Intentional Ignorance: A History of Blind Assessment and Placebo Controls in Medicine

Bulletin of the History of Medicine

Volumn 72, Issue 3, 1998, Pages 389-433

  Kaptchuk, Ted J ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

PLACEBO;

ARTICLE; CONTROLLED CLINICAL TRIAL; DOUBLE BLIND PROCEDURE; EUROPE; HISTORY; HUMAN; METHODOLOGY; RESEARCH; SINGLE BLIND PROCEDURE; UNITED STATES;

CONTROLLED CLINICAL TRIALS; DOUBLE-BLIND METHOD; EUROPE; HISTORY, 18TH CENTURY; HISTORY, 19TH CENTURY; HISTORY, 20TH CENTURY; HUMANS; PLACEBOS; RESEARCH; RESEARCH DESIGN; SINGLE-BLIND METHOD; UNITED STATES;

EID: 0032159929     PISSN: 00075140     EISSN: None     Source Type: Journal    
DOI: 10.1353/bhm.1998.0159     Document Type: Article

References (260)

1. A review of even the best sources on the history of medical research reveals little, inaccurate, and contradictory information. For example, one source devotes five paragraphs to masked assessment and traces the first double-blind trial to 1931: Abraham M. Lilienfeld, "Ceteris paribus: The Evolution of the Clinical Trial," Bull. Hist. Med., 1982, 56: 1-18. No direct mention of blind assessment can be found in J. P. Bull, "The Historical Development of Clinical Therapeutic Trials," J. Chron. Dis., 1959, 10 (3): 218-48 . A third source has three sentences on blind assessment and traces the first double-blind trial to 1937: Michael D. Rawlins, "Development of a Rational Practice of Therapeutics," Brit. Med. J., 1990, 301: 729-33. A fourth has four paragraphs on blind assessment and placebo controls and mentions the first use as 1933: John H. Gaddum, "Clinical Pharmacology," Proc. Roy. Soc. Med., 1954, 47: 195-204. Textbooks on clinical trials usually have an introductory section on history, and again blind assessment is given only perfunctory attention. For example, one text has two paragraphs on placebo controls describing the Perkins tractor experiment of 1799 and the mint-water experiment of 1863: Christopher J. Bulpitt, Randomized Controlled Clinical Trials (The Hague: Martinus Nijhoff, 1983). Two paragraphs on the history of blind assessment and a chart with two pre-World War II episodes can be found in Curtis L. Meinert and Susan Tonascia, Clinical Trials: Design, Conduct, and Analysis (New York: Oxford University Press, 1986). A similar pattern emerges in histories of research. For example, only a passing mention of blind assessment is found in J. Rosser Matthews, Quantification and the Quest for Medical Certainty (Princeton: Princeton University Press, 1995). One sentence on the double-blind method can be found in Theodore M. Porter, Trust in Numbers: The Pursuit of Objectivity in Science and Public Life (Princeton: Princeton University Press, 1995).
2. A review of even the best sources on the history of medical research reveals little, inaccurate, and contradictory information. For example, one source devotes five paragraphs to masked assessment and traces the first double-blind trial to 1931: Abraham M. Lilienfeld, "Ceteris paribus: The Evolution of the Clinical Trial," Bull. Hist. Med., 1982, 56: 1- 18. No direct mention of blind assessment can be found in J. P. Bull, "The Historical Development of Clinical Therapeutic Trials," J. Chron. Dis., 1959, 10 (3): 218-48 . A third source has three sentences on blind assessment and traces the first double-blind trial to 1937: Michael D. Rawlins, "Development of a Rational Practice of Therapeutics," Brit. Med. J., 1990, 301: 729-33. A fourth has four paragraphs on blind assessment and placebo controls and mentions the first use as 1933: John H. Gaddum, "Clinical Pharmacology," Proc. Roy. Soc. Med., 1954, 47: 195-204. Textbooks on clinical trials usually have an introductory section on history, and again blind assessment is given only perfunctory attention. For example, one text has two paragraphs on placebo controls describing the Perkins tractor experiment of 1799 and the mint-water experiment of 1863: Christopher J. Bulpitt, Randomized Controlled Clinical Trials (The Hague: Martinus Nijhoff, 1983). Two paragraphs on the history of blind assessment and a chart with two pre-World War II episodes can be found in Curtis L. Meinert and Susan Tonascia, Clinical Trials: Design, Conduct, and Analysis (New York: Oxford University Press, 1986). A similar pattern emerges in histories of research. For example, only a passing mention of blind assessment is found in J. Rosser Matthews, Quantification and the Quest for Medical Certainty (Princeton: Princeton University Press, 1995). One sentence on the double-blind method can be found in Theodore M. Porter, Trust in Numbers: The Pursuit of Objectivity in Science and Public Life (Princeton: Princeton University Press, 1995).
3. A review of even the best sources on the history of medical research reveals little, inaccurate, and contradictory information. For example, one source devotes five paragraphs to masked assessment and traces the first double-blind trial to 1931: Abraham M. Lilienfeld, "Ceteris paribus: The Evolution of the Clinical Trial," Bull. Hist. Med., 1982, 56: 1- 18. No direct mention of blind assessment can be found in J. P. Bull, "The Historical Development of Clinical Therapeutic Trials," J. Chron. Dis., 1959, 10 (3): 218-48 . A third source has three sentences on blind assessment and traces the first double-blind trial to 1937: Michael D. Rawlins, "Development of a Rational Practice of Therapeutics," Brit. Med. J., 1990, 301: 729-33. A fourth has four paragraphs on blind assessment and placebo controls and mentions the first use as 1933: John H. Gaddum, "Clinical Pharmacology," Proc. Roy. Soc. Med., 1954, 47: 195-204. Textbooks on clinical trials usually have an introductory section on history, and again blind assessment is given only perfunctory attention. For example, one text has two paragraphs on placebo controls describing the Perkins tractor experiment of 1799 and the mint-water experiment of 1863: Christopher J. Bulpitt, Randomized Controlled Clinical Trials (The Hague: Martinus Nijhoff, 1983). Two paragraphs on the history of blind assessment and a chart with two pre-World War II episodes can be found in Curtis L. Meinert and Susan Tonascia, Clinical Trials: Design, Conduct, and Analysis (New York: Oxford University Press, 1986). A similar pattern emerges in histories of research. For example, only a passing mention of blind assessment is found in J. Rosser Matthews, Quantification and the Quest for Medical Certainty (Princeton: Princeton University Press, 1995). One sentence on the double-blind method can be found in Theodore M. Porter, Trust in Numbers: The Pursuit of Objectivity in Science and Public Life (Princeton: Princeton University Press, 1995).
4. A review of even the best sources on the history of medical research reveals little, inaccurate, and contradictory information. For example, one source devotes five paragraphs to masked assessment and traces the first double-blind trial to 1931: Abraham M. Lilienfeld, "Ceteris paribus: The Evolution of the Clinical Trial," Bull. Hist. Med., 1982, 56: 1- 18. No direct mention of blind assessment can be found in J. P. Bull, "The Historical Development of Clinical Therapeutic Trials," J. Chron. Dis., 1959, 10 (3): 218-48 . A third source has three sentences on blind assessment and traces the first double-blind trial to 1937: Michael D. Rawlins, "Development of a Rational Practice of Therapeutics," Brit. Med. J., 1990, 301: 729-33. A fourth has four paragraphs on blind assessment and placebo controls and mentions the first use as 1933: John H. Gaddum, "Clinical Pharmacology," Proc. Roy. Soc. Med., 1954, 47: 195-204. Textbooks on clinical trials usually have an introductory section on history, and again blind assessment is given only perfunctory attention. For example, one text has two paragraphs on placebo controls describing the Perkins tractor experiment of 1799 and the mint-water experiment of 1863: Christopher J. Bulpitt, Randomized Controlled Clinical Trials (The Hague: Martinus Nijhoff, 1983). Two paragraphs on the history of blind assessment and a chart with two pre-World War II episodes can be found in Curtis L. Meinert and Susan Tonascia, Clinical Trials: Design, Conduct, and Analysis (New York: Oxford University Press, 1986). A similar pattern emerges in histories of research. For example, only a passing mention of blind assessment is found in J. Rosser Matthews, Quantification and the Quest for Medical Certainty (Princeton: Princeton University Press, 1995). One sentence on the double-blind method can be found in Theodore M. Porter, Trust in Numbers: The Pursuit of Objectivity in Science and Public Life (Princeton: Princeton University Press, 1995).
5. A review of even the best sources on the history of medical research reveals little, inaccurate, and contradictory information. For example, one source devotes five paragraphs to masked assessment and traces the first double-blind trial to 1931: Abraham M. Lilienfeld, "Ceteris paribus: The Evolution of the Clinical Trial," Bull. Hist. Med., 1982, 56: 1- 18. No direct mention of blind assessment can be found in J. P. Bull, "The Historical Development of Clinical Therapeutic Trials," J. Chron. Dis., 1959, 10 (3): 218-48 . A third source has three sentences on blind assessment and traces the first double-blind trial to 1937: Michael D. Rawlins, "Development of a Rational Practice of Therapeutics," Brit. Med. J., 1990, 301: 729-33. A fourth has four paragraphs on blind assessment and placebo controls and mentions the first use as 1933: John H. Gaddum, "Clinical Pharmacology," Proc. Roy. Soc. Med., 1954, 47: 195-204. Textbooks on clinical trials usually have an introductory section on history, and again blind assessment is given only perfunctory attention. For example, one text has two paragraphs on placebo controls describing the Perkins tractor experiment of 1799 and the mint-water experiment of 1863: Christopher J. Bulpitt, Randomized Controlled Clinical Trials (The Hague: Martinus Nijhoff, 1983). Two paragraphs on the history of blind assessment and a chart with two pre-World War II episodes can be found in Curtis L. Meinert and Susan Tonascia, Clinical Trials: Design, Conduct, and Analysis (New York: Oxford University Press, 1986). A similar pattern emerges in histories of research. For example, only a passing mention of blind assessment is found in J. Rosser Matthews, Quantification and the Quest for Medical Certainty (Princeton: Princeton University Press, 1995). One sentence on the double-blind method can be found in Theodore M. Porter, Trust in Numbers: The Pursuit of Objectivity in Science and Public Life (Princeton: Princeton University Press, 1995).
6. A review of even the best sources on the history of medical research reveals little, inaccurate, and contradictory information. For example, one source devotes five paragraphs to masked assessment and traces the first double-blind trial to 1931: Abraham M. Lilienfeld, "Ceteris paribus: The Evolution of the Clinical Trial," Bull. Hist. Med., 1982, 56: 1- 18. No direct mention of blind assessment can be found in J. P. Bull, "The Historical Development of Clinical Therapeutic Trials," J. Chron. Dis., 1959, 10 (3): 218-48 . A third source has three sentences on blind assessment and traces the first double-blind trial to 1937: Michael D. Rawlins, "Development of a Rational Practice of Therapeutics," Brit. Med. J., 1990, 301: 729-33. A fourth has four paragraphs on blind assessment and placebo controls and mentions the first use as 1933: John H. Gaddum, "Clinical Pharmacology," Proc. Roy. Soc. Med., 1954, 47: 195-204. Textbooks on clinical trials usually have an introductory section on history, and again blind assessment is given only perfunctory attention. For example, one text has two paragraphs on placebo controls describing the Perkins tractor experiment of 1799 and the mint-water experiment of 1863: Christopher J. Bulpitt, Randomized Controlled Clinical Trials (The Hague: Martinus Nijhoff, 1983). Two paragraphs on the history of blind assessment and a chart with two pre-World War II episodes can be found in Curtis L. Meinert and Susan Tonascia, Clinical Trials: Design, Conduct, and Analysis (New York: Oxford University Press, 1986). A similar pattern emerges in histories of research. For example, only a passing mention of blind assessment is found in J. Rosser Matthews, Quantification and the Quest for Medical Certainty (Princeton: Princeton University Press, 1995). One sentence on the double-blind method can be found in Theodore M. Porter, Trust in Numbers: The Pursuit of Objectivity in Science and Public Life (Princeton: Princeton University Press, 1995).
7. A review of even the best sources on the history of medical research reveals little, inaccurate, and contradictory information. For example, one source devotes five paragraphs to masked assessment and traces the first double-blind trial to 1931: Abraham M. Lilienfeld, "Ceteris paribus: The Evolution of the Clinical Trial," Bull. Hist. Med., 1982, 56: 1- 18. No direct mention of blind assessment can be found in J. P. Bull, "The Historical Development of Clinical Therapeutic Trials," J. Chron. Dis., 1959, 10 (3): 218-48 . A third source has three sentences on blind assessment and traces the first double-blind trial to 1937: Michael D. Rawlins, "Development of a Rational Practice of Therapeutics," Brit. Med. J., 1990, 301: 729-33. A fourth has four paragraphs on blind assessment and placebo controls and mentions the first use as 1933: John H. Gaddum, "Clinical Pharmacology," Proc. Roy. Soc. Med., 1954, 47: 195-204. Textbooks on clinical trials usually have an introductory section on history, and again blind assessment is given only perfunctory attention. For example, one text has two paragraphs on placebo controls describing the Perkins tractor experiment of 1799 and the mint-water experiment of 1863: Christopher J. Bulpitt, Randomized Controlled Clinical Trials (The Hague: Martinus Nijhoff, 1983). Two paragraphs on the history of blind assessment and a chart with two pre-World War II episodes can be found in Curtis L. Meinert and Susan Tonascia, Clinical Trials: Design, Conduct, and Analysis (New York: Oxford University Press, 1986). A similar pattern emerges in histories of research. For example, only a passing mention of blind assessment is found in J. Rosser Matthews, Quantification and the Quest for Medical Certainty (Princeton: Princeton University Press, 1995). One sentence on the double-blind method can be found in Theodore M. Porter, Trust in Numbers: The Pursuit of Objectivity in Science and Public Life (Princeton: Princeton University Press, 1995).
8. A review of even the best sources on the history of medical research reveals little, inaccurate, and contradictory information. For example, one source devotes five paragraphs to masked assessment and traces the first double-blind trial to 1931: Abraham M. Lilienfeld, "Ceteris paribus: The Evolution of the Clinical Trial," Bull. Hist. Med., 1982, 56: 1- 18. No direct mention of blind assessment can be found in J. P. Bull, "The Historical Development of Clinical Therapeutic Trials," J. Chron. Dis., 1959, 10 (3): 218-48 . A third source has three sentences on blind assessment and traces the first double-blind trial to 1937: Michael D. Rawlins, "Development of a Rational Practice of Therapeutics," Brit. Med. J., 1990, 301: 729-33. A fourth has four paragraphs on blind assessment and placebo controls and mentions the first use as 1933: John H. Gaddum, "Clinical Pharmacology," Proc. Roy. Soc. Med., 1954, 47: 195-204. Textbooks on clinical trials usually have an introductory section on history, and again blind assessment is given only perfunctory attention. For example, one text has two paragraphs on placebo controls describing the Perkins tractor experiment of 1799 and the mint-water experiment of 1863: Christopher J. Bulpitt, Randomized Controlled Clinical Trials (The Hague: Martinus Nijhoff, 1983). Two paragraphs on the history of blind assessment and a chart with two pre-World War II episodes can be found in Curtis L. Meinert and Susan Tonascia, Clinical Trials: Design, Conduct, and Analysis (New York: Oxford University Press, 1986). A similar pattern emerges in histories of research. For example, only a passing mention of blind assessment is found in J. Rosser Matthews, Quantification and the Quest for Medical Certainty (Princeton: Princeton University Press, 1995). One sentence on the double-blind method can be found in Theodore M. Porter, Trust in Numbers: The Pursuit of Objectivity in Science and Public Life (Princeton: Princeton University Press, 1995).
9. It should be noted that this essay deals with the placebo under experimental conditions, and not with its history as a therapy. For a summary of the issue of the placebo in clinical practice, see: Ted J. Kaptchuk, "Powerful Placebo: The Dark Side of the Randomized Controlled Trial," Lancet, 1998, 354: 1722-25; cf. Arthur K. Shapiro, "Semantics of the Placebo," Psychiatric Quart., 1968, 42(4), 653-95. Additionally, the overwhelming majority of experiments described in this essay took place before the notion of "informed consent" had been developed. Most experiments were conducted on patients who unknowingly received sham interventions. For a discussion of the history of informed consent, see Ruth R. Faden and Tom L. Beauchamp in collaboration with Nancy M. P. King, A History and Theory of Informed Consent (New York: Oxford University Press, 1986); Susan E. Lederer, Subjected to Science: Human Experimentation in America before the Second World War (Baltimore: Johns Hopkins University Press, 1995).
10. It should be noted that this essay deals with the placebo under experimental conditions, and not with its history as a therapy. For a summary of the issue of the placebo in clinical practice, see: Ted J. Kaptchuk, "Powerful Placebo: The Dark Side of the Randomized Controlled Trial," Lancet, 1998, 354: 1722-25; cf. Arthur K. Shapiro, "Semantics of the Placebo," Psychiatric Quart., 1968, 42(4), 653-95. Additionally, the overwhelming majority of experiments described in this essay took place before the notion of "informed consent" had been developed. Most experiments were conducted on patients who unknowingly received sham interventions. For a discussion of the history of informed consent, see Ruth R. Faden and Tom L. Beauchamp in collaboration with Nancy M. P. King, A History and Theory of Informed Consent (New York: Oxford University Press, 1986); Susan E. Lederer, Subjected to Science: Human Experimentation in America before the Second World War (Baltimore: Johns Hopkins University Press, 1995).
11. It should be noted that this essay deals with the placebo under experimental conditions, and not with its history as a therapy. For a summary of the issue of the placebo in clinical practice, see: Ted J. Kaptchuk, "Powerful Placebo: The Dark Side of the Randomized Controlled Trial," Lancet, 1998, 354: 1722-25; cf. Arthur K. Shapiro, "Semantics of the Placebo," Psychiatric Quart., 1968, 42(4), 653-95. Additionally, the overwhelming majority of experiments described in this essay took place before the notion of "informed consent" had been developed. Most experiments were conducted on patients who unknowingly received sham interventions. For a discussion of the history of informed consent, see Ruth R. Faden and Tom L. Beauchamp in collaboration with Nancy M. P. King, A History and Theory of Informed Consent (New York: Oxford University Press, 1986); Susan E. Lederer, Subjected to Science: Human Experimentation in America before the Second World War (Baltimore: Johns Hopkins University Press, 1995).
12. It should be noted that this essay deals with the placebo under experimental conditions, and not with its history as a therapy. For a summary of the issue of the placebo in clinical practice, see: Ted J. Kaptchuk, "Powerful Placebo: The Dark Side of the Randomized Controlled Trial," Lancet, 1998, 354: 1722-25; cf. Arthur K. Shapiro, "Semantics of the Placebo," Psychiatric Quart., 1968, 42(4), 653-95. Additionally, the overwhelming majority of experiments described in this essay took place before the notion of "informed consent" had been developed. Most experiments were conducted on patients who unknowingly received sham interventions. For a discussion of the history of informed consent, see Ruth R. Faden and Tom L. Beauchamp in collaboration with Nancy M. P. King, A History and Theory of Informed Consent (New York: Oxford University Press, 1986); Susan E. Lederer, Subjected to Science: Human Experimentation in America before the Second World War (Baltimore: Johns Hopkins University Press, 1995).
13. Several excellent recent histories directly concern the development of the randomized controlled-trial method in medicine. See, for example, Harry M. Marks, The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900-1990 (Cambridge: Cambridge University Press, 1997); and Marcia Lynn Meldrum, "'Departures from the Design': The Randomized Clinical Trial in Historical Context, 1946-1970," Ph.D. dissertation, State University of New York at Stony Brook, 1994 (Ann Arbor, Mich.: University Microfilms, 1997).
14. Several excellent recent histories directly concern the development of the randomized controlled-trial method in medicine. See, for example, Harry M. Marks, The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900-1990 (Cambridge: Cambridge University Press, 1997); and Marcia Lynn Meldrum, "'Departures from the Design': The Randomized Clinical Trial in Historical Context, 1946-1970," Ph.D. dissertation, State University of New York at Stony Brook, 1994 (Ann Arbor, Mich.: University Microfilms, 1997).
15. Kurt Danziger, Constructing the Subject: Historical Origins of Psychological Research (Cambridge: Cambridge University Press, 1994), p. 3.
16. John Harley Warner, "Science in Medicine," Osiris, 2d ser., 1985, 1: 37-58, quotation on p. 52. This account could also be considered an example of "the ongoing narrative reconstruction of scientific practice" that simultaneously reconfigures the past while it sets future research priorities. Joseph Rouse, Engaging Science: How to Understand Its Practice Philosophically (Ithaca, N.Y.: Cornell University Press, 1996), p. 176.
17. John Harley Warner, "Science in Medicine," Osiris, 2d ser., 1985, 1: 37-58, quotation on p. 52. This account could also be considered an example of "the ongoing narrative reconstruction of scientific practice" that simultaneously reconfigures the past while it sets future research priorities. Joseph Rouse, Engaging Science: How to Understand Its Practice Philosophically (Ithaca, N.Y.: Cornell University Press, 1996), p. 176.
18. Robert E. Kohler, From Medical Chemistry to Biochemistry: The Making of a Biomedical Discipline (Cambridge: Cambridge University Press, 1982), p. 6. A similar sentiment is even more emphatically expressed by Richard Lewontin in the context of other scientific enterprises: "the origins of differences in required rigor are not always easy to discern. . . . The quality of evidence itself is tailored to fit ideological demand" (Richard C. Lewontin, "Facts and the Fictitious in Natural Sciences," in Questions of Evidence: Proof, Practice, and Persuasion across the Disciplines, ed. James Chandler, Arnold I. Davidson, and Harry Harootunian [Chicago: University of Chicago Press, 1994], pp. 489, 491).
