Trick or Treatment Read Online Free PDF Page A

procedures. On 5 March 1795 the Board and the Admiralty agreed that sailors’ lives would be saved if they were issued a daily ration of just three-quarters of an ounce of lemon juice. Lind had died just one year earlier, but his mission to rid British ships of scurvy had been ably completed by Blane.
    The British had been tardy in adopting lemon therapy, as almost half a century had passed since Lind’s groundbreaking trial, but many other nations were even tardier. This gave Britain a huge advantage in terms of colonizing distant lands and winning sea battles with its European neighbours. For example, prior to the Battle of Trafalgar in 1805, Napoleon had planned to invade Britain, but he was prevented from doing so by a British naval blockade that trapped his ships in their home ports for several months. Bottling up the French fleet was possible only because the British ships supplied their crews with fruit, which meant that they did not have to interrupt their tour of duty to bring on board new healthy sailors to replace those that would have been dying from scurvy. Indeeed, it is no exaggeration to say that Lind’s invention of the clinical trial and Blane’s consequent promotion of lemons to treat scurvy saved the nation, because Napoleon’s army was much stronger than its British counterpart, so a failed blockade would probably have resulted in a successful French invasion.
    The fate of a nation is of major historic importance, yet the application of the clinical trial would have even greater significance in the centuries ahead. Medical researchers would go on to use clinical trials routinely to decide which treatments worked and which were ineffective. In turn, this would allow doctors to save hundreds of millions of lives around the world because they would be able to cure diseases by confidently relying on proven medicines, rather than mistakenly advocating quack remedies.
    Bloodletting, because of its central role in medicine, was one of the first treatments to be submitted to testing via the controlled clinical trial. In 1809, just a decade after Washington had undergone bloodletting on his deathbed, a Scottish military surgeon called Alexander Hamilton set out to determine whether or not it was advisable to bleed patients. Ideally, his clinical trial would have examined the impact of bloodletting on a single disease or symptom, such as gonorrhoea or fever, because the results tend to be clearer if a trial is focused on one treatment for one ailment. However, the trial took place while Hamilton was serving in the Peninsular War in Portugal, where battlefield conditions did not afford him the luxury of conducting an ideal trial – instead, he examined the impact of bloodletting on a broad range of conditions. To be fair to Hamilton, this was not such an unreasonable design for his trial, because at the time bloodletting was touted as a panacea – if physicians believed that bloodletting could cure every disease, then it could be argued that the trial should include patients with every disease.
    Hamilton began his trial by dividing a sample of 366 soldiers with a variety of medical problems into three groups. The first two groups were treated by himself and a colleague (Mr Anderson) without resorting to bloodletting, whereas the third group was treated by an unnamed doctor who administered the usual treatment of employing a lancet to bleed his patients. The results of the trial were clear:
    It had been so arranged, that this number was admitted, alternately, in such a manner that each of us had one third of the whole. The sick were indiscriminately received, and were attended as nearly as possible with the same care and accommodated with the same comforts…Neither Mr Anderson nor I ever once employed the lancet. He lost two, I four cases; whilst out of the other third thirty-five patients died.’
     
    The death rate for patients treated with bloodletting was ten times greater than for those patients who