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Extract from FASEB J. 2007 Jul;21(9):1948-50."Taking the waters"--springs, wells, and spas. Frosch WA. Department of Psychiatry, Weill Cornell Medical College, 525 East 68th St., New York, NY 10021, USA. wafrosc@med.cornell.edu

PMID: 17592155

While the spas were supported by the recommendations of distinguished visitors, such as Charles Dickens and Thomas Carlyle, today we demand a properly designed outcome study. Such a study has been done of the waters at Bath. It has a large N, careful diagnostic grouping, a consistent treatment protocol, comparison groups, defined outcome measures, and “independent” raters. What makes it surprising is that it was designed and completed in the 18th century.

By the early 18th century, “Palsy after the Colic,” that is, paralyses following attacks of severe, gripping abdominal pain and constipation, were distinguished from paralyses the “consequence of Apoplexes, Epilepsies or Convulsions.” In 1713, the senior physician of Bath noted that this “colica pictonum” was particularly helped by the Bath waters.

Color grinders, pewterers, chemists, painters, potters, plumbers, and printers had heavy exposures to lead and were known to suffer from colic, constipation, and paralysis. It was common knowledge that Bath was the place to go if one were left with palsy after severe colic. In 1737, Bath had a new hospital to serve the “deserving poor”—it offered free care in return for participation in a “trial of the waters.” Treatments would be regulated, carefully recorded, and results published.

“[I]n this hospital every person will be under [the physician’s] government and direction in all circumstances regarding his health so that a few years will furnish more Histories of cases which may be depended on … ”

Upon discharge, the patients were examined by an independent committee of doctors who decided on the final diagnosis and actual outcome of treatment. This was recorded along with the length of stay and personal details.

Sam Ariss was a 25-year-old journeyman painter from Birmingham who had had a weakness in his hand and been unable to work since Christmas 1752. Admitted in November 1753, he was examined when discharged in April 1754 by Dr. Moysey and Mr. Palmer. Their diagnosis was colica pictonum and he was certified as cured. Three other patients discharged at the same time were diagnosed as having rheumatism, nervous weakness, and colic with fits—all were judged “no better” .

Annual reports from 1760 to 1879 consistently show high cure (45%) and improved (93%) rates for lead-related illness, but not for other illnesses. For example, in 1830 only 6% of paralyses due to deformities of the spine, 11% of other paralyses not due to lead (often following strokes) were cured, in contrast to 49% cure rate of cases due to lead poisoning.