19. Robert E. Kohler, From Medical Chemistry to Biochemistry: The Making of a Biomedical Discipline (Cambridge: Cambridge University Press, 1982), p. 6. A similar sentiment is even more emphatically expressed by Richard Lewontin in the context of other scientific enterprises: "the origins of differences in required rigor are not always easy to discern. . . . The quality of evidence itself is tailored to fit ideological demand" (Richard C. Lewontin, "Facts and the Fictitious in Natural Sciences," in Questions of Evidence: Proof, Practice, and Persuasion across the Disciplines, ed. James Chandler, Arnold I. Davidson, and Harry Harootunian [Chicago: University of Chicago Press, 1994], pp. 489, 491).
20. There are many excellent discussions on the emergence of the modern orthodox-versus-sectarian medical disputes, including William F. Bynum and Roy Porter, eds., Medical Fringe and Medical Orthodoxy, 1750-1850 (London: Croom Helm, 1987); Roy Porter, Health for Sale: Quackery in England, 1660-1850 (Manchester: Manchester University Press, 1989); Roger Cooter, ed., Studies in the History of Alternative Medicine (New York: St. Martin's Press, 1988); Alison Klairmont Lingo, "Empirics and Charlatans in Early Modern France: The Genesis of the Classification of the 'Other' in Medical Practice," J. Soc. Hist., 1986, 19: 583-604.
21. There are many excellent discussions on the emergence of the modern orthodox- versus-sectarian medical disputes, including William F. Bynum and Roy Porter, eds., Medical Fringe and Medical Orthodoxy, 1750-1850 (London: Croom Helm, 1987); Roy Porter, Health for Sale: Quackery in England, 1660-1850 (Manchester: Manchester University Press, 1989); Roger Cooter, ed., Studies in the History of Alternative Medicine (New York: St. Martin's Press, 1988); Alison Klairmont Lingo, "Empirics and Charlatans in Early Modern France: The Genesis of the Classification of the 'Other' in Medical Practice," J. Soc. Hist., 1986, 19: 583-604.
22. There are many excellent discussions on the emergence of the modern orthodox- versus-sectarian medical disputes, including William F. Bynum and Roy Porter, eds., Medical Fringe and Medical Orthodoxy, 1750-1850 (London: Croom Helm, 1987); Roy Porter, Health for Sale: Quackery in England, 1660-1850 (Manchester: Manchester University Press, 1989); Roger Cooter, ed., Studies in the History of Alternative Medicine (New York: St. Martin's Press, 1988); Alison Klairmont Lingo, "Empirics and Charlatans in Early Modern France: The Genesis of the Classification of the 'Other' in Medical Practice," J. Soc. Hist., 1986, 19: 583-604.
23. There are many excellent discussions on the emergence of the modern orthodox- versus-sectarian medical disputes, including William F. Bynum and Roy Porter, eds., Medical Fringe and Medical Orthodoxy, 1750-1850 (London: Croom Helm, 1987); Roy Porter, Health for Sale: Quackery in England, 1660-1850 (Manchester: Manchester University Press, 1989); Roger Cooter, ed., Studies in the History of Alternative Medicine (New York: St. Martin's Press, 1988); Alison Klairmont Lingo, "Empirics and Charlatans in Early Modern France: The Genesis of the Classification of the 'Other' in Medical Practice," J. Soc. Hist., 1986, 19: 583-604.
24. The word boundary here follows one of Thomas Gieryn's definitions, where it is meant to "exclude[s] rivals . . . by defining them as outsiders with labels such as 'pseudo,' 'deviant,' or 'amateur'" (Thomas F. Gieryn, "Boundary-Work and the Demarcation of Science from Non-science: Strains and Interests in Professional Ideologies of Scientists," Amer. Sociol. Rev., 1983, 48: 781-95, quotation on p. 792). Cf. Roy Wallis, ed., On the Margins of Science: The Social Construction of Rejected Knowledge (Keele, UK: University of Keele, 1979).
25. The word boundary here follows one of Thomas Gieryn's definitions, where it is meant to "exclude[s] rivals . . . by defining them as outsiders with labels such as 'pseudo,' 'deviant,' or 'amateur'" (Thomas F. Gieryn, "Boundary-Work and the Demarcation of Science from Non-science: Strains and Interests in Professional Ideologies of Scientists," Amer. Sociol. Rev., 1983, 48: 781-95, quotation on p. 792). Cf. Roy Wallis, ed., On the Margins of Science: The Social Construction of Rejected Knowledge (Keele, UK: University of Keele, 1979).
26. For a discussion of the popularity of mesmerism and the entire mesmeric phenomenon, see Robert Darnton, Mesmerism and the End of the Enlightenment (Cambridge: Harvard University Press, 1968). It is possible to find "precursor" incidents of blind assessment in the pre-modern era. Generally they were used to demonstrate medical virtuosity, as opposed to squeezing veracity out of the distortions of the imagination, For example, Muslim and medieval western medicine both featured a well-known story in which a famous physician claimed to be able to perform diagnosis through a string tied to the patient's radial pulse. In a test, the Sultan deceptively gave the physician a string tied to the tibial pulse of a cow and asked the physician to diagnose the "modest" woman in the adjoining room. When the physician said that the creature needed grass he was considered truly proficient (Reuben B. Amber and A. M. Babey-Brooke, The Pulse in Occident and Orient: Its Philosophy and Practice in India, China, Iran, and the West [New York: Santa Barbara Press, 1966], p. 2). Another example from seventeenth-century France involved Sir Kenelm Digby (1603- 65), who reported an accidental blind assessment confirming his "sympathetic natural magic" method of treating wounds. Digby inadvertently discontinued the treatment, while at the exact same moment the patient (in another part of the room) suffered an acute exacerbation of his pain. The incident was reported as a secondary corroboration of Digby's method rather than an important procedure to unshackle material science from the delusions of the mind (Kenelm Digby, Of the Sympathetic Powder: A Discourse in a Solemn Assembly at Montpellier, Made in French, by Sir Kenelm Digby, Knight, 1657 [London: John Williams, 1669], pp. 148-50). Only with the advent of mesmerism did material science perceive the need to overthrow the notion that medical events are accurately accessible to sensory awareness and the mind.
27. For a discussion of the popularity of mesmerism and the entire mesmeric phenomenon, see Robert Darnton, Mesmerism and the End of the Enlightenment (Cambridge: Harvard University Press, 1968). It is possible to find "precursor" incidents of blind assessment in the pre-modern era. Generally they were used to demonstrate medical virtuosity, as opposed to squeezing veracity out of the distortions of the imagination, For example, Muslim and medieval western medicine both featured a well-known story in which a famous physician claimed to be able to perform diagnosis through a string tied to the patient's radial pulse. In a test, the Sultan deceptively gave the physician a string tied to the tibial pulse of a cow and asked the physician to diagnose the "modest" woman in the adjoining room. When the physician said that the creature needed grass he was considered truly proficient (Reuben B. Amber and A. M. Babey-Brooke, The Pulse in Occident and Orient: Its Philosophy and Practice in India, China, Iran, and the West [New York: Santa Barbara Press, 1966], p. 2). Another example from seventeenth-century France involved Sir Kenelm Digby (1603- 65), who reported an accidental blind assessment confirming his "sympathetic natural magic" method of treating wounds. Digby inadvertently discontinued the treatment, while at the exact same moment the patient (in another part of the room) suffered an acute exacerbation of his pain. The incident was reported as a secondary corroboration of Digby's method rather than an important procedure to unshackle material science from the delusions of the mind (Kenelm Digby, Of the Sympathetic Powder: A Discourse in a Solemn Assembly at Montpellier, Made in French, by Sir Kenelm Digby, Knight, 1657 [London: John Williams, 1669], pp. 148-50). Only with the advent of mesmerism did material science perceive the need to overthrow the notion that medical events are accurately accessible to sensory awareness and the mind.
28. For a discussion of the popularity of mesmerism and the entire mesmeric phenomenon, see Robert Darnton, Mesmerism and the End of the Enlightenment (Cambridge: Harvard University Press, 1968). It is possible to find "precursor" incidents of blind assessment in the pre-modern era. Generally they were used to demonstrate medical virtuosity, as opposed to squeezing veracity out of the distortions of the imagination, For example, Muslim and medieval western medicine both featured a well-known story in which a famous physician claimed to be able to perform diagnosis through a string tied to the patient's radial pulse. In a test, the Sultan deceptively gave the physician a string tied to the tibial pulse of a cow and asked the physician to diagnose the "modest" woman in the adjoining room. When the physician said that the creature needed grass he was considered truly proficient (Reuben B. Amber and A. M. Babey-Brooke, The Pulse in Occident and Orient: Its Philosophy and Practice in India, China, Iran, and the West [New York: Santa Barbara Press, 1966], p. 2). Another example from seventeenth-century France involved Sir Kenelm Digby (1603-65), who reported an accidental blind assessment confirming his "sympathetic natural magic" method of treating wounds. Digby inadvertently discontinued the treatment, while at the exact same moment the patient (in another part of the room) suffered an acute exacerbation of his pain. The incident was reported as a secondary corroboration of Digby's method rather than an important procedure to unshackle material science from the delusions of the mind (Kenelm Digby, Of the Sympathetic Powder: A Discourse in a Solemn Assembly at Montpellier, Made in French, by Sir Kenelm Digby, Knight, 1657 [London: John Williams, 1669], pp. 148-50). Only with the advent of mesmerism did material science perceive the need to overthrow the notion that medical events are accurately accessible to sensory awareness and the mind.
29. See George Bloch, trans., Mesmerism: A Translation of the Original Scientific and Medical Writings of F.A. Mesmer (Los Altos, Calif.: William Kaufmann, 1980), p. 25.
30. Franklin had already conducted a series of observations on the use of electricity in paralytic cases in Pennsylvania since at least 1757. These experiments were not blind. See Benjamin Franklin, "Letter XIX. to John Pringle, M.D. and F.R.C.S., December 21, 1757," in Benjamin Franklin's Experiments: A New Edition of Franklin's Experiments and Observations on Electricity, ed. I. Bernard Cohen (Cambridge: Harvard University Press, 1941), p. 347. For further discussion of Franklin's relationship to mesmerism and of how the commission's research strategy may have been conceived, see Denis I. Duveen and Herbert S. Klickstein, "Benjamin Franklin (1706-1790) and Antoine Laurent Lavoisier (1743-1794), Part II: Joint Investigations," Ann. Sci., 1955, 11 (4): 271-308.
31. Franklin had already conducted a series of observations on the use of electricity in paralytic cases in Pennsylvania since at least 1757. These experiments were not blind. See Benjamin Franklin, "Letter XIX. to John Pringle, M.D. and F.R.C.S., December 21, 1757," in Benjamin Franklin's Experiments: A New Edition of Franklin's Experiments and Observations on Electricity, ed. I. Bernard Cohen (Cambridge: Harvard University Press, 1941), p. 347. For further discussion of Franklin's relationship to mesmerism and of how the commission's research strategy may have been conceived, see Denis I. Duveen and Herbert S. Klickstein, "Benjamin Franklin (1706-1790) and Antoine Laurent Lavoisier (1743-1794), Part II: Joint Investigations," Ann. Sci., 1955, 11 (4): 271-308.
32. Mesmer wanted a prospective comparative experiment for any disease but venereal ones: see Claude-Anne Lopez, "Franklin and Mesmer: An Encounter," Yale J. Biol. Med., 1993, 66: 325-31, quotation on p. 327; cf. Geoffrey Sutton, "Electric Medicine and Mesmerism," Isis, 1981, 72: 375-92, quotation on p. 387. When Mesmer's offer was refused he declined to cooperate with the commission, and one of his principal disciples, Charles d'Eslon (1739-86), physician-in-ordinary to the king's brother, performed the treatments during the experiments.
33. Mesmer wanted a prospective comparative experiment for any disease but venereal ones: see Claude-Anne Lopez, "Franklin and Mesmer: An Encounter," Yale J. Biol. Med., 1993, 66: 325-31, quotation on p. 327; cf. Geoffrey Sutton, "Electric Medicine and Mesmerism," Isis, 1981, 72: 375-92, quotation on p. 387. When Mesmer's offer was refused he declined to cooperate with the commission, and one of his principal disciples, Charles d'Eslon (1739-86), physician-in-ordinary to the king's brother, performed the treatments during the experiments.
34. Benjamin Franklin, Majault, Le Roy, Sallin, Jean-Sylvain Bailly, D'Arcet, De Bory, Joseph-Ignace Guillotin, and Antoine Laurent Lavoisier, Report of Dr. Benjamin Franklin, and Other Commissioners, Charged by the King of France, with the Examination of Animal Magnetism, as Now Practiced in Paris, trans. William Godwin (London: J. Johnson, 1785), p. 38. (Whenever possible, I have used a published English translation of original source material; in other cases the translations are my own.)
35. Ibid.
36. Ibid., p. 56.
37. Ibid., p. 58.
38. Sham or decoy assessments were also part of the experimental strategy. For example, a twelve-year-old boy subject, selected by the mesmerist, was led up to five trees, one of which had been mesmerized, in Franklin's garden. Previously, the boy had routinely fainted in the presence of a mesmerized tree. This time he had his eyes covered with bandages so that there would be "no communication" between him and the mesmerist; he passed out and needed to be carried out of the garden when he embraced the wrong tree (ibid., p. 67). At another session, this time at Lavoisier's house, a patient was mesmerized by plain water (when told it was "mesmerized" water), but had no sensations from genuinely treated water (ibid., p. 73).
39. Sham or decoy assessments were also part of the experimental strategy. For example, a twelve-year-old boy subject, selected by the mesmerist, was led up to five trees, one of which had been mesmerized, in Franklin's garden. Previously, the boy had routinely fainted in the presence of a mesmerized tree. This time he had his eyes covered with bandages so that there would be "no communication" between him and the mesmerist; he passed out and needed to be carried out of the garden when he embraced the wrong tree (ibid., p. 67). At another session, this time at Lavoisier's house, a patient was mesmerized by plain water (when told it was "mesmerized" water), but had no sensations from genuinely treated water (ibid., p. 73).
40. Ibid., p. 97. The commission actually concluded that the effects of mesmeric fluid were due to "compression [the touching that happened during sessions], imagination and imitation" (ibid., p. 97). But imagination was generally considered the chief cause: ibid., p. 102.
41. There was another commission appointed by the Royal Society of Medicine that was also supposed to investigate mesmerism. Its report, which was even more adversarial in tone, was issued a few days after the Academy of Sciences' and was never as widely circulated. One of this commission's members, Antoine Laurent de Jussieu (1748-1836) -a distinguished botanist and physician - wrote a separate report dissenting from the majority. He described a blind assessment in which the patient was unaware she was being magnetized in a crowded room where a mingling of researchers' bodies created a shield. De Jussieu claimed that magnetism occurred even under ignorant conditions. De Jussieu's report is in Alexandre J. F. Bertrand, Du magnétisme animal en France (Paris: J. B. Baillière, 1826), pp. 151-210. Critics countered that the precautions to insure blindness were inadequate: see Claude Burdin and Frédéric Dubois, Histoire académique du magnétisme animal accompagnée de notes et de remarques critiques sur tautes les observations et expériences faites jusqu'à ce jour (Paris: J. B. Baillière, 1841), pp. 160-65.
42. There was another commission appointed by the Royal Society of Medicine that was also supposed to investigate mesmerism. Its report, which was even more adversarial in tone, was issued a few days after the Academy of Sciences' and was never as widely circulated. One of this commission's members, Antoine Laurent de Jussieu (1748-1836) - a distinguished botanist and physician - wrote a separate report dissenting from the majority. He described a blind assessment in which the patient was unaware she was being magnetized in a crowded room where a mingling of researchers' bodies created a shield. De Jussieu claimed that magnetism occurred even under ignorant conditions. De Jussieu's report is in Alexandre J. F. Bertrand, Du magnétisme animal en France (Paris: J. B. Baillière, 1826), pp. 151-210. Critics countered that the precautions to insure blindness were inadequate: see Claude Burdin and Frédéric Dubois, Histoire académique du magnétisme animal accompagnée de notes et de remarques critiques sur tautes les observations et expériences faites jusqu'à ce jour (Paris: J. B. Baillière, 1841), pp. 160-65.
43. For excellent discussions of these phenomena see Alan Gauld, A History of Hypnotism (Cambridge: Cambridge University Press, 1992); Frank Podmore, Mesmerism and Christian Science: A Short History of Mental Healing (London: Methuen, 1909); Robert C. Fuller, Mesmerism and the American Cure of Souls (Philadelphia: University of Pennsylvania Press, 1982).
44. For excellent discussions of these phenomena see Alan Gauld, A History of Hypnotism (Cambridge: Cambridge University Press, 1992); Frank Podmore, Mesmerism and Christian Science: A Short History of Mental Healing (London: Methuen, 1909); Robert C. Fuller, Mesmerism and the American Cure of Souls (Philadelphia: University of Pennsylvania Press, 1982).
45. For excellent discussions of these phenomena see Alan Gauld, A History of Hypnotism (Cambridge: Cambridge University Press, 1992); Frank Podmore, Mesmerism and Christian Science: A Short History of Mental Healing (London: Methuen, 1909); Robert C. Fuller, Mesmerism and the American Cure of Souls (Philadelphia: University of Pennsylvania Press, 1982).
46. The most encyclopedic study of mesmeric phenomena is Eric J. Dingwall, ed., Abnormal Hypnotic Phenomena: A Survey of Nineteenth-Century Cases, 4 vols. (London: Churchill, 1967-68). This monumental work meticulously documents scores of episodes of masked mesmeric scientific assessments and entertainment theater throughout Europe and North and South America. Theater performances routinely used blindfolds to show that remarkable feats were possible and as proof of the absence of "trickery." Demonstrations of eyeless sight and forms of clairvoyance where the eyes were bandaged and stuffed with cotton wads attracted both popular and scientific interest. For scientific investigations, more rigorous forms of blinding were adopted. For example, in 1838 John Elliotson (1791-1868) employed a "well-contrived brown paper cap, which completely precluded vision," for his testing of magnectic subjects ("Faculties of Elizabeth O'key," Lancet, 1838, 2: 873-77, quotation on p. 875). John Kearsley Mitchell (1798-1858 - father of neurologist Silas Weir Mitchell [1829-1914]) used a thick "doubled shawl, through which I could not see the slightest ray of light" (John Kearsley Mitchell, Five Essays [Philadelphia: Lippincott, 1859], p. 165). James Braid (1795-1860) put patients in a "dark closet" in his experiments on the "odic force" (James Braid, Magic, Witchcraft, Animal Magnetism, Hypnotism and Electro-Biology: Being a Digest of the Latest Views of the Author on These Subjects [London: John Churchill, 1852], p. 27).
47. The most encyclopedic study of mesmeric phenomena is Eric J. Dingwall, ed., Abnormal Hypnotic Phenomena: A Survey of Nineteenth-Century Cases, 4 vols. (London: Churchill, 1967-68). This monumental work meticulously documents scores of episodes of masked mesmeric scientific assessments and entertainment theater throughout Europe and North and South America. Theater performances routinely used blindfolds to show that remarkable feats were possible and as proof of the absence of "trickery." Demonstrations of eyeless sight and forms of clairvoyance where the eyes were bandaged and stuffed with cotton wads attracted both popular and scientific interest. For scientific investigations, more rigorous forms of blinding were adopted. For example, in 1838 John Elliotson (1791-1868) employed a "well-contrived brown paper cap, which completely precluded vision," for his testing of magnectic subjects ("Faculties of Elizabeth O'key," Lancet, 1838, 2: 873-77, quotation on p. 875). John Kearsley Mitchell (1798-1858 - father of neurologist Silas Weir Mitchell [1829-1914]) used a thick "doubled shawl, through which I could not see the slightest ray of light" (John Kearsley Mitchell, Five Essays [Philadelphia: Lippincott, 1859], p. 165). James Braid (1795-1860) put patients in a "dark closet" in his experiments on the "odic force" (James Braid, Magic, Witchcraft, Animal Magnetism, Hypnotism and Electro-Biology: Being a Digest of the Latest Views of the Author on These Subjects [London: John Churchill, 1852], p. 27).
48. The most encyclopedic study of mesmeric phenomena is Eric J. Dingwall, ed., Abnormal Hypnotic Phenomena: A Survey of Nineteenth-Century Cases, 4 vols. (London: Churchill, 1967-68). This monumental work meticulously documents scores of episodes of masked mesmeric scientific assessments and entertainment theater throughout Europe and North and South America. Theater performances routinely used blindfolds to show that remarkable feats were possible and as proof of the absence of "trickery." Demonstrations of eyeless sight and forms of clairvoyance where the eyes were bandaged and stuffed with cotton wads attracted both popular and scientific interest. For scientific investigations, more rigorous forms of blinding were adopted. For example, in 1838 John Elliotson (1791-1868) employed a "well-contrived brown paper cap, which completely precluded vision," for his testing of magnectic subjects ("Faculties of Elizabeth O'key," Lancet, 1838, 2: 873-77, quotation on p. 875). John Kearsley Mitchell (1798-1858 - father of neurologist Silas Weir Mitchell [1829-1914]) used a thick "doubled shawl, through which I could not see the slightest ray of light" (John Kearsley Mitchell, Five Essays [Philadelphia: Lippincott, 1859], p. 165). James Braid (1795-1860) put patients in a "dark closet" in his experiments on the "odic force" (James Braid, Magic, Witchcraft, Animal Magnetism, Hypnotism and Electro-Biology: Being a Digest of the Latest Views of the Author on These Subjects [London: John Churchill, 1852], p. 27).
