak the bark and then take the water and make a tincture out of it. And this was popular at the time, if you remember, we've talked about proving bark before. Do you remember why?

No. Because the bark contains quinine. Oh, oh, oh. So we've talked about this. This had been like we had figured out that there is something about this bark. There is some property. And at the time, we didn't necessarily know that it was the quinine that made it very helpful with fevers, specifically intermittent fevers, which is what we

call malaria. You have the intermittent fevers, because malaria fevers tend to come and go in a cyclical fashion. And we've done whole episodes about malaria and Peruvian bark and quinine and all that. But anyway, because we had had so much success with Peruvian bark in the treatment of these intermittent fevers that were malaria, we started using it for lots of other things. And so Peruvian bark was used as a treatment in a lot of these cases, like just applying these tinctures and, you know, like mixtures of proving bark directly to the perineum to try to treat it. And they also reported that it was successful, which I don't know. I always think that, like, it doesn't, I don't know why quinine would help with this, right? I don't have any mechanism that tells me quinine would help with a polymicrobial bacterial

infection that's destroying tissue,gery is the treatment for that. But that was the common treatment. And so when you look through Peruvian Barclad literature of the time, you'll find these mentions of things that are probably for Neat Gangrene. I've been Peruvian Barclad literature for the pictures. But... There were also a number of experiments at the time. We've talked about the Royal Society before who were like thinkers and philosophers, scholars, scientists who did a lot of stuff. Remember, they one time like gave that dog intravenous alcohol to see what would happen? Yeah, those guys in the other party.

They were doing a lot of experiments with Peruvian bark to figure out what else it could do. And they also were like comparing it to other medicinal substances and putting it in with stuff that was rotten to see if it could stop a reverse putrefocation. There's this whole series of, they're going to put some Peruvian bark or I think chrasanthamom was another big popular thing to try. And you would put it in with a piece, here's a passage from it.

I've been able to sweeten several small pieces of putrid flesh, beef, imprensies, beef. Just beef, folks, calm down. By repeated effusions of a strong decoction of the bark, and I consequently observed that not only the creptid smell was removed, but a firmness restored to the fibers. So it would take pieces of rotten meat and put them in with substances

and see if you could make it un-rotten. I've un-rottened to this meat. It's right to eat. Enjoy. Enjoy the meat. Now you can eat the beef. Eat the beef. And in a lot of these cases,

if you read the like medical applications, a lot of the tissue was also sluffed off, even if they didn't know they were doing surgical the breathing, they were moving dead stuff. And so like, that's probably what helped. Sloughed is like one of the worst ones we've come up with, I think. The ultimate overlooked, I think, part of the history of fornier's gangering comes from Robert Robertson, who, again, you think you would remember that name. You'd think you would know better than to call your kid that honestly, but here we are.

He was a naval surgeon. He was aboard the HMS rainbow. And in 1777, he published a report. Again, this is before any of these articles we've talked about, except for Ibn Sinas. But he published a case report of one of the sailors got this really terrible infection in the scrotum and penis and perinium. And, you know, why was this not widely recognized? Because, and again, this would fit what we thought at the time about once we learned about Fournier's gangrene. This was an elderly, the elderly ship's butcher. He drank a lot of alcohol. So these are risk factors that we sort of associate

with Four N A's gangrene. And he came in with swelling of the penis and scrotum. Um, he had tied it to having had intercourse with someone 48 hours previously. That's possible. Someone at Port that he met briefly. Possible he just wanted to brag though. Well, yeah, and I'm not gonna, this is a family show. I can't, this is, if this gives you a little clue, I cannot quote to you what Robert Robertson put in his medical paper because it's too racy to say on solba.

Yeah, dig it up. You can ask your dogs. You can find yourself. He was quite explicit as to what exactly the patient said to him thought may have led to this condition. But anyway, he described in great detail, like how quickly it progressed and what everything looked like and what he tried to do to fix it. And all of this was described in excruciating detail,

I would say explicit excruciating detail. So this was published and made like no impact. No one care? No, nobody really can. I mean, I'm sure there were some people who read it and were like, have you? Have you read this? Listen, he uses some words in here.

I'm not sure history's gonna look too kindly on this. They're like, no, it's like explicit. It's like the kind of thing you would hide under your bed so your parents didn't find you reading. Yeah, I know, but we're history right now. And we said we can't read it. So, this is what I'm saying. I just, kids listen to our show,

and I don't wanna repeat the things that this gruffled sailors said. These kids are going wild though, they're on their iPhones trying to find what this gruffled sailors said. Said, you know how hard it is to find kit for kids to find objectionable material in it? He engaged in private activities and he got.

And I don't know that that necessarily had honestly anything to do. By the way, I would say that probably had nothing to do with the gangrene that developed. I don't know why it would. He probably just got it. So it had almost certainly had nothing to do with the sexual encounter,

but that's what he had reported. And at the time, anything that involved the genitals, you would naturally ask questions about sexual encounters, same for today. So he was not part of a lot of these medical societies. He didn't have the standing that forneya dead. And then the other thing that's really interesting is that as I mentioned, forneya did not tie any of this to some sort of sexual thing.

I mean, yes, syphilis, venereal diseases, yes, these are tied, but like he didn't necessarily say that. He said it could come from diabetes, it could come from typhoid, it could come from lots of different things. We don't know. So his was a lot more sort of buttoned up, like a conservative, yes.

