TOOLS OF THE TRADE

MIDWIVES AND SHIT

READING 1: SHAPIRO
The Placebo Effect in Medical History
Everyone has used the placebo effect, and for some reason it is effects The Placebo effect is a psychological or psychophysiological therapeutic effect produced by a placebo,

or in other words, something that works not because it is actually effective in ending the disease, but because the person has been convinced that it works
Recognition of the placebo power came in the 1930s

Significant papers:

Golds initial study (1937)

blind test as a control for the placebo effect of treatments

Houstons proposal (1938, 1416-1418) He said the history of medicine is mostly a history of the placebo effect, because most things in history have been ineffective

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The Placebo Effect in Prehistoric Times

Sir William Osler (1932) o Medicine distinguished hominids from other creatures o Placebos were the dominate treatment in preliterate cultures Earliest knows physicians were Cro-Magnon times, 20000 BC o Haggard 1934; Bromberg 1954 Babylonia and Assyria 2011 BC o 15 medical remedies in the oldest Sumerian medical tablet

All placebos
Earliest records mention 250 drugs or vegetable origin and a smaller number of animal and mineral origin o Examples: wines, droughts, plasters, potions, infusions, dung, cold water Physicians increasingly skeptical about medical treatment

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Egypt Ebers Papyrus (1500 B.C.) is one of the most important medical papyri and is a compilation of recipes for various illnesses o 700 drugs of minerals, vegtables, or animals o 842 prescriptions o Most were completely worthless Examples: dirt, blood or animals, fat of animals, grated human skull, beetles, wood soaked in water Fond of dung and urine because it repealed spirits o Diseases were viewed as a curse; bloodletting was used to purify the body o They were obsessed with the anus Referred to in 82 prescriptions Divine Clyster (p. 4) Had an effect of the Greek, Roman, and Western medicine First to write medicine texts Greece Chiron o Centaur, the teacher of pharmacy who taught Apollo who handed knowledge down to Asclepius who surpassed healers and became a god Carved on a pillar outside of the sanctuary of Asclepius in Pergamon: Death Cannot Enter Here. Very religious and stuff; nothing really stood out too much, but its all there on page 6

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The Four Humors First taught by Pythagorean in Greek medicine Became fundamental for Hippocratic medicine Was further emphasized by Galen and other physicians Based on the idea that the basic elements were earth, air, fire, and water Four humors: blood (secreted by the liver), phlegm (secreted by the lungs), yellow bile (gallbladder), and

black bile (spleen), with the brain secreting mucus

o Qualities are moist and warm, moist and cold, dry and warm, dry and cold

o Each different in color, temperature, and humidity

Diseases caused by imbalance on page 7 So nature can heal by adjusting the humors

o Affected by diet, weather, climate

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Hippocrates Hippocratic Corpus (70 essays of his medical practice) o 195-400 drugs mentioned Mainly of vegetable origin o References to purification Enemas, emetics, sudorifics, bloodletting, massage, hydrotherapy, purgatives Medicine became more practical and humanistic

Emphasized diet, but discouraged fruits and vegetables

Direct treatment of wounds did little harm and some good (Guido Majno) o Subsequent treatment bad to hair-raising Enemas, purges, vomiting, all while on a starvation diet Freed medicine from superstitions and philosophical restraints Precepts guided medicine for 2000 years

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China Built on ancient humoral theories that flowered in the fourth or fifth century The emergence of Confusius; books and shit o I Ching (Book of Changes), Chou Li (Institutions of the Chou), and Huang Ti Nei Ching Su Wen (The Yellow Emperors Classic of Internal Medicine) Five Elements o Water, fire, wood, metal, and earth 64 combinations of yin and yang Number lore Five tastes o Vinegar, wine, honey, ginger, and salt Five grains Five drugs o Herbs, trees, insects, stones, grains Five flavors o Pungent, sour, sweet, bitter, and salty Ulcers were treated with acupuncture Five creatures o Viper, scorpion, centipede, toad, and lizard

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India
Major medical writings o The Atharvaveda, The Choraka, and the Sushruta o Between 1500 bc and 1000 ad

o Reluctance to commit ideas to writing

More advanced treatment of wounds Military hospitals, rhinoplasty, couching for cataract, amputation, repair of earlobes, hot oil to stop bleeding Mantras, dieting, drugs, abstinence from sex, meat, and emotions; fasting, vomiting, purging, venesection,

and enemas
Alexandria Little is known about medical history because of the destruction of the library of Alexandria

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Rome Didnt like physicians

Relied primarily on folk medicine for 600 years

Rational observation of Celius o Held that surgical treatment is better than medical Pliny o Assembled 20,000 facts from 2000 volumes by 100s of authors o Physicians acquire knowledge from our danger Galen o Never as yet have I gone astray o Osler said: He cures most in whom most are confident

