van Helmont's proposal for a randomised comparison of treating fevers with or without bloodletting and purging.

Around the year 1643, Joan Baptista van Helmont, a Flemish chemist, alchemist and physician who had devised what he claimed to be a new form of medicine, proposed a 'challenge' to traditional Galenic physicians to compare treatment of fever by traditional methods and by a regime which did not involve bloodletting and purging. Two groups of patients were to be treated and 'casting of lots' was to be used - in some way not specified in detail - to decide who received which treatment. This 'challenge' has been regarded as the first proposal for the use of randomisation in a clinical trial. This paper explains the background to the challenge and discusses what can be deduced from Helmont's text about the details of how he proposed that the 'trial' was to be carried out. It concludes that internal evidence in Helmont's writings makes it certain that no such 'trial' was ever conducted. It seems that the 'challenge' was probably a rhetorical device to support Helmont's vehement criticism of traditional Galenic medicine and its practitioners, and, in particular, toemphasise his absolute opposition to the use of bloodletting as a medicaltreatment. An appendix includes a short summary of Helmont's theories of the origins of disease and transcriptions of the passages of Helmont's Latin text translated in the article.

Colon preparation and surgical site infection.

BACKGROUND: Colon preparation for elective colon resection to reduce surgical site infection (SSI) remains controversial. METHODS: A review of the published literature was undertaken to define evidence-based practices for colon preparation for elective colon resection. RESULTS: Seventy years of surgical literature has documented that mechanical bowel preparation alone does not reduce SSI. A body of clinical trials has documented the benefits of oral antibiotic bowel preparation compared with a placebo in the reduction of SSI. Clinical trials show the addition of the oral antibiotic bowel preparation to appropriate systemic preoperative preventive antibiotics provide the lowest rates of SSI. CONCLUSIONS: Mechanical bowel preparation alone does not reduce rates of SSI, but oral antibiotic preparation and systemic preoperative antibiotics are superior when compared with systemic antibiotics alone. Additional clinical trials are necessary to define the best combined overall mechanical and oral antibiotic regimen for elective colon surgery.

Locality and circulation in the Habsburg empire: disputing the Carlsbad medical salt, 1763-1784.

By looking at the fierce debates in the city of Carlsbad in Bohemia around the fabrication of medical salt by a local doctor, David Becher, from 1763 to 1784, the paper examines the interactions between different spheres or levels of circulation of knowledge in the Habsburg Empire. The dispute crystallized around the definition of the product, about its medical qualities and its relation with the water of the local mineral spring. The city's inhabitants contested the vision of the medical experts, fearing that the extraction of the medical salt from the spring water and its sale outside the town would have a negative effect on the number of visitors to the spa. Their vision implied a more or less 'popularized' form of alchemical thinking as it identified the mineral water with the extracted 'salt', conceived as the 'essence' of the water, produced by evaporation. The Carlsbad salt dispute highlights the complex interactions among the different networks in which knowledge circulated through the Habsburg Empire in the eighteenth century. The different actors relied on specific networks with different logics of discourse and different modes of circulation. In each case the relation between the local, the regional and the imperial had to be negotiated. The paper thus sketches out the different geographies of knowledge in the Habsburg Empire but also its localization in and around Carlsbad.

[Galen and medioeval translations: the De purgantium medicamentorum facultate]. / Galeno e le traduzioni medievali: il De purgantium medicamentorum facultate.

The De purgantium medicamentorum facultate is a short pharmacological polemic work, written by Galen against the Asclepiades' and Erasitratus' thought about a supposed attractive power of evacuating pharmaka. The work is an important contribution to the defence of Hippocratic humoralism. The article deals with a Latin translation of the Galenic text from Greek, earlier dating than Niccolò da Reggio's ones, examining the autenticity and dating, the Greek and Latin translation, the Greek texts and its medioeval tradition.

[Spanish purgatives waters "made in France"]. / Les eaux minérales naturelles purgatives espagnoles "made in France".

Before the First world War, many french societies exploited spanish purgatives watters. The watter was drawn in Spain, but it was bottled in France for many reasons. The authors of this article explain the beginnings of exploitation of three of the most famous purgatives watters: Rubinat source Llorach, Carabaña and Villacabras.

Review article: the history of acute infectious diarrhoea management--from poorly focused empiricism to fluid therapy and modern pharmacotherapy.

BACKGROUND: Acute diarrhoea management has progressed from largely ineffective measures in the early years to a more effective physiologic approach in recent years. AIM: To review the history of acute diarrhoea management. METHODS: Citations in PubMed were reviewed on 'acute diarrhoea treatment' along with an extensive file maintained by the corresponding author. RESULTS: Freedom from diarrhoea was equated in early military conflicts with bravery and strength where diarrhoea-free soldiers had the 'guts' to fight. Until early 20th century, colonic irrigants, purgatives and emetic drugs were used to help eliminate undesired intestinal contents. Only a few early authorities suggested the need for replacement of fluids and salt, now standard treatment. Drugs aimed at diarrhoea symptom control have been broadly used for more than 100 years. The evolving history of one of those drugs, kaopectate is unappreciated. Once understanding the pathophysiology and infectious aetiology of acute diarrhoea, new oral fluids, pharmacologic agents designed to block specific secretory alterations and anti-infective drugs have been identified. CONCLUSIONS: Physiologic and antimicrobial approaches to controlling diarrhoea can lead to reduction of stool number and enteric complaints, important in industrialized areas, with the potential for decreasing threat of fatal illness among infants in developing regions.