49. The most encyclopedic study of mesmeric phenomena is Eric J. Dingwall, ed., Abnormal Hypnotic Phenomena: A Survey of Nineteenth-Century Cases, 4 vols. (London: Churchill, 1967-68). This monumental work meticulously documents scores of episodes of masked mesmeric scientific assessments and entertainment theater throughout Europe and North and South America. Theater performances routinely used blindfolds to show that remarkable feats were possible and as proof of the absence of "trickery." Demonstrations of eyeless sight and forms of clairvoyance where the eyes were bandaged and stuffed with cotton wads attracted both popular and scientific interest. For scientific investigations, more rigorous forms of blinding were adopted. For example, in 1838 John Elliotson (1791-1868) employed a "well-contrived brown paper cap, which completely precluded vision," for his testing of magnectic subjects ("Faculties of Elizabeth O'key," Lancet, 1838, 2: 873-77, quotation on p. 875). John Kearsley Mitchell (1798-1858 - father of neurologist Silas Weir Mitchell [1829-1914]) used a thick "doubled shawl, through which I could not see the slightest ray of light" (John Kearsley Mitchell, Five Essays [Philadelphia: Lippincott, 1859], p. 165). James Braid (1795-1860) put patients in a "dark closet" in his experiments on the "odic force" (James Braid, Magic, Witchcraft, Animal Magnetism, Hypnotism and Electro-Biology: Being a Digest of the Latest Views of the Author on These Subjects [London: John Churchill, 1852], p. 27).
50. Pierre Foissac, Rapports et discussions de l'Académie Royale de Médecine sur le magnétisme animal recueillis par un sténographe, et publiés, avec des nates explicatives (Paris: J. B. Baillière, 1833), pp. 272-79. Also see Alfred Binet and Charles Féré, Animal Magnetism (London: Kegan Paul, Trench, 1888), p. 33.
51. Pierre Foissac, Rapports et discussions de l'Académie Royale de Médecine sur le magnétisme animal recueillis par un sténographe, et publiés, avec des nates explicatives (Paris: J. B. Baillière, 1833), pp. 272-79. Also see Alfred Binet and Charles Féré, Animal Magnetism (London: Kegan Paul, Trench, 1888), p. 33.
52. Foissac, Rapports et discussions (n. 22), p. 275.
53. Ibid., p. 276.
54. Ibid., p. 279.
55. Other royal and scientific commissions were created because of public pressure. The most famous of these was that appointed by the Royal Academy of Medicine in 1831. Its report, which included blind assessments with concealed magnetic healers in adjoining rooms and masked diagnostic clairvoyants, was ultimately positive and stunned the Academy. It concluded that while the phenomenon of magnetic somnambulism was capable of being "feigned and furnish[ed] to quackery the means of deception . . . [it] has been produced in circumstances, in which the persons magnetised could not see or were ignorant of the means employed to occasion it" (A Committee of the Medical Section of the French Royal Academy of Sciences, Report on the Experiments on Animal Magnetism, trans. John C. Colquhoun [Edinburgh: Robert Cadell, 1833], pp. 194-95). The commission only established what it considered to be the veracity of the phenomena; it felt that it did not have sufficient patients for a long enough period to decide how to evaluate magnetism's therapeutic effects.
56. See Eric T. Carlson and Meribeth M. Simpson, "Perkinism vs. Mesmerism," J .Hist. Behav. Sci., 1970, 6: 16-24; Jacques M. Quen, "Elisha Perkins, Physician, Nostrum-vendor, or Charlatan?" Bull. Hist. Med., 1963, 37: 159-66; idem, "Case Studies in Nineteenth- Century Scientific Rejection: Mesmerism, Perkinism, and Acupuncture," J. Hist. Behav. Sci., 1975, 11: 149-56. Perkins received the first U.S. government patent for a medical device, won the enthusiastic support of Supreme Court Chief Justice Oliver Ellsworth and of Nathan Smith (founder of Yale Medical School), and even sold a set of "metallic tractors" to George Washington. He died in 1799, while trying to demonstrate the tractor's and his other potions' effectiveness against the New York yellow fever epidemic. His death, however, did not stop his son from bringing the device to England, where it received enormous attention.
57. See Eric T. Carlson and Meribeth M. Simpson, "Perkinism vs. Mesmerism," J .Hist. Behav. Sci., 1970, 6: 16-24; Jacques M. Quen, "Elisha Perkins, Physician, Nostrum-vendor, or Charlatan?" Bull. Hist. Med., 1963, 37: 159-66; idem, "Case Studies in Nineteenth- Century Scientific Rejection: Mesmerism, Perkinism, and Acupuncture," J. Hist. Behav. Sci., 1975, 11: 149-56. Perkins received the first U.S. government patent for a medical device, won the enthusiastic support of Supreme Court Chief Justice Oliver Ellsworth and of Nathan Smith (founder of Yale Medical School), and even sold a set of "metallic tractors" to George Washington. He died in 1799, while trying to demonstrate the tractor's and his other potions' effectiveness against the New York yellow fever epidemic. His death, however, did not stop his son from bringing the device to England, where it received enormous attention.
58. See Eric T. Carlson and Meribeth M. Simpson, "Perkinism vs. Mesmerism," J .Hist. Behav. Sci., 1970, 6: 16-24; Jacques M. Quen, "Elisha Perkins, Physician, Nostrum-vendor, or Charlatan?" Bull. Hist. Med., 1963, 37: 159-66; idem, "Case Studies in Nineteenth-Century Scientific Rejection: Mesmerism, Perkinism, and Acupuncture," J. Hist. Behav. Sci., 1975, 11: 149-56. Perkins received the first U.S. government patent for a medical device, won the enthusiastic support of Supreme Court Chief Justice Oliver Ellsworth and of Nathan Smith (founder of Yale Medical School), and even sold a set of "metallic tractors" to George Washington. He died in 1799, while trying to demonstrate the tractor's and his other potions' effectiveness against the New York yellow fever epidemic. His death, however, did not stop his son from bringing the device to England, where it received enormous attention.
59. John Haygarth, Of the Imagination, as a Cause and as a Cure of Disorders of the Body; Exemplified by Fictitious Tractors and Epidemical Convulsions (Bath: R. Cruttwell, 1801), p. 2.
60. Ibid., p. 41.
61. Armand Trousseau and Henri Gouraud, "Répertoire clinique: Expériences homoeopathiques [sic; this Germanic spelling is often used] tentées à l'Hôtel-Dieu de Paris," Journal des Connaissances Médico-Chirurgicales, 1834, 8: 238-41, quotation on p. 239. Trousseau, of the eponymous spasm, is also generally remembered for pioneering the use of tracheotomy and intubation in medicine, and for his Traité de thérapeutique et de matière médicale. He was acutely aware of the magnetic debate, as is evident from his signed entry on magnetism in the Dictionnaire de Médecine (Paris: Bechet, Librairie de la Faculté de Médecine, 1833), pp. 11-25. For a description of the tenor of the homeopathic debates in Paris at the time, see Armand Trousseau, Henri Gouraud, and J. Lebaudy, "Correspondance médicale, "Journal des Connaissances Médico-Chirurgicales, 1833, 1: 141-42. Homeopathy was very much a physician-based practice with an upper-class clientele. See Olivier Faure, Le débat autour de l'homéopathie en France, 1830-1870: Évidence et arrière-plans (Lyon: Centre Pierre Léon, Bioron, 1990).
62. Armand Trousseau and Henri Gouraud, "Répertoire clinique: Expériences homoeopathiques [sic; this Germanic spelling is often used] tentées à l'Hôtel-Dieu de Paris," Journal des Connaissances Médico-Chirurgicales, 1834, 8: 238-41, quotation on p. 239. Trousseau, of the eponymous spasm, is also generally remembered for pioneering the use of tracheotomy and intubation in medicine, and for his Traité de thérapeutique et de matière médicale. He was acutely aware of the magnetic debate, as is evident from his signed entry on magnetism in the Dictionnaire de Médecine (Paris: Bechet, Librairie de la Faculté de Médecine, 1833), pp. 11-25. For a description of the tenor of the homeopathic debates in Paris at the time, see Armand Trousseau, Henri Gouraud, and J. Lebaudy, "Correspondance médicale, "Journal des Connaissances Médico-Chirurgicales, 1833, 1: 141-42. Homeopathy was very much a physician-based practice with an upper-class clientele. See Olivier Faure, Le débat autour de l'homéopathie en France, 1830-1870: Évidence et arrière-plans (Lyon: Centre Pierre Léon, Bioron, 1990).
63. Armand Trousseau and Henri Gouraud, "Répertoire clinique: Expériences homoeopathiques [sic; this Germanic spelling is often used] tentées à l'Hôtel-Dieu de Paris," Journal des Connaissances Médico-Chirurgicales, 1834, 8: 238-41, quotation on p. 239. Trousseau, of the eponymous spasm, is also generally remembered for pioneering the use of tracheotomy and intubation in medicine, and for his Traité de thérapeutique et de matière médicale. He was acutely aware of the magnetic debate, as is evident from his signed entry on magnetism in the Dictionnaire de Médecine (Paris: Bechet, Librairie de la Faculté de Médecine, 1833), pp. 11-25. For a description of the tenor of the homeopathic debates in Paris at the time, see Armand Trousseau, Henri Gouraud, and J. Lebaudy, "Correspondance médicale, "Journal des Connaissances Médico-Chirurgicales, 1833, 1: 141-42. Homeopathy was very much a physician-based practice with an upper-class clientele. See Olivier
64. Armand Trousseau and Henri Gouraud, "Répertoire clinique: Expériences homoeopathiques [sic; this Germanic spelling is often used] tentées à l'Hôtel-Dieu de Paris," Journal des Connaissances Médico-Chirurgicales, 1834, 8: 238-41, quotation on p. 239. Trousseau, of the eponymous spasm, is also generally remembered for pioneering the use of tracheotomy and intubation in medicine, and for his Traité de thérapeutique et de matière médicale. He was acutely aware of the magnetic debate, as is evident from his signed entry on magnetism in the Dictionnaire de Médecine (Paris: Bechet, Librairie de la Faculté de Médecine, 1833), pp. 11-25. For a description of the tenor of the homeopathic debates in Paris at the time, see Armand Trousseau, Henri Gouraud, and J. Lebaudy, "Correspondance médicale, "Journal des Connaissances Médico-Chirurgicales, 1833, 1: 141-42. Homeopathy was very much a physician-based practice with an upper-class clientele. See Olivier Faure, Le débat autour de l'homéopathie en France, 1830-1870: Évidence et arrière-plans (Lyon: Centre Pierre Léon, Bioron, 1990).
65. On Europe, see Martin Dinges, ed., Weltgeschichte der Homöopathie: Länder-Schulen-Heilkundige (Munich: C. H. Beck, 1996); Phillip A. Nicholls, Homoeopathy and the Medical Profession (London: Croom Helm, 1988). On the United States, see Martin Kaufman, Homeopathy in America: The Rise and Fall of a Medical Heresy (Baltimore: Johns Hopkins Press, 1971); William G. Rothstein, American Physicians in the Nineteenth Century: From Sects to Science (1972; Baltimore: Johns Hopkins University Press, 1985).
66. On Europe, see Martin Dinges, ed., Weltgeschichte der Homöopathie: Länder-Schulen- Heilkundige (Munich: C. H. Beck, 1996); Phillip A. Nicholls, Homoeopathy and the Medical Profession (London: Croom Helm, 1988). On the United States, see Martin Kaufman, Homeopathy in America: The Rise and Fall of a Medical Heresy (Baltimore: Johns Hopkins Press, 1971); William G. Rothstein, American Physicians in the Nineteenth Century: From Sects to Science (1972; Baltimore: Johns Hopkins University Press, 1985).
67. On Europe, see Martin Dinges, ed., Weltgeschichte der Homöopathie: Länder-Schulen- Heilkundige (Munich: C. H. Beck, 1996); Phillip A. Nicholls, Homoeopathy and the Medical Profession (London: Croom Helm, 1988). On the United States, see Martin Kaufman, Homeopathy in America: The Rise and Fall of a Medical Heresy (Baltimore: Johns Hopkins Press, 1971); William G. Rothstein, American Physicians in the Nineteenth Century: From Sects to Science (1972; Baltimore: Johns Hopkins University Press, 1985).
68. On Europe, see Martin Dinges, ed., Weltgeschichte der Homöopathie: Länder-Schulen- Heilkundige (Munich: C. H. Beck, 1996); Phillip A. Nicholls, Homoeopathy and the Medical Profession (London: Croom Helm, 1988). On the United States, see Martin Kaufman, Homeopathy in America: The Rise and Fall of a Medical Heresy (Baltimore: Johns Hopkins Press, 1971); William G. Rothstein, American Physicians in the Nineteenth Century: From Sects to Science (1972; Baltimore: Johns Hopkins University Press, 1985).
69. Jean Baptiste Bouillaud, "Rapport sur l'homoeopathie," Bulletin Général de Thérapeutique, 1835, 8: 158-59, quotation on p. 159. It may not be a coincidence that the most venomous opposition to homeopathy in Paris came from people like J. B. Bouillaud (1796-1881) who were considered relentless in their advocacy of bloodletting, while Gabriel Andral (see below), who was allied with Pierre C. A. Louis (1787-1872) in urging less bleeding, was willing to test homeopathy. For a discussion of some of the parallel medical debates during this period, see Erwin H. Ackerknecht, Medicine at the Paris Hospital, 1794-1848 (Baltimore: Johns Hopkins Press, 1967).
70. Jean Baptiste Bouillaud, "Rapport sur l'homoeopathie," Bulletin Général de Thérapeutique, 1835, 8: 158-59, quotation on p. 159. It may not be a coincidence that the most venomous opposition to homeopathy in Paris came from people like J. B. Bouillaud (1796-1881) who were considered relentless in their advocacy of bloodletting, while Gabriel Andral (see below), who was allied with Pierre C. A. Louis (1787-1872) in urging less bleeding, was willing to test homeopathy. For a discussion of some of the parallel medical debates during this period, see Erwin H. Ackerknecht, Medicine at the Paris Hospital, 1794-1848 (Baltimore: Johns Hopkins Press, 1967).
71. The most important such experimental administration was performed by Gabriel Andral (1797-1876) at the Pitié on at least eighty-nine patients: Gabriel Andral, "Expériences homéopathiques faites par M Andral à l'Hôpital de la Pitié," Bulletin Général de Thérapeutique, 1834, 5: 318-22. Also see M. Listianc, "Discussion sur l'homoeopathie," Gazette Médicale de Paris, 2d ser., 1835, 3: 189-90.
72. The most important such experimental administration was performed by Gabriel Andral (1797-1876) at the Pitié on at least eighty-nine patients: Gabriel Andral, "Expériences homéopathiques faites par M Andral à l'Hôpital de la Pitié," Bulletin Général de Thérapeutique, 1834, 5: 318-22. Also see M. Listianc, "Discussion sur l'homoeopathie," Gazette Médicale de Paris, 2d ser., 1835, 3: 189-90.
73. D. M. P. Pigeaux, "Étonnantes vertus homoeopathiques de la mie de pain: Expériences faites à l"Hôtel-Dieu," Bulletin Général de Thérapeutique Médicale et Chirurgicale, 1834, 6: 128-31, quotation on p. 128. Pigeaux was a student of Trousseau and performed his experiment under his teacher's supervision. This report was published slightly before Trousseau and Gouraud"s report (n. 30) and included overlapping data on some of the same patients; the two are clearly linked and should be considered a single experiment.
74. Trousseau and Gouraud, "Expériences homoeopathiques" (n. 30), p. 239.
75. Trousseau and Gouraud, "Expériences homoeopathiques" (n. 30) called them "pilules d"amidon" and Pigeaux (n. 34) called them "la mie de pain." The pills in both experiments were made in the same lot by the same pharmacist and included gum arabic as a binder.
76. Pigeaux, "Étonnantes vertus" (n. 34), p. 128.
77. Trousseau and Gouraud, "Expériences homoeopathiques" (n. 30), p. 239.
78. Ibid., p. 241.
79. Pigeaux, "Étonnantes vertus" (n. 34), p. 131.
80. John Forbes, "Homoeopathy, Allopathy and "Young Physic,'" Brit. & For. Med. Rev., 1846, 21: 225-65, quotation on p. 251.
81. Forbes claimed that "several [experiments] have been made in the German hospitals" that involved "two sets of parallel cases of disease, the one treated homoeopathically, the other treated apparently in the same manner" - but with fictitious globules in lieu of the real globules of homeopathy (ibid., pp. 239-40) (italics in original). Forbes himself performed a comparative homeopathic efficacy experiment using a sham-bread-pill arm: "Many years ago . . . we had occasion to treat an epidemic diarrhea of considerable violence but not dangerous. . . . [W]e put half of our remaining patients on a course of orthodox physic, and half on homoeopathic doses of flour . . . in the shape of bread-pills; and it puzzled us sadly to say which was the most successful treatment" (ibid., p. 249). A blind assessment of homeopathy using a bread pill seems to have taken place in St. Petersburg in 1834: see Otto Prokop and Ludwig Prokop, Homöopathie und Wissenschaft: Eine Kritik des Systems (Stuttgart: Ferdinand Enke, 1957), p. 22. Lisle used homeopathic and sham preparations in experiments that actually focused on the power of bread pills; his experiments had no concurrent controls: E. Lisle, "Feuilleton de l'homoeopathie orthodoxe," L'Union Médicale, 1861, 125: 11-72.
82. Forbes claimed that "several [experiments] have been made in the German hospitals" that involved "two sets of parallel cases of disease, the one treated homoeopathically, the other treated apparently in the same manner" - but with fictitious globules in lieu of the real globules of homeopathy (ibid., pp. 239-40) (italics in original). Forbes himself performed a comparative homeopathic efficacy experiment using a sham-bread-pill arm: "Many years ago . . . we had occasion to treat an epidemic diarrhea of considerable violence but not dangerous. . . . [W]e put half of our remaining patients on a course of orthodox physic, and half on homoeopathic doses of flour . . . in the shape of bread-pills; and it puzzled us sadly to say which was the most successful treatment" (ibid., p. 249). A blind assessment of homeopathy using a bread pill seems to have taken place in St. Petersburg in 1834: see Otto Prokop and Ludwig Prokop, Homöopathie und Wissenschaft: Eine Kritik des Systems (Stuttgart: Ferdinand Enke, 1957), p. 22. Lisle used homeopathic and sham preparations in experiments that actually focused on the power of bread pills; his experiments had no concurrent controls: E. Lisle, "Feuilleton de l'homoeopathie orthodoxe," L'Union Médicale, 1861, 125: 11-72.
83. This trial was not an isolated event; there was much research activity into homeopathy in the American Midwest at the time. For example, a large-scale open-label comparative trial with more than five thousand patients took place at Chicago's Cook County Hospital between 1881 and 1887: see Kaufman, Homeopathy (n. 31), pp. 150-51. For a related discussion of homeopathy's involvement with statistical comparative methods, see James H. Cassedy, American Medicine and Statistical Thinking, 1800-1860 (Cambridge: Harvard University Press, 1984), pp. 124-30.
84. This trial was not an isolated event; there was much research activity into homeopathy in the American Midwest at the time. For example, a large-scale open-label comparative trial with more than five thousand patients took place at Chicago's Cook County Hospital between 1881 and 1887: see Kaufman, Homeopathy (n. 31), pp. 150-51. For a related discussion of homeopathy's involvement with statistical comparative methods, see James H. Cassedy, American Medicine and Statistical Thinking, 1800-1860 (Cambridge: Harvard University Press, 1984), pp. 124-30.
85. One can find many experiments in the mesmeric tradition that can also be described as "double-blind." For example, in 1818 a series of "stomach-seeing" experiments (the subjects read playing cards or written texts in a darkened room through their bellies) took place in Langenberg, Germany; the written material was put in opaque envelopes at other locations, and both the experimenter and the subject were unaware of the content: see Liselotte Moser, "Hypnotism in Germany," in Dingwall, Abnormal Hypnotic Phenomena (n. 21), 2: 136-48. See n. 49 below for a different type of homeopathic experiment on human subjects that also utilized a double-blind design at an even earlier stage of homeopathic history.
86. Samuel Potter and Eugene F. Storke, "Final Report of the Milwaukee Test of the Thirtieth Dilution," Homeopathic Times: A Monthly Journal of Medicine, Surgery, and the Collateral Sciences, 1880, 7 (12): 280-81.
87. For a full account of the experiment see Ted J. Kaptchuk, "Early Use of Blind Assessment in a Homoeopathic Scientific Experiment," Brit. Homoeopathic J., 1997, 86: 49-50.
88. At the same time, these physicians were also active participants in the pioneering innovations in pathological anatomy and physical diagnosis unfolding in orthodox medicine in Vienna. A few of these "half-homeopaths," as their "purist" homeopathic cousins called them, even had appointments at the Allgemeines Krankenhaus: see Hannelore Petry, "Die Wiener Homöopathie, 1842-1849" (Ph.D. diss., University of Mainz, 1954). For an English-language source containing some references to the homeopathic presence in Vienna's medical circles at this time, see Erna Lesky, The Vienna Medical School of the Nineteenth Century (Baltimore: Johns Hopkins University Press, 1976). These scientific homeopaths wanted to combine the best of both worlds and use the most rigorous science to improve upon Hahnemann's vision. For a discussion of the battles between "scientific" homeopathy and "purist" homeopathy, see Anthony Campbell, The Two Faces of Homeopathy (London: Robert Hale, 1984).
