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In 1966 NASA engineer Jim LeBlanc was testing a prototype spacesuit in a vacuum chamber when his pressurization hose came loose. Within 10 seconds his suit pressure fell to near zero, and he stayed conscious for 14 seconds, long enough to feel the saliva on his tongue begin to boil. A colleague got oxygen to him within about 25 seconds, and he walked away with an earache. This episode works through what leaving Earth does to a body built for one g, a thick atmosphere and a magnetic shield: launch forces of four to six g that drain blood from the brain, the Armstrong limit at about 19 kilometers where water boils at body temperature, and the 1971 Soyuz 11 depressurization that killed all three crew members.

The slower dangers fall under NASA's RIDGE hazards. Cosmic rays shatter DNA and damage lymphocytes, letting latent viruses such as Epstein-Barr reawaken. In microgravity astronauts can lose up to 20 percent of their muscle mass in five to 11 days and 1 to 1.5 percent of their bone density each month, fluids shift toward the head and can flatten the eyeball, and blood volume can drop by up to 22 percent. A 2006 experiment found salmonella grew more virulent in orbit. The episode closes on a Mars round trip of roughly 18 months in transit and how little is known about older travelers, children and reproduction in space.

• Why a body in a vacuum swells but does not explode, and the 90 second survival window
• Space adaptation syndrome, which hits roughly 45 percent of space travelers
• Spaceflight-associated neuro-ocular syndrome and astronauts returning with permanently blurred vision
• Hot sauce cravings, a gag reflex triggered by cream sherry, and tears that pool over the eye
• Molting foot soles, cooling fans that stop exhaled carbon dioxide from pooling, and Valery Ryumin quoting O. Henry on confinement

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In 1816 at a Paris hospital, physician René Laennec was called to examine a young woman with the signs of heart disease. Tapping her chest told him little through the extra tissue, and pressing his ear to her bare chest, the accepted method then called immediate auscultation, broke the social propriety of the day. Remembering that a pin scratched at one end of a solid piece of wood can be heard clearly at the other end, a game he had seen children playing in the Paris streets, he rolled a quire of paper into a tight cylinder and heard her heart more clearly than he ever had with his bare ear. This episode traces Laennec from his 1781 birth in Quimper, Brittany, through a sickly childhood, the death of his mother from tuberculosis when he was five, and years spent carving and playing wooden flutes, to medical study in Paris under Jean-Nicolas Corvisart, champion of chest percussion.

Laennec built a wooden tube about 25 centimeters long and matched what he heard in living patients to what he found at autopsy, mapping the sounds of disease. His 1819 book on mediate auscultation named the stethoscope from the Greek words for chest and examination and introduced terms doctors still use. He also named cirrhosis and lectured on melanoma as a student in 1804, which set off a lasting feud with his former teacher Dupuytren. Many physicians resisted the tube for decades. Then Laennec contracted tuberculosis himself, was diagnosed by his nephew Mériadec using his own invention, and died in August 1826 at 45.

• Why chest tapping, as Corvisart taught it, revealed density but not the details of disease
• Rales, rhonchi, crepitance and egophony, the voice that sounds like a bleating goat through fluid around the lungs
• A professor's 1885 advice to use ears and not a stethoscope, and L.A. Conner's silk handkerchief
• Laennec's will, which called his stethoscope the greatest legacy of his life
• The binaural rubber-tube stethoscope of the 1850s, Kipling's Rewards and Fairies and the 1949 film Dr. Laennec

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The snake oil salesman is an icon of the Old West, but this episode traces the idea to 18th century Europe, where oil from viper fat was a common treatment for rheumatism, joint pain and skin disease. Patent medicines date to 1712, when Richard Stoughton received a patent for his elixir. In America the rattlesnake became a logo rather than an ingredient, and sellers used mineral oil mixed with herbs, spices and roots. William Rockefeller Sr. sold supposed cancer cures door to door, and after the Civil War traveling medicine shows with up to 20 performers drew crowds before the pitch, often for elixirs laced with cocaine, opium and alcohol.

The 1906 Pure Food and Drug Act changed the rules. In 1916 the Bureau of Chemistry analyzed Clark Stanley's snake oil liniment and found no snake at all: mineral oil, about 1 percent beef tallow, capsaicin, turpentine and camphor. In US District Court in Rhode Island, Stanley pleaded nolo contendere and was fined $20. The episode then follows the trope into Westerns and cartoons and into modern supplements like Neuriva.

