Were Irish ‘Sweating houses’ used to treat Arthritis?

I’m not much of a student of history, but I’m intrigued by glimpses into the way medicine was practised a few centuries ago. I guess there would be a few people who would be amused to hear that physicians in Ireland were widely known as ‘leeches‘ – presumably because of their expertise in the ancient Galenic practice of blood letting rather than their avaricious nature! The ancient physician went about on horseback carrying around a ‘fer bolg’ or medicine bag, full of herbal remedies.

Among the few remaining physical traces of the physician’s work are the stone ‘sweating houses’ known in Gaelic as Tigh ‘n alluis [Teenollish]. These small one-man huts were built with small entrance portals that people would have had to crawl through. They were dotted around Ireland, often in quite remote rural areas. Quite a few of them are still to be found in remote fields, but I don’t think any have been used for quite some time!

imageA fire would be lit in the hearth inside the sweating house  – using a cart-load of turf – and allowed to burn out leaving the stones hot for the sweating session the following day.

 

A great fire of turf was kindled inside till the house became heated like an oven; after which the embers were swept out; and vapour was produced by throwing water on the hot stones. Then the person, wrapping himself in a blanket, crept in and sat on a bench of sods, after which the door was closed up. He remained there an hour or so till he was in a profuse sweat; and then creeping out, plunge right into the cold water, after emerging from which he was well rubbed till he became warm. After several baths at intervals of some days he usually got cured of Rheumatism

So apparently this sort of treatment was prescribed for people with rheumatism. Sadly we don’t know if there was a secret therapeutic ingredient (although there has been plenty of speculation). I can’t imagine that many of my patients would agree to trudge up the hill, undress and crawl through a tiny entrance into a very rough sauna before struggling out and jumping in the local pond! My ancestors were clearly made of hardy stuff!

sauna_cabinI got to thinking about whether or not there had been some studies that have looked at sauna treatment for rheumatoid arthritis or AS. I know that there is a strong tradition of spa therapy (Balneotherapy) for arthritis and there may be weak evidence of benefit – but what about dry heat? A small pilot study into the potential benefits of an ‘infrared sauna’ for treating RA and AS was published in 2008 by Oosterveld et al. They used an infrared sauna cabin similar to the one pictured and found that although patients felt less pain and stiffness during the sauna, the benefits in pain and stiffness were not sustained. Of course, the study did not include the post-sauna dip into an ice cold Irish peat bog puddle – which could well have been the secret ingredient! I note, with approval, the authors’ use of stiffness as an outcome and their use of the little used EPM-ROM scale for quantifying range of movement. Sadly, there was no sustained improvement in pain or stiffness or range of movement.

So, do you think that the ancient Irish physicians were right about the benefits of the sweating house – or can you prove them wrong?

Philip Gardiner

Wannabe Irish Leech-Doctor
(in search of a sweating house and some good hungry leeches!)


Further reading: A Social History of Ancient Ireland http://www.libraryireland.com/SocialHistoryAncientIreland/II-XIV-4.php

Isomäki H (1988) The sauna and rheumatic diseases. Ann Clin
Res 20:271–275
Nurmikko T, Hietaharju A (1992) Effect of exposure to sauna heat
on neuropathic and rheumatoid pain. Pain 49:43–51

Bayer and the birth of ‘Big Pharma’

There is a growing resentment against what are seen as the excesses of modern Pharmaceutical companies of profiteering from over-charging patients and marketing direct to the patient. ‘Big Pharma’ has been brilliantly lampooned in a hilarious rap video by ZDoggMD. So where did it all begin, and is ‘Big Pharma’ completely malevolent or just capitalism working well to make the industry more efficient?

I am not an expert in the history of the pharmaceutical industry, but in my reading around the discovery and marketing of Aspirin, it seems striking that at the end of the nineteenth century Bayer revolutionized the pharmaceutical industry and sparked a series of scandals and controversies that rumble on today.