89. At the same time, these physicians were also active participants in the pioneering innovations in pathological anatomy and physical diagnosis unfolding in orthodox medicine in Vienna. A few of these "half-homeopaths," as their "purist" homeopathic cousins called them, even had appointments at the Allgemeines Krankenhaus: see Hannelore Petry, "Die Wiener Homöopathie, 1842-1849" (Ph.D. diss., University of Mainz, 1954). For an English-language source containing some references to the homeopathic presence in Vienna's medical circles at this time, see Erna Lesky, The Vienna Medical School of the Nineteenth Century (Baltimore: Johns Hopkins University Press, 1976). These scientific homeopaths wanted to combine the best of both worlds and use the most rigorous science to improve upon Hahnemann's vision. For a discussion of the battles between "scientific" homeopathy and "purist" homeopathy, see Anthony Campbell, The Two Faces of Homeopathy (London: Robert Hale, 1984).
90. At the same time, these physicians were also active participants in the pioneering innovations in pathological anatomy and physical diagnosis unfolding in orthodox medicine in Vienna. A few of these "half-homeopaths," as their "purist" homeopathic cousins called them, even had appointments at the Allgemeines Krankenhaus: see Hannelore Petry, "Die Wiener Homöopathie, 1842-1849" (Ph.D. diss., University of Mainz, 1954). For an English-language source containing some references to the homeopathic presence in Vienna's medical circles at this time, see Erna Lesky, The Vienna Medical School of the Nineteenth Century (Baltimore: Johns Hopkins University Press, 1976). These scientific homeopaths wanted to combine the best of both worlds and use the most rigorous science to improve upon Hahnemann's vision. For a discussion of the battles between "scientific" homeopathy and "purist" homeopathy, see Anthony Campbell, The Two Faces of Homeopathy (London: Robert Hale, 1984).
91. Hahnemann initially had used toxological reports. His later provings were open-label and relied on the investigator's integrity to insure accuracy. See Samuel Hahnemann, Organon of Medicine (1921; New Delhi: B. Jain, 1980), pp. 209-10 (this is the 6th ed. of the Organon, which was published posthumously). Also see Franz Hartmann, "Hahnemann's Union for Proving Remedies," in Richard Haehl, Samuel Hahnemann: Life and Work, vol. 2, trans. Marie L. Wheeler (New Delhi: B.Jain, 1992). Thousands of symptoms were recorded in homeopathic tomes that dwarfed in size any kind of conventional medical text.
92. Hahnemann initially had used toxological reports. His later provings were open- label and relied on the investigator's integrity to insure accuracy. See Samuel Hahnemann, Organon of Medicine (1921; New Delhi: B. Jain, 1980), pp. 209-10 (this is the 6th ed. of the Organon, which was published posthumously). Also see Franz Hartmann, "Hahnemann's Union for Proving Remedies," in Richard Haehl, Samuel Hahnemann: Life and Work, vol. 2, trans. Marie L. Wheeler (New Delhi: B.Jain, 1992). Thousands of symptoms were recorded in homeopathic tomes that dwarfed in size any kind of conventional medical text.
93. The impetus for this internal homeopathic self-correction may have also come from external confrontation directed not at homeopathy's medical efficacy, but toward the internal validity of its dilution and proving claims. In fact, the earliest such investigation I have found is also the earliest "double-blind" trial of a "substance" I have uncovered. This trial, which had the ambience of theater as much as of science, was organized by a journalist in Nuremberg beginning on 4 February 1835. See George Löhner, Die homöopathischen Kochsalzversuche zu Nürnberg, Mit einem Anhang: Ein Beispiel homöopathischer Heilart (Nuremberg, 1835): Common salt was first prepared according to Hahnemann's method of "potentiation" (Hahnemann believed that some inert substances such as salt became extremely powerful through the process of dilution and shaking). Then, fifty bottles were filled with potentized salt and another fifty with distilled snow, which served as a dummy control. The numerically coded contents were placed in a sealed envelope and the bottles were carefully "mixed up" ("gemischt," "gemengt" [p. 15]) to further conceal their identity. Fifty-five participants then received numbered vials. On 12 March at the Red Rooster Inn ("Gasthaus zum rothen Hahn" [p. 6]), the fifty participants who completed the study mostly reported that they had noticed nothing (nineteen had been taking homeopathic salt, and twenty-three taking snow water); of the other eight subjects, a few in each group had either cold symptoms or lower abdominal discomfort. Homeopaths criticized the trial because the participants had not followed the proper diet for a proving. The report explicitly stated that "the decisive punctum saliens [was]: to prevent the individual test persons from knowing when they are receiving certain homeopathic medications or certain nonmedicated trial substances. Even the person preparing and distributing the doses may not know, as in our experiments, what this [vial] or the other [vial] may contain" (pp. 23-24). Other such challenges to homeopathy's internal validity also took place (e.g., the Milwaukee investigation described above actually included a second experiment with a similiar design). Oliver Wendell Holmes's famous denunciation of homeopathy also mentioned such a discussion of research methodology in Paris:
94. Oliver Wendell Holmes, Homoeópathy [sic] and Its Kindred Delusions: Two Lectures Delivered before the Boston Society for the Diffusion of Useful Knowledge (Boston: William D. Ticknor, 1842), p. 44.
95. Philipp Anton Watzke, "Materialien zu einem physiologischen Umbau der Hahnemann'schen Arzneimittellehre. I: Die Koloquinte," Österreichische Zeitschrift für Homöeopathie, 1844, 1: 1-151, quotation on p. 41.
96. Philipp Anton Watzke, "Wirkung des Kochsalzes im gesunden menschlichen und thierischen Körper - Unfreiwillige physiologische Kochsalz-prüfungen," Österreichische Zeitschrift für Homöeopathie, 1849, 4: 13-129, quotation on p. 125.
97. Edith Heischkel, "Arzneimittelversuche in ärztlichen Vereinen um die Mitte des 19. Jahrhunderts," Hippokrates: Zeitschrift für praktische Heilkunde, 1955, 26: 536-39. Also see Petry, "Die Wiener Homöopathie" (n. 47).
98. Edith Heischkel, "Arzneimittelversuche in ärztlichen Vereinen um die Mitte des 19. Jahrhunderts," Hippokrates: Zeitschrift für praktische Heilkunde, 1955, 26: 536-39. Also see Petry, "Die Wiener Homöopathie" (n. 47).
99. For example, between 1901 and 1903 the "scientific" camp conducted a proving coordinated at eleven centers through the Boston University School of Medicine (which was then homeopathic). This experiment, which probably was the largest proving ever performed, adopted placebo controls, which were "inert solutions [that] so resemble the tincture or dilutions to be employed . . . in dose, taste and color, that [the subject] will be unable to discriminate between the blank and the medicine" (Howard P. Bellows, The Test Drug-Proving of the "O. O. & L. Society": A Re-Proving of Belladonna [Boston: O. O. & L. Society, 1906], p. 25). Even the "purist" homeopaths adopted blind assessment. For example, the dean of the so-called classical uncompromising school of homeopathy, James Tyler Kent (1846-1916), spoke of blind assessment as a routine procedure in his turn-of-the-century writings: "The provers do not know what they are taking" (James Tyler Kent, Lectures on Homeopathic Philosophy [1900; Berkeley: North Atlantic, 1972], p. 185).
100. For example, between 1901 and 1903 the "scientific" camp conducted a proving coordinated at eleven centers through the Boston University School of Medicine (which was then homeopathic). This experiment, which probably was the largest proving ever performed, adopted placebo controls, which were "inert solutions [that] so resemble the tincture or dilutions to be employed . . . in dose, taste and color, that [the subject] will be unable to discriminate between the blank and the medicine" (Howard P. Bellows, The Test Drug-Proving of the "O. O. & L. Society": A Re-Proving of Belladonna [Boston: O. O. & L. Society, 1906], p. 25). Even the "purist" homeopaths adopted blind assessment. For example, the dean of the so-called classical uncompromising school of homeopathy, James Tyler Kent (1846-1916), spoke of blind assessment as a routine procedure in his turn-of-the-century writings: "The provers do not know what they are taking" (James Tyler Kent, Lectures on Homeopathic Philosophy [1900; Berkeley: North Atlantic, 1972], p. 185).
101. Although these experiments were often performed by prominent practitioners, they seem to have had little influence on ordinary practice and have generally been forgotten. Cf. Oswei Temkin, "Historical Aspects of Drug Therapy," in Drugs in Our Society, ed. Paul Talalay (Baltimore: Johns Hopkins Press, 1964), pp. 3-16.
102. Austin Flint, "A Contribution Toward the Natural History of Articular Rheumatism; Consisting of a Report of Thirteen Cases Treated Solely with Palliative Measures," Amer. J. Med. Sci., 1863, 46: 17-36, quotation on p. 21 (italics in original).
103. Henry G. Sutton, "Cases of Rheumatic Fever, Treated for the Most Part by Mint Water. Collected from the Clinical Books of Dr. Gull, with Some Remarks on the Natural History ofthat Disease," Guy's Hospital Report, 1865, 11: 292-428, quotation on p. 392.
104. Ibid.
105. Josef Skoda (1805-81) and Ferdinand von Hebra (1816-80), the Viennese therapeutic nihilists, are reported to have performed "feigning treatment in some cases in order to demonstrate to [their] own satisfaction that [patients] could get well of themselves" (Fielding H. Garrison, An Introduction to the History of Medicine [1913; Philadelphia: Saunders, 1968], p. 434). Similiar events are implied by other historians: see Erwin H. Ackerknecht, A Short History of Medicine (Baltimore: Johns Hopkins University Press, 1982), p. 155; Max Neuburger, The Doctrine of the Healing Power of Nature Throughout the Course of Time (New York: New York Homeopathic College, 1933), p. 177.
106. Josef Skoda (1805-81) and Ferdinand von Hebra (1816-80), the Viennese therapeutic nihilists, are reported to have performed "feigning treatment in some cases in order to demonstrate to [their] own satisfaction that [patients] could get well of themselves" (Fielding H. Garrison, An Introduction to the History of Medicine [1913; Philadelphia: Saunders, 1968], p. 434). Similiar events are implied by other historians: see Erwin H. Ackerknecht, A Short History of Medicine (Baltimore: Johns Hopkins University Press, 1982), p. 155; Max Neuburger, The Doctrine of the Healing Power of Nature Throughout the Course of Time (New York: New York Homeopathic College, 1933), p. 177.
107. Josef Skoda (1805-81) and Ferdinand von Hebra (1816-80), the Viennese therapeutic nihilists, are reported to have performed "feigning treatment in some cases in order to demonstrate to [their] own satisfaction that [patients] could get well of themselves" (Fielding H. Garrison, An Introduction to the History of Medicine [1913; Philadelphia: Saunders, 1968], p. 434). Similiar events are implied by other historians: see Erwin H. Ackerknecht, A Short History of Medicine (Baltimore: Johns Hopkins University Press, 1982), p. 155; Max Neuburger, The Doctrine of the Healing Power of Nature Throughout the Course of Time (New York: New York Homeopathic College, 1933), p. 177.
108. Ian Hacking, "Telepathy: Origins of Randomization in Experimental Design," Isis, 1988, 79: 427-51. Also see Stephen M. Stigler, The History of Statistics: The Measurement of Uncertainty before 1900 (Cambridge: Harvard University Press, 1986), p. 253.
109. Ian Hacking, "Telepathy: Origins of Randomization in Experimental Design," Isis, 1988, 79: 427-51. Also see Stephen M. Stigler, The History of Statistics: The Measurement of Uncertainty before 1900 (Cambridge: Harvard University Press, 1986), p. 253.
110. Peirce and Jastrow were interested in quantifying the relationship between physical stimuli and the mental experience of those stimuli, a field of research that had earlier received the hopeful name of psychophysics from Gustav Fechner (1801-87). They were improving on Fechner's earlier unblinded experiment. An even earlier series of blind assessments in psychophysics is described in Trudy Dehue, "Deception, Efficiency, and Random Groups: Psychology and the Gradual Origination of Random Group Design," Isis, 1997, 88: 655-73.
111. Charles Sanders Peirce and Joseph Jastrow, "On Small Differences of Sensation," Mem. Nat. Acad. Sci., 1884, 3 (1): 75-83, quotation on p. 79. Also see Stephen M. Stigler, "Mathematical Statistics in the Early States," Ann. Statist., 1978, 6: 239-65. To further prevent bias, Peirce and Jastrow also used a mathematical randomization scheme with playing cards to select the direction of their tests (whether to increase or decrease the weights).
112. Charles Sanders Peirce and Joseph Jastrow, "On Small Differences of Sensation," Mem. Nat. Acad. Sci., 1884, 3 (1): 75-83, quotation on p. 79. Also see Stephen M. Stigler, "Mathematical Statistics in the Early States," Ann. Statist., 1978, 6: 239-65. To further prevent bias, Peirce and Jastrow also used a mathematical randomization scheme with playing cards to select the direction of their tests (whether to increase or decrease the weights).
113. From the beginning of the nineteenth century astronomers were acutely aware of what was called the personal equation, which represented a tendency for different observers to have a persistent and systematic variance in their observations. See Simon Schaffer, "Astronomers Mark Time: Discipline and the Personal Equation," Science in Context, 1988, 2 (1): 115-45.
114. A direct linkage to psychical research can easily be argued. For example, Peirce was recruited by his friend William James (1842-1910) to be a founding member of the American Society for Psychical Research (ASPR) in 1884, and the unremitting skeptic Jastrow was an original member of the ASPR's Scientific Advisory Council. They were both immersed in the telepathy debates, which affected their conventional work (and vice versa). In fact, the original publication of their study concluded by stating that their methodology had "highly important practical bearings" for the plausibility of telepathy, which "ought to be fully studied by the psychologist and assiduously cultivated by everyman" (Peirce and Jastrow, "Small Differences of Sensation" [n. 61], p. 83). Blinding very gradually became standard in some types of psychology investigations. An early example includes the adoption of "screens" reported in C. E. Seashore, "Measurements of Illusions and Hallucinations in Normal life," Stud. Yale Psychol. Lab., 1895, 3: 1-67, quotation on p. 6.
115. A direct linkage to psychical research can easily be argued. For example, Peirce was recruited by his friend William James (1842-1910) to be a founding member of the American Society for Psychical Research (ASPR) in 1884, and the unremitting skeptic Jastrow was an original member of the ASPR's Scientific Advisory Council. They were both immersed in the telepathy debates, which affected their conventional work (and vice versa). In fact, the original publication of their study concluded by stating that their methodology had "highly important practical bearings" for the plausibility of telepathy, which "ought to be fully studied by the psychologist and assiduously cultivated by everyman" (Peirce and Jastrow, "Small Differences of Sensation" [n. 61], p. 83). Blinding very gradually became standard in some types of psychology investigations. An early example includes the adoption of "screens" reported in C. E. Seashore, "Measurements of Illusions and Hallucinations in Normal life," Stud. Yale Psychol. Lab., 1895, 3: 1-67, quotation on p. 6.
116. The practice of adopting a new legitimate name for an unconventional phenomenon is a recurrent theme in the history of unconventional science. For example, the word psychic itself was invented in 1856 by Robert Hare (1781-1858) - a chemist at the University of Pennsylvania, and the inventor of the oxyhydrogen blowpipe - to dissociate his research on spiritualism from the taint of quackery: see James McClenon, Deviant Science: The Case of Parapsychology (Philadelphia: University of Pennsylvania Press, 1984), p. 5.
117. The SPR sought to "naturalize the supernatural by inserting into that framework" the methods and goals of scientific research (Janet Oppenheim, The Other World: Spiritualism and Psychical Research in England, 1850-1914 [Cambridge: Cambridge University Press, 1985], pp. 152-53).
118. Making a clear distinction between "higher" mesmerism and spiritualism can be problematic. Spiritualism "surpassed" higher mesmerism but was also a direct continuation of the movement. See J. Stillson Judah, The History and Philosophy of the Metaphysical Movements in America (Philadelphia: Westminster, 1967), pp. 51-56; Fuller, Mesmerism (n. 20), pp. 69-104; R. Laurence Moore, In Search of White Crows: Spiritualism, Parapsychology, and American Culture (New York: Oxford University Press, 1977), pp. 9-11.
119. Making a clear distinction between "higher" mesmerism and spiritualism can be problematic. Spiritualism "surpassed" higher mesmerism but was also a direct continuation of the movement. See J. Stillson Judah, The History and Philosophy of the Metaphysical Movements in America (Philadelphia: Westminster, 1967), pp. 51-56; Fuller, Mesmerism (n. 20), pp. 69-104; R. Laurence Moore, In Search of White Crows: Spiritualism, Parapsychology, and American Culture (New York: Oxford University Press, 1977), pp. 9-11.
120. Making a clear distinction between "higher" mesmerism and spiritualism can be problematic. Spiritualism "surpassed" higher mesmerism but was also a direct continuation of the movement. See J. Stillson Judah, The History and Philosophy of the Metaphysical Movements in America (Philadelphia: Westminster, 1967), pp. 51-56; Fuller, Mesmerism (n. 20), pp. 69-104; R. Laurence Moore, In Search of White Crows: Spiritualism, Parapsychology, and American Culture (New York: Oxford University Press, 1977), pp. 9-11.
121. See R. Laurence Moore, "The Occult Connection? Mormonism, Christian Science, and Spiritualism," in The Occult in America: New Historical Perspectives, ed. Howard Kerr and Charles L. Crow (Urbana: University of Illinois Press, 1986), pp. 135-61. "Clairvoyant physicians" were not uncommon. See John Patrick Deveney, Paschal Beverly Randolph: A Nineteenth-Century Black American Spiritualist, Rosicrucian, and Sex Magician (Albany: State University of New York Press, 1997), p. 25.
122. See R. Laurence Moore, "The Occult Connection? Mormonism, Christian Science, and Spiritualism," in The Occult in America: New Historical Perspectives, ed. Howard Kerr and Charles L. Crow (Urbana: University of Illinois Press, 1986), pp. 135-61. "Clairvoyant physicians" were not uncommon. See John Patrick Deveney, Paschal Beverly Randolph: A Nineteenth-Century Black American Spiritualist, Rosicrucian, and Sex Magician (Albany: State University of New York Press, 1997), p. 25.
123. Hacking, "Telepathy" (n. 59). For additional background, see Stewart Wolf, Brain, Mind, and Medicine: Charles Richet and the Origins of Physiological Psychology (New Brunswick, N.J.: Transaction, 1993).
124. Hacking, "Telepathy" (n. 59). For additional background, see Stewart Wolf, Brain, Mind, and Medicine: Charles Richet and the Origins of Physiological Psychology (New Brunswick, N.J.: Transaction, 1993).
125. Charles R. Richet, "La suggestion mentale et le calcul des probabilités," Revue Philosophique, 1884, 18: 609-74, quotation on p. 635.
126. Ibid., p. 652. With time, Richet's blinding methods became more rigorous and he used envelopes and then double envelopes: Charles R. Richet, "Relation de diverses expériences sur la transmission mentale, la lucidité et autres phénomènes non explicables par les données scientifiques actuelles," Proc. Soc. Psychical Res., 1888, 5: 18-168.
127. Hacking, "Telepathy" (n. 59). Hacking, in his perceptive article on the subject of early randomization, does not mention an earlier, more primitive, mesmeric and hypnotism tradition in relation to this methodology. For example, in 1846 James Braid, in his tests of the "odic force" of Karl von Reichenbach (1786-1869), used what would now be called quasi-randomization methods to turn real or sham electromagnets on or off with "no regular order in the experiments" ( James Braid, The Power of the Mind Over the Body [1846], reprinted in Foundations of Hypnosis: From Mesmer to Freud, ed. M. M. Tinterow [Springfield, Ill.: C. C. Thomas, 1970], p. 333). Other examples are easy to find. Also, homeopathy experiments attempted to use some method of "mixing" in their methodology (see n. 49). It should be noted that after Richet's experiments, the Society of Psychical Research quickly adopted blind assessment and randomization in its experiments. By 1889, telepathy experiments routinely selected numbers or cards "drawn at random" as a further precaution against subtle cues ("Messrs. Hansen and Lehmann on the Telepathic Problem," J. Soc. Psychical Res., 1889, 9: 113-30, quotation on p. 119 [italics in original]).
128. Hacking, "Telepathy" (n. 59). Hacking, in his perceptive article on the subject of early randomization, does not mention an earlier, more primitive, mesmeric and hypnotism tradition in relation to this methodology. For example, in 1846 James Braid, in his tests of the "odic force" of Karl von Reichenbach (1786-1869), used what would now be called quasi-randomization methods to turn real or sham electromagnets on or off with "no regular order in the experiments" ( James Braid, The Power of the Mind Over the Body [1846], reprinted in Foundations of Hypnosis: From Mesmer to Freud, ed. M. M. Tinterow [Springfield, Ill.: C. C. Thomas, 1970], p. 333). Other examples are easy to find. Also, homeopathy experiments attempted to use some method of "mixing" in their methodology (see n. 49). It should be noted that after Richet's experiments, the Society of Psychical Research quickly adopted blind assessment and randomization in its experiments. By 1889, telepathy experiments routinely selected numbers or cards "drawn at random" as a further precaution against subtle cues ("Messrs. Hansen and Lehmann on the Telepathic Problem," J. Soc. Psychical Res., 1889, 9: 113-30, quotation on p. 119 [italics in original]).