• Lydia Pinkham's vegetable compound and its genuine relief for menstrual and menopause symptoms
• Dr. Guild's Green Mountain Asthmatic Compound and its belladonna and stramonium
• The shill in the crowd who throws down his crutches
• Betty Boop selling Jippo in the 1932 cartoon Betty Boop M.D.
• Neuriva's 2023 class action settlement and the Shuanghuanglian buying panic early in COVID-19

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Long before vaccines, people protected themselves from smallpox, which killed about 30 percent of those infected, by deliberately catching a mild case. This episode traces variolation from China, where healers as early as the 16th century blew powdered old scabs mixed with musk up the nose through a silver pipe, right nostril for boys and left for girls. Dried scabs carried a lower viral load. In Sudan mothers bargained for infected cloth in a practice called buying the smallpox, and in India tikadars rubbed scabs into needle pricks. Lady Mary Wortley Montagu brought the practice to England, and six condemned prisoners at Newgate survived a 1721 trial in exchange for pardons.

Elite doctors then added deep cuts and bleeding, raising the danger, while the Sutton family's shallow scratch method treated hundreds of thousands. In Shetland, self taught Johnny Notions variolated about 3,000 people with no recorded deaths. In Boston, Onesimus, an enslaved West African man, told Cotton Mather about the practice, and in 1721 only six of about 300 variolated people died, against 1,000 of 6,000 natural cases.

• A small explosive device thrown through Cotton Mather's window
• Johnny Notions drying pus with peat smoke and burying it with camphor for up to eight years
• George Washington ordering variolation of the Continental Army in 1775
• Catherine the Great's relay of horses for Thomas Dimsdale's escape in 1769
• Edward Jenner's cowpox vaccine, Russia's 1805 ban, and pox parties

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In 2020, scientists drilling about 230 feet beneath the seabed of the South Pacific gyre found microbes in sediment up to 101.5 million years old, and with a few nutrients they started growing again. This episode uses that discovery to explore suspended animation, a profound slowing of metabolism in which heartbeat and breathing become nearly undetectable. It explains why humans seem shut out: the brain uses about 20 percent of the body's oxygen, stores none, and begins irreversible damage after about five minutes without it as calcium floods cells and enzymes digest them from within.

Cold changes the math. Swedish radiologist Anna Bågenholm spent 80 minutes under the ice of a frozen stream in 1999 with no heartbeat and recovered, and toddlers Erika Nordby and Paulie Hynek were revived after hours of hypothermic cardiac arrest. The episode explains the Arrhenius equation, bone lesions at Spain's Atapuerca site that may point to hominin hibernation, and Emergency Preservation and Resuscitation, which replaces blood with chilled solution. Researchers are also testing hydrogen sulfide to put cells into a chemical safe mode.

• Mitsutaka Uchikoshi's claimed 24 days on a Japanese mountain and the skepticism around it
• Lorises and bush babies entering torpor to survive scarcity
• Induced hypothermia in open heart surgery since the 1970s
• University of Pittsburgh dogs revived after three hours of deep stasis
• Massachusetts General Hospital pig trials with a 90 percent success rate

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Botulinum toxin is described in this episode as the deadliest natural substance in chemical literature, with an estimated lethal intravenous dose of 1.3 to 2.1 nanograms per kilogram, yet millions pay to have it injected into their faces. Its story begins in 1793 in Wildbad, Germany, when 13 people fell ill and six died after eating blood sausage stuffed into a pig's stomach. Between 1817 and 1822 physician Justinus Kerner mapped the illness, noted it formed in airless conditions and paralyzed the nervous system, and predicted it might one day treat overactive nerves. In 1870 Müller coined botulism from the Latin for sausage, and in 1895 Émile van Ermengem isolated Clostridium botulinum after a funeral ham outbreak in Belgium.

The toxin destroys SNARE proteins so nerve endings cannot release acetylcholine. That made it a weapon studied at Fort Detrick and by Soviet and Iraqi programs, and later a medicine. Edward Schantz supplied purified toxin to researchers, ophthalmologist Alan B. Scott began treating crossed eyes in 1977 with a drug called Oculinum, and Allergan won approval in 1989 and renamed it Botox.

• Why a temporarily paralyzed eye muscle stays aligned after the toxin wears off
• Patients crossing into Canada when Oculinum lost its liability insurance in 1986
• Richard Clark's 1989 forehead symmetry case and the Carruthers' frown line study
• FDA approvals for cosmetic use in 2002 and chronic migraine in 2010
• Uses for sweating, spasticity, bladder and jaw clenching, and the 2009 boxed warnings

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Before antibiotics, a tuberculosis diagnosis came with a prescription for months of rest, fresh air and rich food in a scenic setting. This episode traces the sanatorium from English physician George Bodington, whose 1840 essay on cold air and beef, wine and milk was dismissed by The Lancet as very crude ideas, to Hermann Brehmer's 1863 facility in Silesia, which proved the model at scale. It explains why it helped: TB bacteria survive inside macrophages, so the body walls them off in granulomas, and rest and nutrition supported that effort. The name itself came from the Latin verb sanare, to heal.