And this was like, you know, Taint Rash for the Common Man. Sure, I got you. So, no, we're- Liberate it. Get it out there. So, Robertson didn't get to name it Robertson's gangrene. Although he described in great detail, you know,

a case of this. Yeah, he's like, he's on it. But we don't call it Robertson's gangrene. We call it forniase gangrene. And it's funny because despite the fact that like, it is probably that explicit nature that kept this, I mean, this was not the kind of thing you were gonna read in front of the Royal Society, right?

Like you weren't, that just wasn't gonna happen. Right. Maybe privately when they're at the pub, but not in front of like a conference. Forniase would go on to become like one of the early fathers of sexual education, which is kind of wild. So even though his was the more conservative approach, and he got to name the gangrene after himself, he insisted that after studying all of these diseases, there's no way that we

can successfully protect people, like help them prevent and treat and manage these kinds of illnesses by only educating doctors. We have to educate everybody. We have to teach everybody about safe sex because everybody, not everybody, but a lot of people are going to have sex. So we have to educate the masses. And this was a wild idea at the time. And a lot of people thought he was a nasty dog for it. He made a little booklet called Four Hours

Sons. I am not a nasty dog. The Fournier story. And you can find it like out there, the copies of the Four Hours Sons. And now again, like, how about all of us? There are some of us daughters, she would like some sex ed to be. And some just, like how about all of us? There's some of us daughters who would like some sex ed to these. And some just like everybody. General offspring. Yeah, general, all people, adults and kids, a lot of us. Like we, let's not just focus on adolescents and teenagers and young adults. Like there are a lot of adults who need more sex ed.

Let's just be honest about that. So anyway, he was kind of known for his, you know, defense of sexual education and kind of like destigmatizing talking about sex. Despite the fact that he was known as like privately, kind of a conservative. Like, he would have these fancy dinner parties every weekend and host people and it was all very like high society and aboo-ji. But he also was kind of an assidulter. That's all very interesting, Sydney. But I am on pins and needles over here

because you haven't answered the actual question that you set out to answer. You're right. So we know what forneas gangrenees We know where it came from, who named it, and how to treat it. What, why in the world would Jardians and the medicines in that same class? Why would they cause it? So the way that these medications work in part is that the excess sugar in your bloodstream, you pee out. So the concentration of glucose of sugar in your urine goes up. So there's more sugar in your genital area,

and bacteria love to eat sugar. So by increasing the amount of sugar that is around your perineum, you make it more susceptible to bacterial infections. increasing the amount of sugar that is around your perineum, you make it more susceptible to bacterial infections. Why are these people peeing on their taints? How is that happening? Well, I mean, I think they're just getting pee all down there. Just pee everywhere. I think the risk is that if you get some pee, okay, like Justin, do you wipe after you pee?

Absolutely. So where does that pee go? Where does drips go when you pull your pants? Matter, no matter how you wiggle and dance, the last two drops in up in your pants. That's true. And then your pants get smashed right back up again. And my sweet, sweet pee gets right on my tank.

God. Yeah. And then in your imagine, and you imagine for people with vaginas, you're rethra is close to of course closer to everything down there. And so any kind of infection, any kind of bacteria in that area is more likely to get spread around. That's why people with vaginas are more likely to get urinary tract infections. Right. So like, the answer is that it makes it makes you tank sweet.

Sweet, sweet tank. That's how the episode ends. That's really tasty to bacteria. Thanks for listening to our podcast. So let me be regretting the choice now. I'm sorry kids. I'm so sorry kids. We, sorry to parents and guardians of kids. I'm sorry. We got too nasty. We are very happy for you to join us.

If you head on over to McElroyMarch.com, you can find a brand new Saubon's Challenge coin to celebrate our 10-year anniversary. So if you would buy some of those, I think if you're a fan of the show, it's a great coin. It's just a 10-year, can you believe this? No, I cannot believe it. It's wild. is that is out there right now. Yes, it.

I just want to say after our xylazine episode, I had several veterinarians reach out to me, people with veterinary expertise reach out to me to tell me about various reversal agents they use in veterinary medicine for xylazine. And I really appreciate, people sent me papers. It was super helpful. I have passed some of those along to like researchers at our institution to see is this something we could try some compassionate use trials for some of these medicines and stuff like that.

Right now, none of them are okay for us to use in humans, but just because we haven't done the research to prove it, yet, but I think I just really appreciated you reaching out with those kinds of things. I had looked into that and I wish I would have talked more about it, but thank you. Some of the stuff you sent me has been sent on

to researchers at my institution to say, can we do this? I have another request. If you find yourself with some free time, the weekends of June 16th, June 23rd, or June 30th, we would love if you'd come see the show we did, said, not direct to the SpongeBob musical, it is honestly, you're gonna have a blast,

this show is great music, it's got great performances and we worked really hard on it, so if you wanna come. The cast is just fantastic. We can't take the credit, it's the cast, they're just incredible. I say kids, they're all adults, but it's like the kids make some 42. But the tickets are like 15 bucks for children, 18 bucks for adults. If you get a SpongeBobWV.com, you can get all the details and we hope to see you there. That's going to do it for us until next time. And it was just a macaroid. I'm Sydney Macaroid. And as always, don't draw a hole in your head. Alright!