129. Hacking, "Telepathy" (n. 59). Hacking, in his perceptive article on the subject of early randomization, does not mention an earlier, more primitive, mesmeric and hypnotism tradition in relation to this methodology. For example, in 1846 James Braid, in his tests of the "odic force" of Karl von Reichenbach (1786-1869), used what would now be called quasi-randomization methods to turn real or sham electromagnets on or off with "no regular order in the experiments" ( James Braid, The Power of the Mind Over the Body [1846], reprinted in Foundations of Hypnosis: From Mesmer to Freud, ed. M. M. Tinterow [Springfield, Ill.: C. C. Thomas, 1970], p. 333). Other examples are easy to find. Also, homeopathy experiments attempted to use some method of "mixing" in their methodology (see n. 49). It should be noted that after Richet's experiments, the Society of Psychical Research quickly adopted blind assessment and randomization in its experiments. By 1889, telepathy experiments routinely selected numbers or cards "drawn at random" as a further precaution against subtle cues ("Messrs. Hansen and Lehmann on the Telepathic Problem," J. Soc. Psychical Res., 1889, 9: 113-30, quotation on p. 119 [italics in original]).
130. Hacking, "Telepathy" (n. 59). Hacking, in his perceptive article on the subject of early randomization, does not mention an earlier, more primitive, mesmeric and hypnotism tradition in relation to this methodology. For example, in 1846 James Braid, in his tests of the "odic force" of Karl von Reichenbach (1786-1869), used what would now be called quasi-randomization methods to turn real or sham electromagnets on or off with "no regular order in the experiments" ( James Braid, The Power of the Mind Over the Body [1846], reprinted in Foundations of Hypnosis: From Mesmer to Freud, ed. M. M. Tinterow [Springfield, Ill.: C. C. Thomas, 1970], p. 333). Other examples are easy to find. Also, homeopathy experiments attempted to use some method of "mixing" in their methodology (see n. 49). It should be noted that after Richet's experiments, the Society of Psychical Research quickly adopted blind assessment and randomization in its experiments. By 1889, telepathy experiments routinely selected numbers or cards "drawn at random" as a further precaution against subtle cues ("Messrs. Hansen and Lehmann on the Telepathic Problem," J. Soc. Psychical Res., 1889, 9: 113-30, quotation on p. 119 [italics in original]).
131. Hacking, "Telepathy" (n. 59). Also see McClenon. Deviant Science (n. 64). One of the earliest such efforts was at the Division of Psychical Research at Stanford University. Between 1912 and 1917 an avowed skeptic-scientist, John Edgar Coover (1872-1938), performed more than ten thousand trials on more than two hundred subjects, using cards selected from a deck. These experiments utilized a method of randomization, and always "the reagent sat with his back toward the experimenter, and in the experimental interval he closed his eyes" (John Edgar Coover, Experiments in Psychical Research at Leland Stanford Junior University [Stanford, Calif.: Stanford University Press, 1917], p. 54). Also see Seymour H. Mauskopf and Michael R. McVaugh, The Elusive Science: Origins of Experimental Psychical Research (Baltimore: Johns Hopkins University Press, 1980).
132. Hacking, "Telepathy" (n. 59). Also see McClenon. Deviant Science (n. 64). One of the earliest such efforts was at the Division of Psychical Research at Stanford University. Between 1912 and 1917 an avowed skeptic-scientist, John Edgar Coover (1872-1938), performed more than ten thousand trials on more than two hundred subjects, using cards selected from a deck. These experiments utilized a method of randomization, and always "the reagent sat with his back toward the experimenter, and in the experimental interval he closed his eyes" (John Edgar Coover, Experiments in Psychical Research at Leland Stanford Junior University [Stanford, Calif.: Stanford University Press, 1917], p. 54). Also see Seymour H. Mauskopf and Michael R. McVaugh, The Elusive Science: Origins of Experimental Psychical Research (Baltimore: Johns Hopkins University Press, 1980).
133. Hacking, "Telepathy" (n. 59). Also see McClenon. Deviant Science (n. 64). One of the earliest such efforts was at the Division of Psychical Research at Stanford University. Between 1912 and 1917 an avowed skeptic-scientist, John Edgar Coover (1872-1938), performed more than ten thousand trials on more than two hundred subjects, using cards selected from a deck. These experiments utilized a method of randomization, and always "the reagent sat with his back toward the experimenter, and in the experimental interval he closed his eyes" (John Edgar Coover, Experiments in Psychical Research at Leland Stanford Junior University [Stanford, Calif.: Stanford University Press, 1917], p. 54). Also see Seymour H. Mauskopf and Michael R. McVaugh, The Elusive Science: Origins of Experimental Psychical Research (Baltimore: Johns Hopkins University Press, 1980).
134. Hacking, "Telepathy" (n. 59). Also see McClenon. Deviant Science (n. 64). One of the earliest such efforts was at the Division of Psychical Research at Stanford University. Between 1912 and 1917 an avowed skeptic-scientist, John Edgar Coover (1872-1938), performed more than ten thousand trials on more than two hundred subjects, using cards selected from a deck. These experiments utilized a method of randomization, and always "the reagent sat with his back toward the experimenter, and in the experimental interval he closed his eyes" (John Edgar Coover, Experiments in Psychical Research at Leland Stanford Junior University [Stanford, Calif.: Stanford University Press, 1917], p. 54). Also see Seymour H. Mauskopf and Michael R. McVaugh, The Elusive Science: Origins of Experimental Psychical Research (Baltimore: Johns Hopkins University Press, 1980).
135. The fact that it is hard to determine when the mesmeric issues ceased to be unconventional and became an agenda within an intraorthodox debate exemplifies the idea that the boundary between conventional and irregular medicine is not necessarily sharp or fixed. In fact, preceding the hypnotism debates, Charcot was interested in "metallotherapy" (the utilization of magnets for curative purposes), which in many ways was an extension of mesmerism. Additionally, as in all the mesmeric debates, metallotherapy significantly involved blind assessment. For example, Dr. Landouzy at La Charité Hôpital in Paris, in cooperation with Charcot, investigated magnetic effects while blindfolding ("bander les yeux") his patients (L. Landouzy, "Relation d'un cas de léthargie provoquée par l'application d'un aimant," Progrès Médical, 1879, 7: 60-62, quotation on p. 61). The English medical literature also had numerous reports of experiments on such therapy utilizing blinding and wooden decoys; e.g.,
136. A. Hughes Bennett, "Case of Complete Anaethesia of the Right and Partial Anaesthesia of the Left Side. - Experiments on Metalloscopy and Metallotheraphy," Brit. Med. J., 1878, 2: 759-61, quotation on p. 759.
137. For a discussion of this entire episode and its effect on the later Salpêtrière-Nancy debate, see Anne Harrington, "Metals and Magnets in Medicine: Hysteria, Hypnosis, and Medical Culture in fin-de-siècle Paris," Psychol Med., 1988, 18: 21-38.
138. See Christopher Goetz, Michel Bonduelle, and Toby Gelfand, Charcot: Constructing Neurology (New York: Oxford University Press, 1995).
139. Hippolyte Bernheim, Suggestive Therapeutics: A Treatise on the Nature and Uses of Hypnotism, trans. Christian A. Herter (New York: Putnam, 1897), p. 125. This is the English translation of De la suggestion, et de ses applications à la thérapeutique (Paris: O. Doin, 1886).
140. Alfred Binet and Charles Féré, "L'hypnotisme chez les hystériques," Revue Philosophique, 1885, 19: 1-25, quotation on p. 4.
141. Bernheim attacked the experiments as not having sufficient precautions to exclude suggestion: Bernheim, Suggestive Therapeutics (n. 75), pp. 91-104. The Society of Psychical Research also criticized these experiments as having insufficient precautions to exclude suggestion: see Frederic W. H. Myers, "Report of the General Meeting," J. Soc. Psychical Res., 1886, 2: 443-55. The harshest contemporary critique of the experiments was provided by the Belgian psychology professor J. L. R. Delboeuf (1831-96) of the University of Liège, who after his visit to the Salpêtrière reported that the experimenters announced "aloud what was going to happen," and that the magnet was a visible "heavy horseshoe" casually drawn from the pocket (Joseph R. L. Delboeuf, Le magnétisme animal à propos d'une visite à l'École de Nancy [Paris: Ancienne Librairie Germain Baillière, 1889], pp. 7-8). Delboeuf also replicated these experiments with the additional precaution of using both "false and true magnets [avec de faux et avec de vrais aimants]" and, like Bernheim, "without any magnets at all" (ibid., p. 19). (See p. 414.)
142. Bernheim attacked the experiments as not having sufficient precautions to exclude suggestion: Bernheim, Suggestive Therapeutics (n. 75), pp. 91-104. The Society of Psychical Research also criticized these experiments as having insufficient precautions to exclude suggestion: see Frederic W. H. Myers, "Report of the General Meeting," J. Soc. Psychical Res., 1886, 2: 443-55. The harshest contemporary critique of the experiments was provided by the Belgian psychology professor J. L. R. Delboeuf (1831-96) of the University of Liège, who after his visit to the Salpêtrière reported that the experimenters announced "aloud what was going to happen," and that the magnet was a visible "heavy horseshoe" casually drawn from the pocket (Joseph R. L. Delboeuf, Le magnétisme animal à propos d'une visite à l'École de Nancy [Paris: Ancienne Librairie Germain Baillière, 1889], pp. 7-8). Delboeuf also replicated these experiments with the additional precaution of using both "false and true magnets [avec de faux et avec de vrais aimants]" and, like Bernheim, "without any magnets at all" (ibid., p. 19). (See p. 414.)
143. Bernheim attacked the experiments as not having sufficient precautions to exclude suggestion: Bernheim, Suggestive Therapeutics (n. 75), pp. 91-104. The Society of Psychical Research also criticized these experiments as having insufficient precautions to exclude suggestion: see Frederic W. H. Myers, "Report of the General Meeting," J. Soc. Psychical Res., 1886, 2: 443-55. The harshest contemporary critique of the experiments was provided by the Belgian psychology professor J. L. R. Delboeuf (1831-96) of the University of Liège, who after his visit to the Salpêtrière reported that the experimenters announced "aloud what was going to happen," and that the magnet was a visible "heavy horseshoe" casually drawn from the pocket (Joseph R. L. Delboeuf, Le magnétisme animal à propos d'une visite à l'École de Nancy [Paris: Ancienne Librairie Germain Baillière, 1889], pp. 7-8). Delboeuf also replicated these experiments with the additional precaution of using both "false and true magnets [avec de faux et avec de vrais aimants]" and, like Bernheim, "without any magnets at all" (ibid., p. 19). (See p. 414.)
144. Bernheim, Suggestive Therapeutics (n. 75), p. 93. Even before the suggestion debates, Bernheim was involved in at least one blind assessment utilizing a sham "magnetic field" therapy that had claims akin to metallotherapy: see Robert C. Hillman, "A Scientific Study of Mystery: The Role of the Medical and Popular Press in the Nancy-Salpêtrière Controversy on Hypnotism," Bull. Hist. Med., 1965, 39: 163-82, quotation on pp. 169-70.
145. Bernheim, Suggestive Therapeutics (n. 75), p. 93. Even before the suggestion debates, Bernheim was involved in at least one blind assessment utilizing a sham "magnetic field" therapy that had claims akin to metallotherapy: see Robert C. Hillman, "A Scientific Study of Mystery: The Role of the Medical and Popular Press in the Nancy-Salpêtrière Controversy on Hypnotism," Bull. Hist. Med., 1965, 39: 163-82, quotation on pp. 169-70.
146. Joseph F. F. Babinski, "Recherches servant à établir que certaines manifestations hystériques peuvent être transférées d'un sujet àun autre sous l'influence de l'aimant," Revue Philosophique, 1886, 22: 697-700, quotation on p. 700.
147. Myers, "General Meeting" (n. 77), provided an excellent firsthand description of the Babinski experiments. The weakness of the blindness was apparent, and Myers recommended sham magnets and sham metals as a necessary but missing component of any replication of Babinski's work. Myers also reported that Charcot was comfortable just repeating the experiment in his presence without troubling to use any intervening screen. 81. Additional cases can be found in Dingwall, Abnormal Hypnotic Phenomena (n. 21), and Gauld, History of Hypnotism (n. 20).
148. This episode began with a series of blind assessments performed in 1885 at the medical school of Rochefort under the direction of two professors. They were able to demonstrate "magnetically" transmitted drug effects: see Henri J. H. Bourru and Prosper F. Burot, La suggestion mentale et l'action à distance des substances toxiques et médicamenteuses (Paris: J. B. Baillière, 1887). The mishap occurred during a "nonpartisan" replication performed at the School of Naval Medical Officers in Rochefort under the direction of a Dr. Duplouy. A. T. Myers (1851-94), Frederic Myers's brother, described the incident: "Another gentleman during Dr. Duplouy's investigation made an experiment which was rendered especially important by a mistake. He had two similiar bottles in his pocket, both wrapped in paper; one contained cantharides, the other valerian; he chose the one which he thought contained cantharides and held it up to the patient; to his surprise the results which accompany valerian followed, and then he found that he had made a mistake and was holding the bottle containing valerian" (Arthur Thomas Myers, "On the Action of Drugs at a Distance," J. Soc. Psychical Res., 1885, 2: 58-62, quotation on p. 61). A commission of the Academy of Medicine headed by Georges Dujardin-Beaumetz replicated versions of these experiments in what seems an intentional double-blind manner. Tubes with genuine drugs were matched with identical empty tubes; the tubes were numbered and then covered with paper so that the experimenter could not tell whether substance or sham was being tested: Georges Dujardin-Beaumetz, "Sur l'action des médicaments à distance," Bulletin Général de Thérapeutique Médicale et Chirurgicale, 1888, 114: 241-61. Most of the other independent replications seem to have been single-blind; e.g., J. Voisin, "Suggestion, auto-suggestion et vivacité du souvenir dans le sommeil hypnotique. - Action des médicaments à distance," Revue de l'Hypnotisme, 1888, 2: 209-11.
149. This episode began with a series of blind assessments performed in 1885 at the medical school of Rochefort under the direction of two professors. They were able to demonstrate "magnetically" transmitted drug effects: see Henri J. H. Bourru and Prosper F. Burot, La suggestion mentale et l'action à distance des substances toxiques et médicamenteuses (Paris: J. B. Baillière, 1887). The mishap occurred during a "nonpartisan" replication performed at the School of Naval Medical Officers in Rochefort under the direction of a Dr. Duplouy. A. T. Myers (1851-94), Frederic Myers's brother, described the incident: "Another gentleman during Dr. Duplouy's investigation made an experiment which was rendered especially important by a mistake. He had two similiar bottles in his pocket, both wrapped in paper; one contained cantharides, the other valerian; he chose the one which he thought contained cantharides and held it up to the patient; to his surprise the results which accompany valerian followed, and then he found that he had made a mistake and was holding the bottle containing valerian" (Arthur Thomas Myers, "On the Action of Drugs at a Distance," J. Soc. Psychical Res., 1885, 2: 58-62, quotation on p. 61). A commission of the Academy of Medicine headed by Georges Dujardin-Beaumetz replicated versions of these experiments in what seems an intentional double-blind manner. Tubes with genuine drugs were matched with identical empty tubes; the tubes were numbered and then covered with paper so that the experimenter could not tell whether substance or sham was being tested: Georges Dujardin-Beaumetz, "Sur l'action des médicaments à distance," Bulletin Général de Thérapeutique Médicale et Chirurgicale, 1888, 114: 241-61. Most of the other independent replications seem to have been single-blind; e.g., J. Voisin,
150. This episode began with a series of blind assessments performed in 1885 at the medical school of Rochefort under the direction of two professors. They were able to demonstrate "magnetically" transmitted drug effects: see Henri J. H. Bourru and Prosper F. Burot, La suggestion mentale et l'action à distance des substances toxiques et médicamenteuses (Paris: J. B. Baillière, 1887). The mishap occurred during a "nonpartisan" replication performed at the School of Naval Medical Officers in Rochefort under the direction of a Dr. Duplouy. A. T. Myers (1851-94), Frederic Myers's brother, described the incident: "Another gentleman during Dr. Duplouy's investigation made an experiment which was rendered especially important by a mistake. He had two similiar bottles in his pocket, both wrapped in paper; one contained cantharides, the other valerian; he chose the one which he thought contained cantharides and held it up to the patient; to his surprise the results which accompany valerian followed, and then he found that he had made a mistake and was holding the bottle containing valerian" (Arthur Thomas Myers, "On the Action of Drugs at a Distance," J. Soc. Psychical Res., 1885, 2: 58-62, quotation on p. 61). A commission of the Academy of Medicine headed by Georges Dujardin-Beaumetz replicated versions of these experiments in what seems an intentional double-blind manner. Tubes with genuine drugs were matched with identical empty tubes; the tubes were numbered and then covered with paper so that the experimenter could not tell whether substance or sham was being tested: Georges Dujardin-Beaumetz, "Sur l'action des médicaments à distance," Bulletin Général de Thérapeutique Médicale et Chirurgicale, 1888, 114: 241-61. Most of the other independent replications seem to have been single-blind; e.g., J. Voisin, "Suggestion, auto-suggestion et vivacité du souvenir dans le sommeil hypnotique. - Action des médicaments à distance," Revue de l'Hypnotisme, 1888, 2: 209-11.
151. This episode began with a series of blind assessments performed in 1885 at the medical school of Rochefort under the direction of two professors. They were able to demonstrate "magnetically" transmitted drug effects: see Henri J. H. Bourru and Prosper F. Burot, La suggestion mentale et l'action à distance des substances toxiques et médicamenteuses (Paris: J. B. Baillière, 1887). The mishap occurred during a "nonpartisan" replication performed at the School of Naval Medical Officers in Rochefort under the direction of a Dr. Duplouy. A. T. Myers (1851-94), Frederic Myers's brother, described the incident: "Another gentleman during Dr. Duplouy's investigation made an experiment which was rendered especially important by a mistake. He had two similiar bottles in his pocket, both wrapped in paper; one contained cantharides, the other valerian; he chose the one which he thought contained cantharides and held it up to the patient; to his surprise the results which accompany valerian followed, and then he found that he had made a mistake and was holding the bottle containing valerian" (Arthur Thomas Myers, "On the Action of Drugs at a Distance," J. Soc. Psychical Res., 1885, 2: 58-62, quotation on p. 61). A commission of the Academy of Medicine headed by Georges Dujardin-Beaumetz replicated versions of these experiments in what seems an intentional double-blind manner. Tubes with genuine drugs were matched with identical empty tubes; the tubes were numbered and then covered with paper so that the experimenter could not tell whether substance or sham was being tested: Georges Dujardin-Beaumetz, "Sur l'action des médicaments à distance," Bulletin Général de Thérapeutique Médicale et Chirurgicale, 1888, 114: 241-61. Most of the other independent replications seem to have been single-blind; e.g., J. Voisin, "Suggestion, auto-suggestion et vivacité du souvenir dans le sommeil hypnotique. -Action des médicaments à distance," Revue de l'Hypnotisme, 1888, 2: 209-11.
152. Charles Édouard Brown-Séquard, "Des effets produits chez l'homme par des injections sous-cutanées d'un liquide retiré des testicules frais de cobaye et de chien," Comptes Rendus de la Société de Biologie, 1889, 41: 419.
153. Ibid.
154. For example, the Brit. Med. J.'s report of Brown-Séquard's observations stated that "they [Brown-Séquard's observations] would require to be rigidly tested and fully confirmed by other self-experimenters before they were likely to meet with general acceptance" (Brit. Med. J., 1889, 1: 1416); no mention is made of the need to make blind assessments. Throughout the debate, Brown-Séquard's defense comprised long recitals of the effects of the extracts on hundreds of cases of such diseases as cancer and tuberculosis See Charles Édouard Brown-Séquard, "On a New Therapeutic Method Consisting in the Use of Organic Liquids Extracted from Glands and other Organs," Brit. Med. J., 1893, 1: 1212-14. He never seemed to discuss blind assessment, with the exception of the one passing reference discussed below (see n. 89).
155. For example, the Brit. Med. J.'s report of Brown-Séquard's observations stated that "they [Brown-Séquard's observations] would require to be rigidly tested and fully confirmed by other self-experimenters before they were likely to meet with general acceptance" (Brit. Med. J., 1889, 1: 1416); no mention is made of the need to make blind assessments. Throughout the debate, Brown-Séquard's defense comprised long recitals of the effects of the extracts on hundreds of cases of such diseases as cancer and tuberculosis See Charles Édouard Brown-Séquard, "On a New Therapeutic Method Consisting in the Use of Organic Liquids Extracted from Glands and other Organs," Brit. Med. J., 1893, 1: 1212-14. He never seemed to discuss blind assessment, with the exception of the one passing reference discussed below (see n. 89).
156. The popular press spoke of the "fountain of perpetual youth," "elixir of youth," the "Alchemist's Dream," and said that a "cult of injection spread like wildfire" (James M. D. Olmsted, Charles-Édouard Brown-Séquard: A Nineteenth-Century Neurologist and Endocrinologist [Baltimore: Johns Hopkins Press, 1946], pp. 210-11). Also see Michael J. Aminoff, Brown- Séquard: A Visionary of Science (New York: Raven Press, 1993); Merriley Borell, "Brown- Séquard's Organotherapy and Its Appearance in America at the End of the Nineteenth Century," Bull. Hist. Med., 1976, 50: 309-20.