[An apothecary apprentice crosses his tracks--about Ibsen's prescriptions]. / En apotekerlaerling krysser sitt spor--om Ibsens medisinbestillinger.

As a youngster, Henrik Ibsen (1828-1906) worked as an apothecary apprentice for six years at the apothecary in Grimstad. Here, he learnt apothecary Latin, which he later on used in his literary works. Also in his own life, he used this knowledge during his last years of life when he prescribed drugs for himself. Ibsen's last six years were characterized by disease. The National Library in Oslo has three prescriptions in which the poet prescribes two different kinds of drugs, even though they should have been prescribed by a medical doctor. One of the drugs was iodide of sodium, a well-known drug for arteriosclerosis at that time. The other drug was a laxative called Brandt's Schweizer pills. Iodide of sodium was a relatively new drug introduced to the market at the end of the 19th century. Even though there was uncertainty about the effect and mode of action, it had become an established part of medical practice. That was not the case for Brandt's Schweizer pills. They were produced by the German apothecary Richard Brandt (1828-1903) in 1877. Medical doctors warned against using them. It was a so-called arcanum, i.e. the producer kept the content secret. The use of such drugs came out of control in the 1890ies and was a serious community problem.

Did some 18th and 19th century treatments for mental disorders act on the brain?

Review of 18th and 19th century psychiatric therapies raises the possibility that several may have altered the activity of vasopressin or Na-K-ATPase. Bleeding, whirling, nausea created by medicines, and vagus nerve stimulation by application of electricity through the skin all perturb the hypothalamic hormone, arginine vasopressin, while helleborus and digitalis inhibit the sodium pump enzyme, Na-K-ATPase. These approaches were used with reported benefit many years ago, acting on the brain in ways ongoing research suggests may play a role in affective disorders. Study of long-abandoned treatments may clarify their mechanisms of action and the characteristics of responsive patients.

[The miraculous effects of taking laxatives. Success and failure of pre-modern medical treatment from the patients' perspective]. / Die wundersame Heilkraft von Abführmitteln. Erfolg und Scheitern vormoderner krankheitsbehandlung aus der patientensicht.

The massive use of laxatives, emetics and blood-letting in pre-modern medicine has often intrigued historians. Why did generations of prominent and often quite empirically minded physicians resort to methods which, in hindsight, were usually much more likely to do harm than good? And why did the patients not rebel?Based on patients' personal documents and, in particular, on the letter consultations many of them wrote ot renowned early modern physicians, this essay traces, how the sick and their relatives experienced and responded to this kind of treatment. These sources provide ample evidence, first of al, that early modern lay-men not only accepted evacuative treatment with laxatives and the like but often explicitly demanded it. To them these methods seemed plausible and indispensable in the light of their notions of disease causation. For diseases were generally though to result no so much from an imbalance of humours or qualities (as is often believed) but from a specific, impure, morbific matter which had to be expelled. And patients frequently felt better or even totally cured immediately after taking a drastic laxative. In hindsight, we may attribute this to a placebo effect or the self-limiting nature of most disease episodes. But in the patients' experience the efficacy of evacuative treatment was thus constantly reconfirmed. Indeed, the very physical perception of curative effects was already shaped by their deeply embodied belief in the predominantly humoural nature of human physiology and pathology, increasing the likelihood of placebo effects from treatment that occasioned a marked, clearing visible evacuation. Therapeutic failure, on the other hand, was a common experience, too, but it could easily be explained on a case to the case basis, as a result of divine will or, more commonly, of the physician's incompetence. Presumably he had not chose the right evacuative treatment or drug, which was adequate in the specific case and another physician with a slightly different approach might well have more luck. The beneficial effects of evacuative treatment as such, however, were not called into question. Treatment with laxatives, emetics and blood-letting thus became obsolete very gradually only, in the nineteenth century, when new, more solidistic body concepts started to prevail also among the population.

The power to terrify: eclampsia in 19th-century American practice.

Throughout the 19th century, eclampsia was among the most dreaded complications of pregnancy. Conflicts arose over proposed etiologies and therapeutic modalities. Bloodletting and other harsh therapies reflected the prevailing humoral, neurovascular, and toxicologic theories. The role of untrained and professional nurses in the lying-in room of an eclamptic woman emerges from the literature of the time. An appreciation of the history of eclampsia provides context for the modern obstetric nurse.