The early history of the placebo

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Summary

In the late 18th century the term “placebo” became part of medical jargon. In contrast to the prevailing opinion that it was the Scottish physician and pharmacologist William Cullen (1710–1790) who introduced this expression into medical language in 1772, the credit must be given to another English physician, Alexander Sutherland (born before 1730 – died after 1773).

The main reason for administering placebos in late 18th-century medical practice was to satisfy the patient's demand and his expectations. Another reason was obstinancy of the patient: the motivation behind such prescriptions may be summarized as prescribing inert drugs for the satisfaction of the patient's mind, and not with the view of producing any direct remedial effect. In most cases these 18th century physicians did not administer “pure” placebos but resorted to any kind of medicine which they thought simple, feeble, or altogether powerless, non-perturbing medicines.

Today we make the distinction between pure placebos (substances with no pharmacological effect, e.g. sugar pills) and impure placebos (substances with pharmacological effect but not on the condition being treated). In the 18th century those physicians who prescribed placebo usually thought of drugs which were considered not very effective in the particular case, e.g. a mild ointment. At the same time, only very few brilliant minds came up with the ingenious idea of using inert substances as placebo. An alternative to milk sugar used as placebo in homeopathy was breadpills.

Recent research suggests that expectancy is an integral part of the placebo effect. As early as 1775 the English bishop John Douglas (1721–1807) anticipated the findings of modern research on the placebo effect.

Section snippets

Placebo in medical terminology

In the late 18th century the term “placebo” became part of medical jargon. In contrast to the prevailing opinion that it was the Scottish physician and pharmacologist William Cullen (1710–1790) who introduced this expression into medical language in 1772, the credit must be given to another English physician, Alexander Sutherland (born before 1730 – died after 1773) of whom we hard have any biographical information. Being a doctor in Bath, he was familiar with the latest medical fads, including

Reason for using placebo in medical practice

The main reason for administering placebos in medical practice was to satisfy the patient's demand and his expectations, as can be learned from a letter by the British surgeon William Gaitskell which was communicated by Dr John C. Lettsom in the Medical Society of London in 1789.5

Another reason was obstinancy of the patient: “I got him to swallow two drams at once, which rendered him so entirely averse to the medicine, that he would take no more afterwards. However, to his great joy and my

Prescribing sugar pills or other inert substances

Today we make the distinction between pure placebos (substances with no pharmacological effect, e.g. sugar pills) and impure placebos (substances with pharmacological effect but not on the condition being treated). In the 18th century those physicians who prescribed placebo usually thought of drugs which were considered not very effective in the particular case, e.g. a mild ointment. At the same time, only very few brilliant minds came up with the ingenious idea of using inert substances as

Explaining the placebo effect: early attempts

Recent research suggests that expectancy is an integral part of the placebo effect. Many studies have shown that certain expectation of pain relief is sufficient to reduce the experience of pain. A number of centuries ago not only physicians but also philosophers were aware of the powerful force which they defined as “imaginatio”. The French writer Michel de Montaigne (1533–1592), for example, described the stunning effect of the imagination on the human body: he mentioned a patient who

Conclusion

The remarkable thing about the placebo effect is that already in the past learned men, not only physicians, knew or had at least a premonition that this phenomenon is caused by a sense of certainty, an optimistic expectation, that a treatment will be efficacious.

Conflict of interest

None declared.

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