157. The popular press spoke of the "fountain of perpetual youth," "elixir of youth," the "Alchemist's Dream," and said that a "cult of injection spread like wildfire" (James M. D. Olmsted, Charles-Édouard Brown-Séquard: A Nineteenth-Century Neurologist and Endocrinologist [Baltimore: Johns Hopkins Press, 1946], pp. 210-11). Also see Michael J. Aminoff, Brown-Séquard: A Visionary of Science (New York: Raven Press, 1993); Merriley Borell, "Brown- Séquard's Organotherapy and Its Appearance in America at the End of the Nineteenth Century," Bull. Hist. Med., 1976, 50: 309-20.
158. The popular press spoke of the "fountain of perpetual youth," "elixir of youth," the "Alchemist's Dream," and said that a "cult of injection spread like wildfire" (James M. D. Olmsted, Charles-Édouard Brown-Séquard: A Nineteenth-Century Neurologist and Endocrinologist [Baltimore: Johns Hopkins Press, 1946], pp. 210-11). Also see Michael J. Aminoff, Brown- Séquard: A Visionary of Science (New York: Raven Press, 1993); Merriley Borell, "Brown-Séquard's Organotherapy and Its Appearance in America at the End of the Nineteenth Century," Bull. Hist. Med., 1976, 50: 309-20.
159. Editorial, "Animal Extracts as Therapeutic Agents," Brit. Med. J., 1893, 1: 1279.
160. M. G. Variot, "Trois expériences sur l'action physiologique du suc testiculaire injecté sous la peau, suivant la méthode de M. Brown-Séquard," Comptes Rendus de la Société de Biologie, 1889, 41: 451-54.
161. Brown-Séquard reported on the Variot experiments and the subsequent single episode of blind assessment in Charles Édouard Brown-Séquard, "Remarques à l'occasion du travail de M. Variot, sur les injections de liquide testiculaire chez l'homme," Comptes Rendus de la. Société de Biologie, 1889, 41: 454-55, quotation on p. 455. (Also see idem, "The Effects Produced on Man by Subcutaneous Injections of a Liquid Obtained from the Testicules of Animals," Lancet, 1889, 2: 105-7, which also provides an English summary of Brown-Séquard's original French report.) This is the only mention of blind assessment by Brown-Séquard that I have been able to find.
162. Brown-Séquard reported on the Variot experiments and the subsequent single episode of blind assessment in Charles Édouard Brown-Séquard, "Remarques à l'occasion du travail de M. Variot, sur les injections de liquide testiculaire chez l'homme," Comptes Rendus de la. Société de Biologie, 1889, 41: 454-55, quotation on p. 455. (Also see idem, "The Effects Produced on Man by Subcutaneous Injections of a Liquid Obtained from the Testicules of Animals," Lancet, 1889, 2: 105-7, which also provides an English summary of Brown-Séquard's original French report.) This is the only mention of blind assessment by Brown-Séquard that I have been able to find.
163. At least one other blind assessment on Brown-Séquard's testicular extract was performed in France. It was a single-subject cross-over design (extract, then water, then extract): see Charles Éloy, La méthode de Broum-Séquard (Paris: J. B. Baillière, 1893), p. 47.
164. Gauld, History of Hypnotism (n. 20), p. 345.
165. Auguste Forel, "Das Verhältnis gewisser therapeutischer Methoden zur Suggestion," Zeitschrift für Hypnotismus, Suggestionstherapie, Suggestionslehre und verwandte psychologische Forschungen, 1893/94, 2: 385-90, quotation on p. 390. The article is based on a lecture presented in 1894 at the 60th Meeting of the German Biological Researchers and Doctors in Vienna. Forel visited Bernheim in 1887 and was considered an accomplished hypnotist. See Henri F. Ellenberger, The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry (New York: Basic Books, 1970), p. 88.
166. Auguste Forel, "Das Verhältnis gewisser therapeutischer Methoden zur Suggestion," Zeitschrift für Hypnotismus, Suggestionstherapie, Suggestionslehre und verwandte psychologische Forschungen, 1893/94, 2: 385-90, quotation on p. 390. The article is based on a lecture presented in 1894 at the 60th Meeting of the German Biological Researchers and Doctors in Vienna. Forel visited Bernheim in 1887 and was considered an accomplished hypnotist. See Henri F. Ellenberger, The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry (New York: Basic Books, 1970), p. 88.
167. Forel, "Verhältnis gewisser therapeutischer Methoden" (n. 92), p. 388. Forel specifically stated that "one speaks of results obtained without the patient's kowledge; but how can a patient not notice an injection? One should also make comparisons with injections of other substances" (ibid.).
168. Fritz Pregl, "Zwei weitere ergographische Versuchsreihen über die Wirkung orchitischen Extraktes," Archiv für die gesamte Physiologie, 1896, 62: 379-99. quotation on p. 387. After an initial baseline assessment, one student received the extract and another received sham glycerin. Later, in a crossover manner, they received the oppoosite substances. Pregl states that the blinding precautions included mixing salt with the glycerin so that "its injection . . . more or less produced the same burning and pressure sensation" as the verum (ibid., p. 385). As a further safeguard, syringes were filled in another room that the subjects could not enter, and subjects were treated separately (ibid., p. 386).
169. Wacław Sobierański, "Über den Einfluss des pharmakologischen Mittels auf die Muskelkraft der Menschen," Centralblatt für Physiologie, 1896, 5: 126-27. His research papers do not use the word blind, but that is clearly his intention. This particular paper studied the effects of cocaine and caffeine on muscle strength as measured by "exhaustion curves" using ergography.
170. Wacław Sobierański, "O wpływie środków farmakologicznych na siłȩ mȩśniowa̧ ludzi," Gazeta Lekarska (Warsaw), 2d ser., 1896, 16: 86-95, quotation on p. 90. A summary of his research efforts was reported in a Polish-language lecture in Warsaw on 24 September 1895, though most of his scientific papers were written in German.
171. Ibid., p. 89. Even when blind assessment was acknowledged as important, its implementation was erratic. For example, in 1899 a Hanover military officer and professor named Schumburg was interested in rumors that cola kept French soldiers marching while their horses and mules were too tired to even eat. In his experiments, soldiers were given either a sham substance or cola-extract on different days; for unexplained reasons, however, when he evaluated caffeine, tea, mate, and alcohol he used no sham intervention: Wilhelm A. E. F. Schumburg, "Ueber die Bedeutung von Kola, Caffee, Thee, Mate und Alkohol für die Leistung der Muskeln," Archiv füir Anatomie und Physiologie, 1899, 5: 289-313, quotation on p. 293. Schumburg's other experiments include Wilhelm A. E. F. Schumburg, "Ueber die Bedeutung des Zuckers für die Leistungsfähigkeit des Menschen," Zeitschrift für diätetische und physikalische Therapie, 1899, 2: 185-88. The German interest in blind assessment received a boost with the discovery of subliminal stimuli in 1908; see Gerd Gigerenzer, Zeno Swijtink, Theodore Porter, Lorraine Daston, John Beatty, and Lorenz Krüger, The Empire of Chance: How Probability Changed Science and Everyday Life (Cambridge: Cambridge University Press 1989), p. 87. The psychophysics movement may have also contributed to the German pharmacological interest in blind assessment. See Dehue, "Deception" (n. 60).
172. Ibid., p. 89. Even when blind assessment was acknowledged as important, its implementation was erratic. For example, in 1899 a Hanover military officer and professor named Schumburg was interested in rumors that cola kept French soldiers marching while their horses and mules were too tired to even eat. In his experiments, soldiers were given either a sham substance or cola-extract on different days; for unexplained reasons, however, when he evaluated caffeine, tea, mate, and alcohol he used no sham intervention: Wilhelm A. E. F. Schumburg, "Ueber die Bedeutung von Kola, Caffee, Thee, Mate und Alkohol für die Leistung der Muskeln," Archiv füir Anatomie und Physiologie, 1899, 5: 289-313, quotation on p. 293. Schumburg's other experiments include Wilhelm A. E. F. Schumburg, "Ueber die Bedeutung des Zuckers für die Leistungsfähigkeit des Menschen," Zeitschrift für diätetische und physikalische Therapie, 1899, 2: 185-88. The German interest in blind assessment received a boost with the discovery of subliminal stimuli in 1908; see Gerd Gigerenzer, Zeno Swijtink, Theodore Porter, Lorraine Daston, John Beatty, and Lorenz Krüger, The Empire of Chance: How Probability Changed Science and Everyday Life (Cambridge: Cambridge University Press 1989), p. 87. The psychophysics movement may have also contributed to the German pharmacological interest in blind assessment. See Dehue, "Deception" (n. 60).
173. Ibid., p. 89. Even when blind assessment was acknowledged as important, its implementation was erratic. For example, in 1899 a Hanover military officer and professor named Schumburg was interested in rumors that cola kept French soldiers marching while their horses and mules were too tired to even eat. In his experiments, soldiers were given either a sham substance or cola-extract on different days; for unexplained reasons, however, when he evaluated caffeine, tea, mate, and alcohol he used no sham intervention: Wilhelm A. E. F. Schumburg, "Ueber die Bedeutung von Kola, Caffee, Thee, Mate und Alkohol für die Leistung der Muskeln," Archiv füir Anatomie und Physiologie, 1899, 5: 289-313, quotation on p. 293. Schumburg's other experiments include Wilhelm A. E. F. Schumburg, "Ueber die Bedeutung des Zuckers für die Leistungsfähigkeit des Menschen," Zeitschrift für diätetische und physikalische Therapie, 1899, 2: 185-88. The German interest in blind assessment received a boost with the discovery of subliminal stimuli in 1908; see Gerd Gigerenzer, Zeno Swijtink, Theodore Porter, Lorraine Daston, John Beatty, and Lorenz Krüger, The Empire of Chance: How Probability Changed Science and Everyday Life (Cambridge: Cambridge University Press 1989), p. 87. The psychophysics movement may have also contributed to the German pharmacological interest in blind assessment. See Dehue, "Deception" (n. 60).
174. Ibid., p. 89. Even when blind assessment was acknowledged as important, its implementation was erratic. For example, in 1899 a Hanover military officer and professor named Schumburg was interested in rumors that cola kept French soldiers marching while their horses and mules were too tired to even eat. In his experiments, soldiers were given either a sham substance or cola-extract on different days; for unexplained reasons, however, when he evaluated caffeine, tea, mate, and alcohol he used no sham intervention: Wilhelm A. E. F. Schumburg, "Ueber die Bedeutung von Kola, Caffee, Thee, Mate und Alkohol für die Leistung der Muskeln," Archiv füir Anatomie und Physiologie, 1899, 5: 289-313, quotation on p. 293. Schumburg's other experiments include Wilhelm A. E. F. Schumburg, "Ueber die Bedeutung des Zuckers für die Leistungsfähigkeit des Menschen," Zeitschrift für diätetische und physikalische Therapie, 1899, 2: 185-88. The German interest in blind assessment received a boost with the discovery of subliminal stimuli in 1908; see Gerd Gigerenzer, Zeno Swijtink, Theodore Porter, Lorraine Daston, John Beatty, and Lorenz Krüger, The Empire of Chance: How Probability Changed Science and Everyday Life (Cambridge: Cambridge University Press 1989), p. 87. The psychophysics movement may have also contributed to the German pharmacological interest in blind assessment. See Dehue, "Deception" (n. 60).
175. William H. R. Rivers, The Influence of Alcohol and Other Drugs on Fatigue: The Croonian Lectures Delivered at the Royal College of Physicians in 1906 (London: Edward Arnold, 1908), p. 19.
176. Ibid., p. 20.
177. Harry Levi Hollinsworth, "The Influence of Caffein on Mental and Motor Efficiency," Arch. Psychol., 1912, 22: 1-166.
178. Albion W. Hewlett, "Clinical Effects of 'Natural' and 'Synthetic' Sodium Salicylate," JAMA, 1913, 61: 319-21, quotation on p. 319. Of the 82 physicians recruited, only 27 reported back on 230 separate observations. The word blind does not appear in the paper. Hewlett (1874-1925) was a professor at the University of Michigan Medical School.
179. Hewlett described the rationale for the blinding as related to "the personal equations of different observers [and] the tendency to bias" (ibid., p. 319). (Also see n. 62.) In general, when the European concern for blind assessment was translated into English, the Continental preoccupation with suggestion was omitted. This can be seen in the writings of Sollmann, who was German-born and did postgraduate work in Germany. When he made an early English-language plea for blind assessment he spoke only of natural history: even "the best type of clinical reports . . . lack one important essential, namely, an adequate control of the natural course of the disease. . . . Since this cannot be controlled directly, it must be compensated indirectly. . . . The . . . method consists in the attempt to distinguish unknown preparations by their effects - the method that might be called . . . the 'blind test'" (Torald Sollmann, "The Crucial Test of Therapeutic Evidence," JAMA, 1917, 69: 198-99, quotation on p. 199). Sollmann's call seems to have been mainly ignored, and it is unclear to what extent he acted on his own prescription. Harry Marks, Progress of Experiments (n. 3), p. 36, cites at least one other Sollmann blind assessment.
180. David I. Macht, N. B. Herman, and Charles S. Levy, "A Quantitative Study of the Analgesia Produced by Opium Alkaloids, Individually and in Combination with Each Other, in Normal Man," J. Pharm. Exp. Ther., 1916, 8: 1-37, quotation on p. 7.
181. The introduction of diphtheria antitoxin in 1894 was accompanied by much hope and also doubt. Inexact identification of the illness, difficulty with the timing of the serum's administration, and general utilization of historic or other-site comparisions when the virulence of the disease varied from season to season and place to place, made evaluation difficult and engendered lack of enthusiasm, dissension, and open skepticism. See Rothstein, American Physicians (n. 31); Evelynn Maxine Hammonds, "The Search for Perfect Control: A Social History of Diphtheria, 1880-1930" (Ph.D. diss., Harvard University, 1993).
182. The actual design of the experiment was more complex. In 1911, Bingel admitted only adults into the trial. In 1912, he lowered the age of the subjects, and by 1913 he was allocating patients regardless of age or severity of disease. Eventually, 90 percent of his patients were children. See Adolf Bingel, "Über Behandlung der Diphtherie mit gewöhnlichem Pferdeserum," Deutsches Archiv für klinische Medizin, 1918, 125: 284-332.
183. Bingel's exact words were: "in order to make as objective a test as possible . . . [I asked for evaluations from] the attending physicians . . . without explaining to them the nature of the test serum" (ibid., p. 288). Bingel explicitly called his procedure a "blind-method (his quotes) and recommended its adoption by his colleagues (ibid.). He continued to perform experiments with diphtheria antitoxin even during World War II: Adolf Bingel,"Wirkt das Diphtherieheilserum bei der menschlichen Diphtheriekrankheit spezifisch durch seinen Antitoxingehalt oder unspezifisch?" Deutscht medizinische Wochenschrift, 1949, 74: 101-3; idem, "Zur umstrittenen Wirkung des Di.-antitoxins beim Menschen," ibid., 1950, 47: 1585-87. He also received explicit support for his position from another clinical trial performed on "more than 450 patients" in which "treatment was alternatively either genuine serum antitoxin or 'empty' horse serum [Pferde-Leer-Serum]" (A. Hottinger and D. Töpfer, "Über den Wert der Serumtherapie bei Diphtherie, insbesondere bei der malignen, toxischen Form," Zeitschrift für Kinderheilkunde, 1933, 54: 505-40, quotation on p. 513). Not surprisingly Bingel's work has been entirely forgotten, while the famous 1898 open-label diphtheria experiment conducted by Johannes A. G. Fibiger (1867-1928) at Blegdam's Hospital in Copenhagen with 488 patients is a more commemorated episode in the official histories of diphtheria and of clinical trials. (It is worth speculating that the "peculiar- results that some blind assessments produced may have contributed to the resistance to the method. Warner has pointed out a similiar predicament when orthodox medicine resisted the "numerical method . . . as a revealer of therapeutic truth" because it could present homeopathy in a favorable light [John Harley Warner, The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820-1885 (Cambridge: Harvard University Press, 1980), pp. 202-3].)
184. Bingel's exact words were: "in order to make as objective a test as possible . . . [I asked for evaluations from] the attending physicians . . . without explaining to them the nature of the test serum" (ibid., p. 288). Bingel explicitly called his procedure a "blind- method (his quotes) and recommended its adoption by his colleagues (ibid.). He continued to perform experiments with diphtheria antitoxin even during World War II: Adolf Bingel,"Wirkt das Diphtherieheilserum bei der menschlichen Diphtheriekrankheit spezifisch durch seinen Antitoxingehalt oder unspezifisch?" Deutscht medizinische Wochenschrift, 1949, 74: 101-3; idem, "Zur umstrittenen Wirkung des Di.-antitoxins beim Menschen," ibid., 1950, 47: 1585-87. He also received explicit support for his position from another clinical trial performed on "more than 450 patients" in which "treatment was alternatively either genuine serum antitoxin or 'empty' horse serum [Pferde-Leer-Serum]" (A. Hottinger and D. Töpfer, "Über den Wert der Serumtherapie bei Diphtherie, insbesondere bei der malignen, toxischen Form," Zeitschrift für Kinderheilkunde, 1933, 54: 505-40, quotation on p. 513). Not surprisingly Bingel's work has been entirely forgotten, while the famous 1898 open-label diphtheria experiment conducted by Johannes A. G. Fibiger (1867-1928) at Blegdam's Hospital in Copenhagen with 488 patients is a more commemorated episode in the official histories of diphtheria and of clinical trials. (It is worth speculating that the "peculiar- results that some blind assessments produced may have contributed to the resistance to the method. Warner has pointed out a similiar predicament when orthodox medicine resisted the "numerical method . . . as a revealer of therapeutic truth" because it could present homeopathy in a favorable light [John Harley Warner, The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820-1885 (Cambridge: Harvard University Press, 1980), pp. 202-3].)
185. Bingel's exact words were: "in order to make as objective a test as possible . . . [I asked for evaluations from] the attending physicians . . . without explaining to them the nature of the test serum" (ibid., p. 288). Bingel explicitly called his procedure a "blind- method (his quotes) and recommended its adoption by his colleagues (ibid.). He continued to perform experiments with diphtheria antitoxin even during World War II: Adolf Bingel,"Wirkt das Diphtherieheilserum bei der menschlichen Diphtheriekrankheit spezifisch durch seinen Antitoxingehalt oder unspezifisch?" Deutscht medizinische Wochenschrift, 1949, 74: 101-3; idem, "Zur umstrittenen Wirkung des Di.-antitoxins beim Menschen," ibid., 1950, 47: 1585-87. He also received explicit support for his position from another clinical trial performed on "more than 450 patients" in which "treatment was alternatively either genuine serum antitoxin or 'empty' horse serum [Pferde-Leer-Serum]" (A. Hottinger and D. Töpfer, "Über den Wert der Serumtherapie bei Diphtherie, insbesondere bei der malignen, toxischen Form," Zeitschrift für Kinderheilkunde, 1933, 54: 505-40, quotation on p. 513). Not surprisingly Bingel's work has been entirely forgotten, while the famous 1898 open-label diphtheria experiment conducted by Johannes A. G. Fibiger (1867-1928) at Blegdam's Hospital in Copenhagen with 488 patients is a more commemorated episode in the official histories of diphtheria and of clinical trials. (It is worth speculating that the "peculiar- results that some blind assessments produced may have contributed to the resistance to the method. Warner has pointed out a similiar predicament when orthodox medicine resisted the "numerical method . . . as a revealer of therapeutic truth" because it could present homeopathy in a favorable light [John Harley Warner, The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820-1885 (Cambridge: Harvard University Press, 1980), pp. 202-3].)
186. Bingel's exact words were: "in order to make as objective a test as possible . . . [I asked for evaluations from] the attending physicians . . . without explaining to them the nature of the test serum" (ibid., p. 288). Bingel explicitly called his procedure a "blind- method (his quotes) and recommended its adoption by his colleagues (ibid.). He continued to perform experiments with diphtheria antitoxin even during World War II: Adolf Bingel,"Wirkt das Diphtherieheilserum bei der menschlichen Diphtheriekrankheit spezifisch durch seinen Antitoxingehalt oder unspezifisch?" Deutscht medizinische Wochenschrift, 1949, 74: 101-3; idem, "Zur umstrittenen Wirkung des Di.-antitoxins beim Menschen," ibid., 1950, 47: 1585-87. He also received explicit support for his position from another clinical trial performed on "more than 450 patients" in which "treatment was alternatively either genuine serum antitoxin or 'empty' horse serum [Pferde-Leer-Serum]" (A. Hottinger and D. Töpfer, "Über den Wert der Serumtherapie bei Diphtherie, insbesondere bei der malignen, toxischen Form," Zeitschrift für Kinderheilkunde, 1933, 54: 505-40, quotation on p. 513). Not surprisingly Bingel's work has been entirely forgotten, while the famous 1898 open-label diphtheria experiment conducted by Johannes A. G. Fibiger (1867-1928) at Blegdam's Hospital in Copenhagen with 488 patients is a more commemorated episode in the official histories of diphtheria and of clinical trials. (It is worth speculating that the "peculiar-results that some blind assessments produced may have contributed to the resistance to the method. Warner has pointed out a similiar predicament when orthodox medicine resisted the "numerical method . . . as a revealer of therapeutic truth" because it could present homeopathy in a favorable light [John Harley Warner, The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820-1885 (Cambridge: Harvard University Press, 1980), pp. 202-3].)
187. His methods included rules to "exclude [Ausschaltung, switch off] suggestive or other irrelevant [unsachlicher] factors in the blinded test [unwissentliche Versuchsanordnung]. . . . The medications must be given to the patient in a shape or wrapping that does not permit recognition of their special character or purpose, they must be camouflaged. . . . Even during the preservation period . . . [one must use] a fake medication treatment using inert substances" (Paul Martini, Methodenlehre der therapeutischen Untersuchung [Berlin: Julius Springer, 1932], p. 8).
