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Research Christmas 2012: Yesterday’s World

Placebos in 19th century medicine: a quantitative analysis of the BMJ

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8326 (Published 18 December 2012) Cite this as: BMJ 2012;345:e8326

Re: Placebos in 19th century medicine: a quantitative analysis of the BMJ

We would like to thank the authors of the article “Placebos in 19th Century Medicine: a Quantitative Analysis of the BMJ” (1) for highlighting the long history and different meanings that the term placebo has obtained in the medical literature, especially in the BMJ. There was, however, one detail in their paper that raised a question. The authors attributed the first use of the term “placebo effect” to Stuart Wolf’s article in 1950 (2). Since “placebo” has been used in the medical literature since the early 19th century, we suspected that “placebo effect” may have appeared in medical vocabulary earlier than 1950.

Medline proved to be unhelpful in this respect, but the results of a Google search showed that our suspicions were well justified. In 1900, for example, in the International Journal of Surgery (3), Pigg pondered how his “rule is to prohibit all pulling in the first stage, and dispense with chloroform entirely, unless it be a little for its placebo effect – not enough to arrest contractions”, when he discussed obstetric problems.

In turn, in The Sanitarian in 1902 (4), Oswald wrote that “there may have been a mere placebo effect about the procedure … where a victim of serpent bites was dosed with a decoction of boiled ants…” in his discussion of indigenous healing methods used among Africans.

In his Presidential Address to the Missouri State Medical Association in 1909 (5), Kiefer observed how the “confidence reposed in a family physician by his patrons is equaled only by that which mutually exists between the members of a well-bred family. It would be a safe deduction that the placebo effect of his prescriptions exceeds their actual physiological effects.”

These three examples should suffice to show that the priority of using the term placebo effect cannot be given to Wolf in 1950 (2). The exact date on which the term came into use, where, by whom, and for what reasons have not, to our knowledge, been discovered as yet. This information can be left for professional historians to uncover. What is evident, however, is that the term placebo effect was in use among physicians already in the early years of the 20th century.

References:

1. Raicek JE, Stone BH, Kaptchuk TJ. Placebos in 19th century medicine: a qualitative analysis of the BMJ. BMJ 2012;345:e8326

2. Wolf S. Effects of suggestion and conditioning on the action of chemical agents in human subjects – the pharmacology of placebos. J Clinic Invest 1950;29:100–9.

3. Pigg WB. A plea for the better study of diseases of women by the general practitioner. International Journal of Surgery 1900;13:236–8.

4. Oswald FL. Cosmopolitan health studies. The Sanitarian 1902;49:500–5.

5. Kiefer A. President’s address. Journal Missouri State Medical Association 1909;6: 1–10.

Authors:

Pekka Louhiala, Hjelt Institute, University of Helsinki, Finland, pekka.louhiala@helsinki.fi

Raimo Puustinen, Medical School, University of Tampere, Finland, raimo.puustinen@uta.fi

Competing interests: No competing interests
13 February 2013
Pekka Louhiala
University lecturer
Raimo Puustinen
Hjelt Institute, University of Helsinki, Finland
P.O.Box 41, 00014 University of Helsinki, Finland
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