PAST PRESCRIBINGBMJ 1996; 312 doi: http://dx.doi.org/10.1136/bmj.312.7034.837 (Published 30 March 1996) Cite this as: BMJ 1996;312:837
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An 18th century medical student worries about placebos
James Beattie, the poet (1735-1803), was professor of moral philosophy at Marischal College, Aberdeen, for the last four decades of the 18th century. He was much loved by his students, who often sought his advice. One of them, Thomas Christie, who had gone to London as a medical student, sent this moral condundrum to Beattie on 31 January 1786:
”I shall mention to you an opinion delivered to us in the class of Dr Osborne, of which, as it relates to Morals, I should be glad to know your sentiments. He said that in many cases, wherein he knew that no medicine could avail, he nevertheless prescribed a medicine, and that he made it a rule, and recommended it to us, that whenever a Physician is called, he should prescribe something. I do not mean, adds he, that you are to overload the patient's stomach with useless drugs, but you ought to order some simple remedy, something that will do no harm if it does no good. For
”(1) Your Patient expects something of you, and your refusing to give him any thing will damp his expectations, and perhaps give him a desponding view of his case, and these circumstances may often give a fatal turn to the distemper.
”(2) If you prescribe something, however simple, it will have a tendency to revive your patient's spirits, and give him fresh hopes, and it is needless for me to inform you how much the power of the imagination will do in any disease.
”(3) If you prescribe nothing, it is ten to one that your Patient will be dissatisfied with your advice, and entertain doubts of your skill. Perhaps before you have crossed the street, another Physician will be sent for, who will dose the patients with loads of trash, and do more harm in an hour than your scrupulous honesty will do good in a year.
”I confess Dr Osborne's assertion surprised me at first, and I thought it came near to the Jesuitic System. But his arguments are strong, and deserve to be weighed. And there is another thing that occurs to me to strengthen them. In almost all diseases of the body, the mind sympathises … and hence pious frauds, intolerable in Theology, are allowable in Medicine.” (From a letter in the Beattie collection, Aberdeen University Library Department of Special Collections and Archives, manuscript 30/2/497).
Beattie's comments are not available. Christie was subsequently superintendent of hospitals in Ceylon.
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