188. E.g., Paul Martini, "Klinische Untersuchung des sog. Herzhormone bei Angina pectoris," Deutsche medizinische Wochenschrift, 1932, 58: 569-72, quotation on p. 570. Interestingly enough, in 1938-39 Martini applied the blind assessment method to a series of historic déjà-vu assessments of homeopathic remedies; e.g., Paul Martini, L. Bruckmer, Karl Dominicus, A. Schulte, and A. Stegemann, "Homöopathische Arzneimittel - Nachprüfungen," Naunyn Schmeidebergs Archiv für experimentelle Pathologie, 1939, 191: 141-71.
189. E.g., Paul Martini, "Klinische Untersuchung des sog. Herzhormone bei Angina pectoris," Deutsche medizinische Wochenschrift, 1932, 58: 569-72, quotation on p. 570. Interestingly enough, in 1938-39 Martini applied the blind assessment method to a series of historic déjà-vu assessments of homeopathic remedies; e.g., Paul Martini, L. Bruckmer, Karl Dominicus, A. Schulte, and A. Stegemann, "Homöopathische Arzneimittel - Nachprüfungen," Naunyn Schmeidebergs Archiv für experimentelle Pathologie, 1939, 191: 141-71.
190. A. Krumeich, "Klinische Prüfung der Wirkung von Arzneimitteln auf den erhöhten Blutdruck," Deutsches Archiv für klinische Medizin, 1933, 175: 527-40, quotation on p. 527.
191. R. Schwenk, "Über den Wert des Histidins bei der Behandlung des Ulcus ventriculi und duodeni," Deutsches Archiv für klinische Medizin, 1941, 189: 139-58, quotation on p. 139.
192. Generally speaking, American and British mainstream physicians lagged behind their Continental colleagues in conceding any ground to suggestion, hypnotism, or non-material agency. An example would be the late recognition that the British Medical Association and the American Medical Association accorded hypnotism: cf. Subcommittee of the Psychological Medicine Group Committee of the British Medical Association, "Medical Use of Hypnosis," Brit. Med. J., Suppl., 1955, 1: 190-93; Council on Mental Health, "Medical Use of Hypnosis," JAMA, 1958, 168: 186-89. Also see n. 101.
193. Generally speaking, American and British mainstream physicians lagged behind their Continental colleagues in conceding any ground to suggestion, hypnotism, or non- material agency. An example would be the late recognition that the British Medical Association and the American Medical Association accorded hypnotism: cf. Subcommittee of the Psychological Medicine Group Committee of the British Medical Association, "Medical Use of Hypnosis," Brit. Med. J., Suppl., 1955, 1: 190-93; Council on Mental Health, "Medical Use of Hypnosis," JAMA, 1958, 168: 186-89. Also see n. 101.
194. Although there were early examples (e.g., the scurvy trial conducted by James Lind [1716-1794]), widespread attention to the issue began only with Louis Pasteur's adoption of concurrent controls in his anthrax experiments on animals (1881). Fibiger's 1898 diphtheria experiment (see n. 105) is often credited as the first carefully performed experiment on humans, where treatment was allocated impartially on entrance (by alternative assignment). But the principle did not begin to take hold for more than another generation. See Alvan R. Feinstein, Clinical Epidemiology: The Architecture of Clinical Research (Philadelphia: Saunders, 1985), pp. 685-86; and cf. Lilienfeld, "Ceteris paribus" (n. 1). The emerging perception that random assignment could eliminate bias in treatment groups (which began to have an effect in medical research with the pioneering work of Major Greenwood [1880-1949] and Udny Yule [1871-1951] on typhoid and cholera) also helped ignite an awareness of the need for equivalent control groups.
195. Austin Bradford Hill, The Clinical Trial," Brit. Med. Bull., 1951, 7 (4): 278-82, quotation on p. 281.
196. "Clinical Trials of New Remedies," Lancet, 1931, 2: 304.
197. James Burns Amberson, B. T. McMahon, and Max Pinner, "A Clinical Trial of Sanocrysin in Pulmonary Tuberculosis," Amer. Rev. Tuberc., 1931, 24: 401-35, quotation on p. 429.
198. Ibid., p. 406. Treatment allotment was by "flip of the coin," and neither the word blind nor the word placebo appeared in the paper.
199. Lilienfeld's reading (" Ceteris paribus" [n. 1], p. 17) of the paper makes him consider this trial "double-blind," which seems plausible.
200. William Evans and Clifford Hoyle, "The Comparative Value of Drugs Used in the Continuous Treatment of Angina Pectoris," Quart. J. Med., n.s., 1933, 26: 311-38, quotation on p. 336. The report emphasized the spontaneous variation of the disease as the reason to adopt placebo control but did mention "mental suggestion" as a possible explanation for the positive results obtained through use of the placebo (ibid., p. 335). This paper used the word placebo, which at the time was very unusual in a research report.
201. The most important of these experiments was a series of large-scale trials concerning various treatments and preventive measures for the common cold, performed on student subjects under Harold S. Diehl (1891-1973) at the University of Minnesota. The reports included Harold S. Diehl, "Medicinal Treatment of the Common Cold," JAMA, 1933, 101: 2042-49; Harold S. Diehl, A. B. Baker, and Donald W. Cowan, "Cold Vaccines: An Evaluation Based on a Controlled Study," JAMA, 1938, 111: 1168-73; and Donald W. Cowan, Harold S. Diehl, and A. B. Baker, "Vitamins for the Prevention of Colds," JAMA, 1942, 120: 1268-71. The placebo controls were designed to show "how much improvement should be considered as due to spontaneous recovery" (Diehl, "Medicinal Treatment" [n. 119], p. 2044). The 1933 experiment trial was "double-blind": "The ratings were made by me and independently by another physician without either of us knowing what medication had been given to the person making the report" (ibid., p. 2043). Other pre-World War II examples of placebo controls used to shape a no-treatment group include Ben Z. Rappaport, Michael Zeller, and Emanuel Padnos, "Ragweed Oral Pollen Therapy Compared with Oral Placebo," JAMA, 1940, 115: 25-27; and George V. LeRoy, "The Effectiveness of the Xanthine Drugs in the Treatment of Angina Pectoris," JAMA, 1941, 116: 921-25 (both of these experiments took place in 1939).
202. The most important of these experiments was a series of large-scale trials concerning various treatments and preventive measures for the common cold, performed on student subjects under Harold S. Diehl (1891-1973) at the University of Minnesota. The reports included Harold S. Diehl, "Medicinal Treatment of the Common Cold," JAMA, 1933, 101: 2042-49; Harold S. Diehl, A. B. Baker, and Donald W. Cowan, "Cold Vaccines: An Evaluation Based on a Controlled Study," JAMA, 1938, 111: 1168-73; and Donald W. Cowan, Harold S. Diehl, and A. B. Baker, "Vitamins for the Prevention of Colds," JAMA, 1942, 120: 1268-71. The placebo controls were designed to show "how much improvement should be considered as due to spontaneous recovery" (Diehl, "Medicinal Treatment" [n. 119], p. 2044). The 1933 experiment trial was "double-blind": "The ratings were made by me and independently by another physician without either of us knowing what medication had been given to the person making the report" (ibid., p. 2043). Other pre-World War II examples of placebo controls used to shape a no-treatment group include Ben Z. Rappaport, Michael Zeller, and Emanuel Padnos, "Ragweed Oral Pollen Therapy Compared with Oral Placebo," JAMA, 1940, 115: 25-27; and George V. LeRoy, "The Effectiveness of the Xanthine Drugs in the Treatment of Angina Pectoris," JAMA, 1941, 116: 921-25 (both of these experiments took place in 1939).
203. The most important of these experiments was a series of large-scale trials concerning various treatments and preventive measures for the common cold, performed on student subjects under Harold S. Diehl (1891-1973) at the University of Minnesota. The reports included Harold S. Diehl, "Medicinal Treatment of the Common Cold," JAMA, 1933, 101: 2042-49; Harold S. Diehl, A. B. Baker, and Donald W. Cowan, "Cold Vaccines: An Evaluation Based on a Controlled Study," JAMA, 1938, 111: 1168-73; and Donald W. Cowan, Harold S. Diehl, and A. B. Baker, "Vitamins for the Prevention of Colds," JAMA, 1942, 120: 1268-71. The placebo controls were designed to show "how much improvement should be considered as due to spontaneous recovery" (Diehl, "Medicinal Treatment" [n. 119], p. 2044). The 1933 experiment trial was "double-blind": "The ratings were made by me and independently by another physician without either of us knowing what medication had been given to the person making the report" (ibid., p. 2043). Other pre-World War II examples of placebo controls used to shape a no-treatment group include Ben Z. Rappaport, Michael Zeller, and Emanuel Padnos, "Ragweed Oral Pollen Therapy Compared with Oral Placebo," JAMA, 1940, 115: 25-27; and George V. LeRoy, "The Effectiveness of the Xanthine Drugs in the Treatment of Angina Pectoris," JAMA, 1941, 116: 921-25 (both of these experiments took place in 1939).
204. The most important of these experiments was a series of large-scale trials concerning various treatments and preventive measures for the common cold, performed on student subjects under Harold S. Diehl (1891-1973) at the University of Minnesota. The reports included Harold S. Diehl, "Medicinal Treatment of the Common Cold," JAMA, 1933, 101: 2042-49; Harold S. Diehl, A. B. Baker, and Donald W. Cowan, "Cold Vaccines: An Evaluation Based on a Controlled Study," JAMA, 1938, 111: 1168-73; and Donald W. Cowan, Harold S. Diehl, and A. B. Baker, "Vitamins for the Prevention of Colds," JAMA, 1942, 120: 1268-71. The placebo controls were designed to show "how much improvement should be considered as due to spontaneous recovery" (Diehl, "Medicinal Treatment" [n. 119], p. 2044). The 1933 experiment trial was "double-blind": "The ratings were made by me and independently by another physician without either of us knowing what medication had been given to the person making the report" (ibid., p. 2043). Other pre-World War II examples of placebo controls used to shape a no-treatment group include Ben Z. Rappaport, Michael Zeller, and Emanuel Padnos, "Ragweed Oral Pollen Therapy Compared with Oral Placebo," JAMA, 1940, 115: 25-27; and George V. LeRoy, "The Effectiveness of the Xanthine Drugs in the Treatment of Angina Pectoris," JAMA, 1941, 116: 921-25 (both of these experiments took place in 1939).
205. The most important of these experiments was a series of large-scale trials concerning various treatments and preventive measures for the common cold, performed on student subjects under Harold S. Diehl (1891-1973) at the University of Minnesota. The reports included Harold S. Diehl, "Medicinal Treatment of the Common Cold," JAMA, 1933, 101: 2042-49; Harold S. Diehl, A. B. Baker, and Donald W. Cowan, "Cold Vaccines: An Evaluation Based on a Controlled Study," JAMA, 1938, 111: 1168-73; and Donald W. Cowan, Harold S. Diehl, and A. B. Baker, "Vitamins for the Prevention of Colds," JAMA, 1942, 120: 1268-71. The placebo controls were designed to show "how much improvement should be considered as due to spontaneous recovery" (Diehl, "Medicinal Treatment" [n. 119], p. 2044). The 1933 experiment trial was "double-blind": "The ratings were made by me and independently by another physician without either of us knowing what medication had been given to the person making the report" (ibid., p. 2043). Other pre-World War II examples of placebo controls used to shape a no-treatment group include Ben Z. Rappaport, Michael Zeller, and Emanuel Padnos, "Ragweed Oral Pollen Therapy Compared with Oral Placebo," JAMA, 1940, 115: 25-27; and George V. LeRoy, "The Effectiveness of the Xanthine Drugs in the Treatment of Angina Pectoris," JAMA, 1941, 116: 921-25 (both of these experiments took place in 1939).
206. The most important of these experiments was a series of large-scale trials concerning various treatments and preventive measures for the common cold, performed on student subjects under Harold S. Diehl (1891-1973) at the University of Minnesota. The reports included Harold S. Diehl, "Medicinal Treatment of the Common Cold," JAMA, 1933, 101: 2042-49; Harold S. Diehl, A. B. Baker, and Donald W. Cowan, "Cold Vaccines: An Evaluation Based on a Controlled Study," JAMA, 1938, 111: 1168-73; and Donald W. Cowan, Harold S. Diehl, and A. B. Baker, "Vitamins for the Prevention of Colds," JAMA, 1942, 120: 1268-71. The placebo controls were designed to show "how much improvement should be considered as due to spontaneous recovery" (Diehl, "Medicinal Treatment" [n. 119], p. 2044). The 1933 experiment trial was "double-blind": "The ratings were made by me and independently by another physician without either of us knowing what medication had been given to the person making the report" (ibid., p. 2043). Other pre-World War II examples of placebo controls used to shape a no-treatment group include Ben Z. Rappaport, Michael Zeller, and Emanuel Padnos, "Ragweed Oral Pollen Therapy Compared with Oral Placebo," JAMA, 1940, 115: 25-27; and George V. LeRoy, "The Effectiveness of the Xanthine Drugs in the Treatment of Angina Pectoris," JAMA, 1941, 116: 921-25 (both of these experiments took place in 1939).
207. It seems that as late as 1933, Gold and his team were still unfamiliar with and had never implemented an experiment with blind assessment. See, e.g., Harold L. Otto, Harry Gold, and Charles R. Messeloff, "Studies on Digitalis in Ambulatory Patients with Cardiac Disease," Arch. Intern. Med., 1933, 52: 725-38. In 1935, Gold co-authored a study using the method of the "blind test" (quotation marks in the original) comparing two active substances (Ella M. Hediger and Harry Gold, "U.S.P. Ether from Urge Drums and Ether from Small Cans Labeled 'For Anesthesia'," JAMA, 1935, 104: 2244-48, quotation on p. 2245.) "Those administering the anesthetics . . . were unaware of the source of the ether and identified the specimens in terms of code numbers." (ibid.)
208. It seems that as late as 1933, Gold and his team were still unfamiliar with and had never implemented an experiment with blind assessment. See, e.g., Harold L. Otto, Harry Gold, and Charles R. Messeloff, "Studies on Digitalis in Ambulatory Patients with Cardiac Disease," Arch. Intern. Med., 1933, 52: 725-38. In 1935, Gold co-authored a study using the method of the "blind test" (quotation marks in the original) comparing two active substances (Ella M. Hediger and Harry Gold, "U.S.P. Ether from Urge Drums and Ether from Small Cans Labeled 'For Anesthesia'," JAMA, 1935, 104: 2244-48, quotation on p. 2245.) "Those administering the anesthetics . . . were unaware of the source of the ether and identified the specimens in terms of code numbers." (ibid.)
209. There were already a few eloquent English statements from medical brahmins that acknowledged "suggestion" and the fallout of the Salpêlrière-Nancy debate. In his last literary work, Charcot himself conceded defeat and spoke of "a confidence, a credulity [and] receptivity of suggestion" as being responsible for the healings that occur at famous religious shrines (Jean-Martin Charcot, "The Faith-Cure," New Rev., 1893, 8: 18-31, quotation on p. 19; t his appeared in French as "La foi qui guérit," Archives de Neurologie, 1893, 25: 72-87). Osier repeated Charcot's argument in discussing religious healing: William Osler, "The Faith That Heals," Brit. Med. J., 1910, 1: 1470-72. But such sentiments were generally restricted to grandiose discussions of the "art" of medicine and were not seen as having research relevance.
210. There were already a few eloquent English statements from medical brahmins that acknowledged "suggestion" and the fallout of the Salpêlrière-Nancy debate. In his last literary work, Charcot himself conceded defeat and spoke of "a confidence, a credulity [and] receptivity of suggestion" as being responsible for the healings that occur at famous religious shrines (Jean-Martin Charcot, "The Faith-Cure," New Rev., 1893, 8: 18-31, quotation on p. 19; t his appeared in French as "La foi qui guérit," Archives de Neurologie, 1893, 25: 72-87). Osier repeated Charcot's argument in discussing religious healing: William Osler, "The Faith That Heals," Brit. Med. J., 1910, 1: 1470-72. But such sentiments were generally restricted to grandiose discussions of the "art" of medicine and were not seen as having research relevance.
211. There were already a few eloquent English statements from medical brahmins that acknowledged "suggestion" and the fallout of the Salpêlrière-Nancy debate. In his last literary work, Charcot himself conceded defeat and spoke of "a confidence, a credulity [and] receptivity of suggestion" as being responsible for the healings that occur at famous religious shrines (Jean-Martin Charcot, "The Faith-Cure," New Rev., 1893, 8: 18-31, quotation on p. 19; t his appeared in French as "La foi qui guérit," Archives de Neurologie, 1893, 25: 72-87). Osier repeated Charcot's argument in discussing religious healing: William Osler, "The Faith That Heals," Brit. Med. J., 1910, 1: 1470-72. But such sentiments were generally restricted to grandiose discussions of the "art" of medicine and were not seen as having research relevance.
212. Harry Gold, Nathaniel T. Kwit, and Harold Otto, "The Xanthines (Theobromine and Aminophylline) in the Treatment of Cardiac Pain," JAMA, 1937, 108: 2173-79, quotation on p. 2178.
213. Ibid., p. 2177. Actually, Gold's experiment had one other crucial difference from the London experiment. Gold was also concerned with physician bias, and his experiment could almost be considered double-blind: "in a further attempt to eliminate the possibility of bias, the questioner usually refrained from informing himself as to the agent that had been issued until after the patient's appraisal" (ibid., p. 2175). The study seems to have begun with a single-blind design and evolved into a double-blind one. It should be noted that it was Gold and his colleagues who in 1950 seem to have been the first to use the now-established phrase double-blind test: see Theodore Greiner, Harry Gold, McKeen Cattel, Janet Travell, Hyman Bakst, Seymour Rinzler, et al., "A Method for the Evaluation of the Effects of Drugs on Cardiac Pain in Patients with Angina on Effort," Amer. J. Med., 1950, 9: 143-55, quotation on p. 146.
214. While Gold's work eventually became critical for the acceptance of placebo controls among his peers in the biomedical community, the notion that the mind and belief could produce "medical" outcomes had already made inroads into the English-language research literature. In 1936, two single-blind clinical trials on ulcer disease used saline injections as controls. The positive results of the sham were explained as partly due to "psychic effects" (David J. Sandweiss, "Treatment of Gastroduodenal Ulcer with Histidine Monohydrochloride [Larostindin]," JAMA, 1936, 106: 1452-59)
215. or "suggestion" (C. A. Flood and C. R. Mullins, "Treatment of Peptic Ulcer by Means of Injections," Am. J. Dig. Dis., 1936, 3: 303-5).
216. Also in 1930, a placebo was given to 40 hypertensive patients. This experiment had no active treatment. The positive outcomes were explained as "the suggestion inherent in any drug" (David Ayman, "An Evaluation of Therapeutic Results in Essential Hypertension," JAMA, 1930, 95 (4): 246-49, quotation on p. 249).
217. Ayman explicitly states that this idea is a personal opinion. Additionally, the orthodox anti-quackery crusades of the 1920s often used sham controls and may have contributed to this increased mainstream recognition of the imagination and subconscious bias. For example, see discussions in: Anon., "Two Electronic Diagnoses: The Reactions of a Guinea-Pig and Sheep to the Reaction of Abrams," JAMA, 1922, 79 (27): 2244-48;
218. Austin C. Lescarboura, "Our Abrams Verdict. The Electronic Reactions of Abrams and Electronic Medicine in General Found Utterly Worthless," Scientific American, 1924, 131 (3): 158-160, 220-22;
219. Arthur K. Cramp, "Some Bald Facts: Professor Scholder Appeals to an Ancient Weakness," Hygeia, 1927, 5: 497-99.
220. The most direct pre-World War II influence of Gold seems to have been on another New York team at Mt. Sinai Hospital, which replicated Gold's experiments on the xanthines; their report's analysis followed the exact wording of the Gold paper and explicitly mentioned "confidence," "encouragement," and the patient-physician relationship: Arthur M. Master, Harry L. Jaffe, and Simon Dack, "The Drug Treatment of Angina Pectoris Due to Coronary Artery Disease," Amer. J. Med. Sci., 1939, 197: 774-82, quotation on p. 774. Another team, at Boston's Beth Israel Hospital (with connections to Harry Gold), adopted sham saline injections as a control in a rheumatoid and osteoarthritis experiment; again, their discussion saw the control as necessary for both "the tendency to natural remission in chronic arthritis . . . [and] the psychological effect of the injection itself" (Nathan Sidel and Maurice I. Abrams, "Treatment of Chronic Arthritis: Results of Vaccine Therapy with Saline Injections Used as Controls," JAMA, 1940, 114: 1740-42, quotation on p. 1742. By 1942, Harold Diehl (mentioned in n. 118) had also explicitly adopted the idea that a control group could experience "psychologic effects" (Harold S. Diehl, "Abstract of Discussion," JAMA, 1942, 120: 1270-71, quotation on p. 1271).
221. The most direct pre-World War II influence of Gold seems to have been on another New York team at Mt. Sinai Hospital, which replicated Gold's experiments on the xanthines; their report's analysis followed the exact wording of the Gold paper and explicitly mentioned "confidence," "encouragement," and the patient-physician relationship: Arthur M. Master, Harry L. Jaffe, and Simon Dack, "The Drug Treatment of Angina Pectoris Due to Coronary Artery Disease," Amer. J. Med. Sci., 1939, 197: 774-82, quotation on p. 774. Another team, at Boston's Beth Israel Hospital (with connections to Harry Gold), adopted sham saline injections as a control in a rheumatoid and osteoarthritis experiment; again, their discussion saw the control as necessary for both "the tendency to natural remission in chronic arthritis . . . [and] the psychological effect of the injection itself" (Nathan Sidel and Maurice I. Abrams, "Treatment of Chronic Arthritis: Results of Vaccine Therapy with Saline Injections Used as Controls," JAMA, 1940, 114: 1740-42, quotation on p. 1742. By 1942, Harold Diehl (mentioned in n. 118) had also explicitly adopted the idea that a control group could experience "psychologic effects" (Harold S. Diehl, "Abstract of Discussion," JAMA, 1942, 120: 1270-71, quotation on p. 1271).