Classic Placebos during the Reign of Galenic Medicine

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Medicines Universal Remedy: Theriac
Theriac: one of medicines oldest and most expensive drugs o Hella substances, took 6 months o Galen wrote an entire book about it, but he called it mithridatum and claimed it drew poison like a

cupping glass

Increased ingredients and time required for maturity

Neros physician further increased the opium content considerably Used as a remedy for everything into the late eighteen hundreds, and even through WWII

It might have worked for pain with enough opium, but it didnt always have it

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Bizarre Placebos Sixth century treatment for gout o Mixed myrrh with nipplelike projections from a young pig, wrapped in the skin of a wolf or dog Seventh century o Paul of Aegina outlined the use of blood

Galen rejected these, but his were just as bizarre

Clysterization o Cause dehydration, and many diseases need hydration Bleeding o First used by the Egyptians o Spread to Greece and Rome o Leeches

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13th century cure for gout o Skin of a puppy and several other animals 17th century cure for gout o Worms and dried vipers, powders of stones, oil of bricks, ants, and other stuff you dont want, moss scraped from the skull of someone who was violently murdered

Super expensive
Mattioli o Italian physician in the 16th century o Antidote to poison and the plague 230 ingredients Unlikely that any of them cured disease Unicorns were important, and they existed basically every where o The horn that was used was actually just the upper incisor tooth of a narwhal The most expensive placebo in medical history; costing ten times its weight in gold in the 16th century o Poor people could buy unicorn drink; water running through a glass horn that was taken through a beaker where a unicorn horn had been dipped o Disputes about how to tell real horn from a fake one, and over whether or not unicorns existed, began in the twelfth century and continued on for five as prices escalated

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o 17th entury; merchants in Copenhagan went to a zoologist to see if it was a real unicorn; when they found out it was narwhal the price declined, but the remedy was still effective
Bezoar stone; from Arabic to European medicine o Used to treat poison o Legend said it was crystallized tear from the eye of a dear bitten by a snake It was actually a gallstone from an animal such as a goat o Often counterfitted, used pebbles instead Many people were tried for doing this Babylonians, Hebrews, greeks, and Nero used mandrake o Like in Harry Potter; they thought it would shriek when pulled up from the Earth Shakespeare refered to the stuff they used in his day in his plays o Likely supplied by his son in law Aphrodisiacs (increases sexual desire) o Mandrake Used in the Bible by Jacob and Leah o Jackals gall o Placenta of a newly foaled mare

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o Menstaul blood
o Mothers and daughters milk mixed together o Bulls balls Powdered Egyptian mummy was believed to heal wounds and a lot of other things The Laying on of Hands One of the oldest, and still used today In the Bible Christ does it The Royal Touch o First in 300 BC by Greek Pyrrhus of Epirus

o Used by Roman Emperor Vespasian in first century BC

o Charles II treated more people than anyone of scrofula, but likely because the diagnosis of scrofula was

invalid

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His touch referenced in Macbeth Commoners started claiming the power of the touch o Valentine Greatrakes, 17th century England o Bridget Bostock, England, 18th century Healer of Coppenhall Animal Magnetism Franz Mesmer o Chains and tubs and circles and magnetic special water Placebo and Nonplacebo drugs during the Decline of Galenical Medicine The First Nonplacebo Drug: Cinchona Cinchona bark contributed to the end of Galenic medicine Introduced to Europe by the Jesuits in 1638 Thomas Sydenham and Thomas Morton introduced it to England Most rejected the bark

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o It is suggested that this is because of adulterated or substituted products, which made it difficult to determine the effectiveness Upset the current medical system o Did what gunpowder did to war Corrupted the humors; the end of Galenic medical practice Considered the first nonplacebo The Treatment of Charles II in 1680 Reasoning for treatment languished in the 17th century Charles II

o Bled
o Given an emetic to vomit o An enema o Rocksalt o Head shaved and a blister put on his scalp

o Sneezing powder to purge his vein

o Pigeon dung put on his feet o More bleeding o Bezoar stone

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Cures for the Falling Sickness Mistletoe was thought to have curative virtues in ancient times Galenic drug of choice Renaissance learning is when medicine and medical thinking started to change o Galenism ended in the seventeenth and eighteenth centuries The Seventeenth Century

Treatment was still primitive, despite progress

The first edition of the London Pharmacyopoeia (1618) still included some pretty not dope remedies

and stuff
o 1650 version contained moss of the skull of someone who was violently murdered

o 1677 contained cinchona bark, but also human urine

SHAPIRO CONCLUDING (FINALLY)

The Eighteenth Century Described as laying the foundation for modern science and medicine Edward Jenner o Vaccination for smallpox James Lind o Citrus juice and scurvy They still did bloodletting

o George Washington
The Nineteenth Century Marked by Claude Bernards 1865 exposition on the scientific method o Led to the direction of experimentation Study of morbid anatomy Science of bacteria Therapy without scientific knowledge continued Homeopathy

DIARY OF MARTHA BALLARD