Following on from my recent post, here’s what Ackermann had to say about Bayer in her  scholarly article on the history of Aspirin. “However, despite the change in the products being manufactured, Bayer retained many of the methods used previously in the sale of dyestuffs in highly competitive markets: sales representatives, advertisements in trade journals, and the use of patents and trade names.” She quoted McTavish, a noted medical historian, who remarked:

By restricting its market to the pharmaceutical and medical professions, the chemical industry avoided the unseemly trappings of the nostrum trade and established itself as a member of the ‘ethical’ fraternity

This quotation illustrates that – according to the author – Bayer originally distinguished itself from the deceptions of that era by resisting the temptation of  selling their drugs directly to their patients. The picture below of ‘Walcott’s Instant Pain Annihilator’ was typical of drug adverts that period: dramatic and wildly optimistic claims for efficacy, with nothing at all said about the content of the potion in question (thought now to be ethyl alcohol and opium).

Advertising 1863 style
Drug Advertising '1863 style'

Ackermann also points out that Bayer used its existing business methods (sales representatives, patents, and advertisements in trade journals) to promote its new pharmaceutical products – with spectacular – and international – success. Within 4 or 5 years both Aspirin and Heroin were being widely sold across the US as well as Europe. So Bayer made pharmaceutical development more business-like and efficient. And there is also no doubt that Bayer brought together a team of highly talented scientists working together in laboratories where vigorous lab testing came before  animal and then human testing. This logical scientific approach to drug development made it possible for them to rapidly gain medical approval via the scientific journals of the day such as the BMJ and Lancet.

However, the story of subsequent scandals, patent battles and intrigues surrounding Bayer is a fascinating one, as they are perhaps the prototypical ‘Big Pharma’ company.

So, what do we want from our pharmaceutical companies in these modern times? It seems that the era of chemically creating simple and effective remedies based on old herbal cures has long passed and now painstaking scientific research into the origins of disease is needed to get new and highly targeted treatments. Most of the research by this method results in drugs that either do not work or are harmful, resulting in a high and expensive ‘dropout rate’. In addition, the manufacture of some of these new products such as the monoclonal antibodies is sometimes much more expensive. But in the case of anti-TNF monoclonal antibodies it is quite scandalous that the enormous cost of the drugs have not significantly fallen over the 13 or 14 years since they were introduced. This is in spite of the entry of a number of competitors who have all chosen to price their drugs at very similar tariffs.

We don’t want to stifle change and innovation, and we recognize that quantum leaps in therapeutics are difficult and costly to achieve. However, there is a wide recognition that Pharmaceutical companies are getting larger and more powerful in their influence both with politicians and on the lay person. Has anyone drawn up a Charter for ‘Ethical Pharma’ fit for the 21st century?

Sydenham: Granddaddy of Rheumatology?

Here’s a little quiz for all you medical historians:

  • Which physician when asked to recommend a medical textbook famously advised the enquirer to buy ‘Don Quixote’?
  • Which physician developed (and personally tested) the liquid preparation of opium better known as Laudanum?
  • Which physician was known as ‘the English Hippocrates’?
  • Which physician wrote the greatest description of a gouty attack in English Literature?

The answer to all of these questions is of course Thomas Sydenham, an English Physician who lived in the seventeenth century in an era where only the rich and famous were privileged enough to be afflicted by gout. He is my pick as the granddaddy of Rheumatology, although I suppose his own hero Hippocrates himself is the great-granddaddy (more of that for another blog). In 1683 he published one of the first texts on gout ‘Tractatus de podagra et hydrope (The Management of [Arthritis] and [Dropsy])’ and in it he shared not only the insights he had gleaned from treating patients but also those learned the painful way. For Sydenham himself had been afflicted with gout since the age of 30, and his constant pain led him to personally try (and reject) most of the proposed ‘cures’ of the time. He eventually relied upon taking Laudanum during acute attacks and barley water as prophylactic. He is quoted as saying “Of all the remedies it has pleased almighty God to give man to relieve his suffering, none is so universal and so efficacious as opium”. It is clear that Sydenham was not a great fan of rational medicine and taught others to learn by careful observation and experience.

If Sydenham were around today, I believe he would be a vigorous proponent of ‘narrative medicine’. His classic description of a gouty attack is for me unparalleled in medical literature and speaks directly from the voice of personal experience.