222. The most direct pre-World War II influence of Gold seems to have been on another New York team at Mt. Sinai Hospital, which replicated Gold's experiments on the xanthines; their report's analysis followed the exact wording of the Gold paper and explicitly mentioned "confidence," "encouragement," and the patient-physician relationship: Arthur M. Master, Harry L. Jaffe, and Simon Dack, "The Drug Treatment of Angina Pectoris Due to Coronary Artery Disease," Amer. J. Med. Sci., 1939, 197: 774-82, quotation on p. 774. Another team, at Boston's Beth Israel Hospital (with connections to Harry Gold), adopted sham saline injections as a control in a rheumatoid and osteoarthritis experiment; again, their discussion saw the control as necessary for both "the tendency to natural remission in chronic arthritis . . . [and] the psychological effect of the injection itself" (Nathan Sidel and Maurice I. Abrams, "Treatment of Chronic Arthritis: Results of Vaccine Therapy with Saline Injections Used as Controls," JAMA, 1940, 114: 1740-42, quotation on p. 1742. By 1942, Harold Diehl (mentioned in n. 118) had also explicitly adopted the idea that a control group could experience "psychologic effects" (Harold S. Diehl, "Abstract of Discussion," JAMA, 1942, 120: 1270-71, quotation on p. 1271).
223. E.g., see Otho B. Ross, "Use of Controls in Medical Research," JAMA, 1951, 145: 72-74, which presented a quantitative discussion of the lack of well-controlled comparative clinical studies in the most prestigious medical journals between January and June of 1950. Ross's criteria emphasized concurrent controls, and he introduced the idea of randomization. Although his two examples of well-controlled trials used a sham interventon for concurrent treatment, he did not explicitly mention blind assessment as a criterion for a good trial.
224. Much has been written on R. A. Fisher. Examples of different approaches to his influence include C. Radhakrishna Rao, "R. A. Fisher: The Founder of Modern Statistics," Statist. Sci., 1992, 7: 34-48; and F. Yates, "Sir Ronald Fisher and the Design of Experiments," Biometrics, 1964, 20: 307-21.
225. Much has been written on R. A. Fisher. Examples of different approaches to his influence include C. Radhakrishna Rao, "R. A. Fisher: The Founder of Modern Statistics," Statist. Sci., 1992, 7: 34-48; and F. Yates, "Sir Ronald Fisher and the Design of Experiments," Biometrics, 1964, 20: 307-21.
226. R. A. Fisher, The Design of Experiments (Edinburgh: Oliver and Boyd, 1935), p. 47.
227. See Gerd Gigerenzer, "Probabilistic Thinking and the Fight against Subjectivity," in The Probabilistic Revolution, vol. 2: Ideas in the Sciences, ed. Gerd Gigerenzer and Mary S. Morgan (Cambridge: MIT Press, 1987), pp. 11-33.
228. Gigerenzer et al., Empire of Chance (n. 97), p. 211.
229. Harry M. Marks, "Notes for the Underground: The Social Organization of Therapeutic Research," in Grand Rounds: One Hundred Years of Internal Medicine, ed. Russell C. Maulitz and Diana E. Long (Philadelphia: University of Pennsylvania Press, 1988), pp. 319-20.
230. Ibid., p. 319. I am indebted to Dr. Marks for sharing a prepublication version of portions of Progress of Experiment (n. 3). Many of the insights in the RCT section of this paper are derived from this pioneering work, esp. pp. 136-63.
231. Cf. David Armstrong, "Clinical Sense and Clinical Science," Soc. Sci. Med., 1977, 11: 599-601.
232. Austin Bradford Hill, "Suspended Judgement: Memories of the British Streptomycin Trial in Tuberculosis. The First Randomized Clinical Trial," Controlled Clin. Trials, 1990, 11: 77-79, quotation on p. 77.
233. Austin Bradford Hill, "The Clinical Trial," N. Engl. J. Med., 1952, 247 (4): 113-19, quotation on p. 118. The article cites a source for this criticism that is not traceable.
234. Robert C. Batterman, "Appraisal of New Drugs" [Letter], JAMA, 1955, 158: 1547.
235. Mainland spoke of researchers' "antagonism to statistics" and experimenters as "long resistant to statistical tests" (Donald Mainland, "The Use and Misuse of Statistics in Medical Publications," Clin. Pharmacol. Therap., 1960, 1: 411-22, quotations on pp. 411, 412). Reid described physicians as feeling that "nothing [was] . . . more depressing than . . . 'the repellent symbolism' of the mathematical statistician" (D. D. Reid, "Statistics in Clinical Research," Ann. New York Acad. Sci., 1950, 52: 931-34, quotation on p. 931). Also see Donald Mainland, "The Clinical Trial - Some Difficulties and Suggestions," J. Chron. Dis., 1960, 11: 484-96.
236. Mainland spoke of researchers' "antagonism to statistics" and experimenters as "long resistant to statistical tests" (Donald Mainland, "The Use and Misuse of Statistics in Medical Publications," Clin. Pharmacol. Therap., 1960, 1: 411-22, quotations on pp. 411, 412). Reid described physicians as feeling that "nothing [was] . . . more depressing than . . . 'the repellent symbolism' of the mathematical statistician" (D. D. Reid, "Statistics in Clinical Research," Ann. New York Acad. Sci., 1950, 52: 931-34, quotation on p. 931). Also see Donald Mainland, "The Clinical Trial - Some Difficulties and Suggestions," J. Chron. Dis., 1960, 11: 484-96.
237. Mainland spoke of researchers' "antagonism to statistics" and experimenters as "long resistant to statistical tests" (Donald Mainland, "The Use and Misuse of Statistics in Medical Publications," Clin. Pharmacol. Therap., 1960, 1: 411-22, quotations on pp. 411, 412). Reid described physicians as feeling that "nothing [was] . . . more depressing than . . . 'the repellent symbolism' of the mathematical statistician" (D. D. Reid, "Statistics in Clinical Research," Ann. New York Acad. Sci., 1950, 52: 931-34, quotation on p. 931). Also see Donald Mainland, "The Clinical Trial - Some Difficulties and Suggestions," J. Chron. Dis., 1960, 11: 484-96.
238. Reid, "Statistics" (n. 137), p. 933. Also see, e.g., Walter Modell and Raymond W. Houde, "Factors Influencing Clinical Evaluation of Drugs," JAMA, 1958, 167: 2190-99. A description of an earlier scientific situation applies here. Suddenly, the physician was no longer safe from "forces working on him that would shift his utterances out of correspondence with reality" (Steven Shapin, A Social History of Truth: Civility and Science in Seventeenth- Century England [Chicago: University of Chicago Press, 1996], p. xxvii).
239. Reid, "Statistics" (n. 137), p. 933. Also see, e.g., Walter Modell and Raymond W. Houde, "Factors Influencing Clinical Evaluation of Drugs," JAMA, 1958, 167: 2190-99. A description of an earlier scientific situation applies here. Suddenly, the physician was no longer safe from "forces working on him that would shift his utterances out of correspondence with reality" (Steven Shapin, A Social History of Truth: Civility and Science in Seventeenth- Century England [Chicago: University of Chicago Press, 1996], p. xxvii).
240. Reid, "Statistics" (n. 137), p. 933. Also see, e.g., Walter Modell and Raymond W. Houde, "Factors Influencing Clinical Evaluation of Drugs," JAMA, 1958, 167: 2190-99. A description of an earlier scientific situation applies here. Suddenly, the physician was no longer safe from "forces working on him that would shift his utterances out of correspondence with reality" (Steven Shapin, A Social History of Truth: Civility and Science in Seventeenth-Century England [Chicago: University of Chicago Press, 1996], p. xxvii).
241. This transition in understanding the "placebo" is obvious in the medical literature but is rarely discussed. See Kaptchuk, "Powerful Placebo" (n. 2).
242. Harry Gold and his colleagues were instrumental in organizing two conferences that advocated blind assessment in order to control for this newly detected placebo effect: see Conferences on Therapy, "The Use of Placebos in Therapy," New York J. Med., 1946, 46: 1718-27; Conference on Therapy, "How to Evaluate a New Drug," Amer. J. Med., 1954, 17: 722-27.
243. Harry Gold and his colleagues were instrumental in organizing two conferences that advocated blind assessment in order to control for this newly detected placebo effect: see Conferences on Therapy, "The Use of Placebos in Therapy," New York J. Med., 1946, 46: 1718-27; Conference on Therapy, "How to Evaluate a New Drug," Amer. J. Med., 1954, 17: 722-27.
244. Hacking points out that probability has had two distinct functions: an epistemological one having to do with credibility and with "assessing reasonable degrees of belief in propositions," and a statistical one having to do with "stochastic laws of chance" (Ian Hacking, The Emergence of Probability: A Philosophical Study of Early Ideas about Probability, Induction, and Statistical Inference [Cambridge: Cambridge University Press, 1975], p. 12). A similiar dichotomy could be said to apply to randomization itself, while blind assessment would have only a credibility dimension.
245. Cf. Richard Doll, "Development of Controlled Trials in Preventive and Therapeutic Medicine," J. Biosoc. Sci., 1991, 23: 265-78. One can see Hill still struggling with assuring genuine randomization in his 1951 description of the 1948 streptomycyin trial. In this trial, only the assessment radiologists were blind to intervention. In order to ensure successful randomization Hill had to resort to enforced secrecy, which can be as difficult with medical personnel as it is with anyone. Hill stated that "the allocation of the patient to treatment or control is kept secret from the clinician until after . . . [the] patient's admission. Thus he can proceed to that decision . . . without any fear of bias" (Hill, "Clinical Trial" [n. 113], p. 280).
246. Cf. Richard Doll, "Development of Controlled Trials in Preventive and Therapeutic Medicine," J. Biosoc. Sci., 1991, 23: 265-78. One can see Hill still struggling with assuring genuine randomization in his 1951 description of the 1948 streptomycyin trial. In this trial, only the assessment radiologists were blind to intervention. In order to ensure successful randomization Hill had to resort to enforced secrecy, which can be as difficult with medical personnel as it is with anyone. Hill stated that "the allocation of the patient to treatment or control is kept secret from the clinician until after . . . [the] patient's admission. Thus he can proceed to that decision . . . without any fear of bias" (Hill, "Clinical Trial" [n. 113], p. 280).
247. Stephen Senn, "A Personal View of Some Controversies in Allocating Treatment to Patients in Clinical Trials," Statist. Med., 1995, 15: 2667. Cf. Feinstein, Clinical Epidemiology (n. 112), p. 688; and Peter Armitage, "The Role of Randomization in Clinical Trials," Statist. Med., 1982, 1: 347.
248. Stephen Senn, "A Personal View of Some Controversies in Allocating Treatment to Patients in Clinical Trials," Statist. Med., 1995, 15: 2667. Cf. Feinstein, Clinical Epidemiology (n. 112), p. 688; and Peter Armitage, "The Role of Randomization in Clinical Trials," Statist. Med., 1982, 1: 347.
249. Stephen Senn, "A Personal View of Some Controversies in Allocating Treatment to Patients in Clinical Trials," Statist. Med., 1995, 15: 2667. Cf. Feinstein, Clinical Epidemiology (n. 112), p. 688; and Peter Armitage, "The Role of Randomization in Clinical Trials," Statist. Med., 1982, 1: 347.
250. Hill, "Clinical Trial" (n. 135). p. 117.
251. Eugene F. DuBois, "The President's Address," Trans. Assoc. Amer. Phys., 1939, 54: 1-5, quotation on p. 5. DuBois was a close senior associate of Harry Gold at Cornell-New York Hospital; in his address he educated physicians regarding the availability and potential value of blind assessment, but he still was not advocating its universal adoption.
252. The words blind or double-blind or double unknowns are often kept in quotation marks in biomedical journals well into the mid-1950s to denote the novelty of the technique. E.g., see Louis Lasagna, John M. von Felsinger, and Henry K. Beecher, "Drug-Induced Mood Changes in Man,"JAMA, 1955, 157: 1006-20; Henry K. Beecher, "Appraisal of Drugs Intended to Alter Subjective Responses, Symptoms," ibid., 158: 399-401.
253. The words blind or double-blind or double unknowns are often kept in quotation marks in biomedical journals well into the mid-1950s to denote the novelty of the technique. E.g., see Louis Lasagna, John M. von Felsinger, and Henry K. Beecher, "Drug- Induced Mood Changes in Man,"JAMA, 1955, 157: 1006-20; Henry K. Beecher, "Appraisal of Drugs Intended to Alter Subjective Responses, Symptoms," ibid., 158: 399-401.
254. Ian Hacking, "Statistical Language, Statistical Truth and Statistical Reason: The Self-Authentification of a Style of Scientific Reasoning," in The Social Dimensions of Science, ed. Ernan McMullin (Notre Dame: University of Notre Dame Press, 1992), pp. 130-57; Hacking describes this style as follows: "the truth is what we find out in such and such a way. We recognize it as truth because of how we find it out. And how do we know that the method is good? Because it gets at the truth" (p. 135).
255. Ibid., p. 132.
256. Obviously, many of the authors cited in this essay - such as Marks, Gigerenzer, Porter, and Matthews - are actively engaged in this critical analysis. Many other sociologists and historians could be mentioned. On the scientific side, many debates are also raging. Concerning blind assessment, it should be mentioned that there is already a small literature concerned with critically examining the unintended consequences of blind assessment and the a priori assumptions embedded in the methodology. Important examples of this literature include Irving Kirsch and Michael J. Rosadino, "Do Double-Blind Studies with Informed Consent Yield Externally Valid Results?" Psychopharmacology, 1993, 110: 437-42; Irving Kirsch and Lynne J. Weixel, "Double-Blind versus Deceptive Administration of a Placebo," Behav. Neurosci., 1988, 102: 319-23; Mauro Moscucci, Louise Byrne, Michael Weintraub, and Christopher Cox, "Blinding, Unblinding, and the Placebo Effect: An Analysis of Patients' Guesses of Treatment Assignment in a Double-Blind Clinical Trial," Clin. Pharmacol. Therap., 1987, 41: 259-65; Sydnor B. Penick and Seymour Fisher, "Drug-Set Interaction: Psychological and Physiological Effects of Epinephrine under Differential Expectations," Psychosom. Med., 1965, 27: 177-82; J. H. Noseworth, G. C. Ebers, M. K. Vandervoort, R. E. Farquhar, E. Yetisir, and R. Roberts, "The Impact of Blinding on the Results of a Randomized, Placebo-Controlled Multiple Sclerosis Clinical Trial," Neurology, 1994, 44, 16-20. In fact, reading this literature was the incentive for me to undertake this examination of the history of blind assessment.
257. Obviously, many of the authors cited in this essay - such as Marks, Gigerenzer, Porter, and Matthews - are actively engaged in this critical analysis. Many other sociologists and historians could be mentioned. On the scientific side, many debates are also raging. Concerning blind assessment, it should be mentioned that there is already a small literature concerned with critically examining the unintended consequences of blind assessment and the a priori assumptions embedded in the methodology. Important examples of this literature include Irving Kirsch and Michael J. Rosadino, "Do Double-Blind Studies with Informed Consent Yield Externally Valid Results?" Psychopharmacology, 1993, 110: 437- 42; Irving Kirsch and Lynne J. Weixel, "Double-Blind versus Deceptive Administration of a Placebo," Behav. Neurosci., 1988, 102: 319-23; Mauro Moscucci, Louise Byrne, Michael Weintraub, and Christopher Cox, "Blinding, Unblinding, and the Placebo Effect: An Analysis of Patients' Guesses of Treatment Assignment in a Double-Blind Clinical Trial," Clin. Pharmacol. Therap., 1987, 41: 259-65; Sydnor B. Penick and Seymour Fisher, "Drug-Set Interaction: Psychological and Physiological Effects of Epinephrine under Differential Expectations," Psychosom. Med., 1965, 27: 177-82; J. H. Noseworth, G. C. Ebers, M. K. Vandervoort, R. E. Farquhar, E. Yetisir, and R. Roberts, "The Impact of Blinding on the Results of a Randomized, Placebo-Controlled Multiple Sclerosis Clinical Trial," Neurology, 1994, 44, 16-20. In fact, reading this literature was the incentive for me to undertake this examination of the history of blind assessment.
258. Obviously, many of the authors cited in this essay - such as Marks, Gigerenzer, Porter, and Matthews - are actively engaged in this critical analysis. Many other sociologists and historians could be mentioned. On the scientific side, many debates are also raging. Concerning blind assessment, it should be mentioned that there is already a small literature concerned with critically examining the unintended consequences of blind assessment and the a priori assumptions embedded in the methodology. Important examples of this literature include Irving Kirsch and Michael J. Rosadino, "Do Double-Blind Studies with Informed Consent Yield Externally Valid Results?" Psychopharmacology, 1993, 110: 437- 42; Irving Kirsch and Lynne J. Weixel, "Double-Blind versus Deceptive Administration of a Placebo," Behav. Neurosci., 1988, 102: 319-23; Mauro Moscucci, Louise Byrne, Michael Weintraub, and Christopher Cox, "Blinding, Unblinding, and the Placebo Effect: An Analysis of Patients' Guesses of Treatment Assignment in a Double-Blind Clinical Trial," Clin. Pharmacol. Therap., 1987, 41: 259-65; Sydnor B. Penick and Seymour Fisher, "Drug-Set Interaction: Psychological and Physiological Effects of Epinephrine under Differential Expectations," Psychosom. Med., 1965, 27: 177-82; J. H. Noseworth, G. C. Ebers, M. K. Vandervoort, R. E. Farquhar, E. Yetisir, and R. Roberts, "The Impact of Blinding on the Results of a Randomized, Placebo-Controlled Multiple Sclerosis Clinical Trial," Neurology, 1994, 44, 16-20. In fact, reading this literature was the incentive for me to undertake this examination of the history of blind assessment.
259. Obviously, many of the authors cited in this essay - such as Marks, Gigerenzer, Porter, and Matthews - are actively engaged in this critical analysis. Many other sociologists and historians could be mentioned. On the scientific side, many debates are also raging. Concerning blind assessment, it should be mentioned that there is already a small literature concerned with critically examining the unintended consequences of blind assessment and the a priori assumptions embedded in the methodology. Important examples of this literature include Irving Kirsch and Michael J. Rosadino, "Do Double-Blind Studies with Informed Consent Yield Externally Valid Results?" Psychopharmacology, 1993, 110: 437- 42; Irving Kirsch and Lynne J. Weixel, "Double-Blind versus Deceptive Administration of a Placebo," Behav. Neurosci., 1988, 102: 319-23; Mauro Moscucci, Louise Byrne, Michael Weintraub, and Christopher Cox, "Blinding, Unblinding, and the Placebo Effect: An Analysis of Patients' Guesses of Treatment Assignment in a Double-Blind Clinical Trial," Clin. Pharmacol. Therap., 1987, 41: 259-65; Sydnor B. Penick and Seymour Fisher, "Drug-Set Interaction: Psychological and Physiological Effects of Epinephrine under Differential Expectations," Psychosom. Med., 1965, 27: 177-82; J. H. Noseworth, G. C. Ebers, M. K. Vandervoort, R. E. Farquhar, E. Yetisir, and R. Roberts, "The Impact of Blinding on the Results of a Randomized, Placebo-Controlled Multiple Sclerosis Clinical Trial," Neurology, 1994, 44, 16-20. In fact, reading this literature was the incentive for me to undertake this examination of the history of blind assessment.
260. Obviously, many of the authors cited in this essay - such as Marks, Gigerenzer, Porter, and Matthews - are actively engaged in this critical analysis. Many other sociologists and historians could be mentioned. On the scientific side, many debates are also raging. Concerning blind assessment, it should be mentioned that there is already a small literature concerned with critically examining the unintended consequences of blind assessment and the a priori assumptions embedded in the methodology. Important examples of this literature include Irving Kirsch and Michael J. Rosadino, "Do Double-Blind Studies with Informed Consent Yield Externally Valid Results?" Psychopharmacology, 1993, 110: 437- 42; Irving Kirsch and Lynne J. Weixel, "Double-Blind versus Deceptive Administration of a Placebo," Behav. Neurosci., 1988, 102: 319-23; Mauro Moscucci, Louise Byrne, Michael Weintraub, and Christopher Cox, "Blinding, Unblinding, and the Placebo Effect: An Analysis of Patients' Guesses of Treatment Assignment in a Double-Blind Clinical Trial," Clin. Pharmacol. Therap., 1987, 41: 259-65; Sydnor B. Penick and Seymour Fisher, "Drug-Set Interaction: Psychological and Physiological Effects of Epinephrine under Differential Expectations," Psychosom. Med., 1965, 27: 177-82; J. H. Noseworth, G. C. Ebers, M. K. Vandervoort, R. E. Farquhar, E. Yetisir, and R. Roberts, "The Impact of Blinding on the Results of a Randomized, Placebo-Controlled Multiple Sclerosis Clinical Trial," Neurology, 1994, 44, 16-20. In fact, reading this literature was the incentive for me to undertake this examination of the history of blind assessment.