Sanatoriums spread from Saranac Lake, New York, to the Swiss Alps and to Alvar Aalto's Paimio Sanatorium in Finland, completed in 1933 with a chair reclined at 110 degrees and silent sinks. In the United States, Asheville and Arizona marketed their climates, and penniless migrants ended up in tent camps like Sunnyslope, with 7,000 arriving in Tucson by 1920. Black Americans were largely excluded. Albert Schatz's 1943 discovery of streptomycin emptied the buildings in the West, while Soviet sanatoriums became worker spas.

• Asheville's claim that 2,200 feet of elevation stopped lungs from hemorrhaging
• Oregon's 1910 law requiring housing for patients who could not afford care
• Piedmont Sanatorium in Burkeville, Virginia, the South's first built for Black Americans
• The putevka prescription and Soviet capacity of 50,000 guests by 1990
• Waverly Hills, The Magic Mountain and the sanatorium as a horror setting

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Hermann Rorschach, vice president of the Swiss Psychoanalytic Society, designed his 10 inkblots to help diagnose schizophrenia, then died of a ruptured appendix in 1922 at 37, believing his work had failed. This episode traces how he hand drew hundreds of designs, tested them on 300 mental patients and 100 controls, and chose near perfect bilateral symmetry because subjects rejected asymmetrical figures. When his 1921 book Psychodiagnostik went to press, the printer laid down uneven ink, adding shading he embraced as a richer tool. The book barely sold.

After his death, other psychologists used the test on everyone, and in the 1960s John E. Exner built the Comprehensive System, coding location, white space and determinants such as shading. The episode then covers the backlash: Loren and Jean Chapman at the University of Wisconsin showed that accepted clinical signs used to label homosexuality, then classified as a pathology, had no predictive value, an example of illusory correlation. Cultural differences in responses and a 2009 Wikipedia fight over Dr. James Heilman posting all 10 plates followed.

• Leonardo da Vinci's stains and the Victorian parlor game Gobolinks
• Why the examiner sits beside and slightly behind the patient
• Card IV, the so-called father card, and the chaotic colors of Card X
• French subjects seeing chameleons and Scandinavians seeing Christmas elves
• Heilman's eye chart argument and the plates' public domain status

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In the early 1920s, cattle across the northern United States and Canada began bleeding to death after minor procedures, with 21 of 22 cows dying after dehorning on one farm. This episode follows the chemical behind it. In 1921 Canadian veterinary pathologist Frank Schofield traced the deaths to moldy sweet clover silage, and in 1929 Lee M. Roderick showed it destroyed prothrombin. Between 1933 and 1940 Karl Paul Link's team at the University of Wisconsin isolated dicoumarol, formed when fungi metabolize the sweet smelling plant compound coumarin, and by 1948 they had developed warfarin, named for the Wisconsin Alumni Research Foundation, as a rat poison.

In 1951 a US Navy inductee survived several days of warfarin doses after treatment with vitamin K, opening the door to human trials. The FDA approved it in 1954, and in 1955 it treated President Dwight D. Eisenhower after his heart attack. The episode explains why it is not a true blood thinner but a blocker of the VKORC1 enzyme that recycles vitamin K, and why diet, antibiotics and genetics make dosing a narrow balancing act.

• An unverified rumor that Lavrentiy Beria used warfarin against Joseph Stalin
• INR monitoring and eating the same amount of leafy greens every day
• Warfarin necrosis, protein C, and bridging with heparin in the first days
• Purple toe syndrome and fetal warfarin syndrome
• Resistant rats, bioaccumulating superwarfarins, and poison gel spread through vampire bat grooming

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Rabies is nearly 100 percent fatal once symptoms appear and nearly 100 percent preventable if treated in time, and it has stalked humanity since at least 2000 BC in ancient Mesopotamia. This episode explains how the lyssavirus enters through a bite, quietly replicates in muscle without alerting the immune system, binds acetylcholine receptors at the neuromuscular junction, and hijacks the motor protein dynein to travel up nerves toward the brain. That journey explains why incubation usually runs one to three months and depends on how far the bite is from the head.

Once in the brain, the virus moves outward to the salivary glands. Furious rabies, about 80 percent of cases, brings aggression and hydrophobia: painful throat spasms that stop swallowing and keep saliva loaded with virus. Dumb rabies brings creeping paralysis. The episode covers Louis Pasteur and Émile Roux's 1885 vaccine, modern post-exposure prophylaxis, Jeanna Giese's 2004 survival under the Milwaukee Protocol and doubts about it, and the roughly 59,000 deaths each year, 40 percent of them children under 15.

• Why birds largely resist rabies, opossums run too cool, and small rodents rarely carry it
• Domestic dogs causing 99 percent of human cases globally, bats 70 percent in the United States
• India's stray dogs, a 2001 protection law, and puppy pregnancy syndrome
• Switzerland eliminating rabies with vaccine-laced chicken heads dropped for foxes
• Corneal transplant transmission and Peruvian Amazon residents with natural antibodies