An 18th century controlled trial prompted by a potential shortage of hospital beds

Abstract

At the end of 1760, the political authorities in Geneva were preoccupied by a threatening epidemic of venereal disease. Doctors and surgeons had been alerted to this possibility having seen a few women who had contracted venereal disease after contact with a ‘mother sucker’. Mother suckers were women paid to suck the breasts of women who had recently given birth and who did not want to (or could not) breastfeed their babies. It was believed that emptying the breast was required to stop lactation and that accumulating excess milk could be deleterious for a young mother's health. Medical as well as lay people believed that health resulted from a proper balance of the body's circulating humors, and between what entered and left the body.1 The city authorities were concerned that the resources of the Geneva Hospital would become overwhelmed by the epidemic and they asked the surgeons and physicians to examine all the mother suckers, and to inform new mothers of the danger of contamination. They also directed the doctors to discuss how best to cure venereal diseases. It was widely believed that mercury cured syphilis specifically (even though the mechanism of action was unknown), but it was prescribed in different ways. All but one of the doctors supported using it in the traditional way, which involved rubbing all or some of the body with a mercurial ointment daily for about 40 days, in hospital. This was a cumbersome and stigmatizing treatment for patients, who naturally had difficulty in hiding the nature of their affliction. An alternative to this traditional treatment was the use of proprietary pills containing a combination of mercuric oxide and acetic acid, which had been marketed by a French military surgeon, Jean Keyser. Keyser pills sometimes had quite strong side effects, such as violent vomiting, but they had been used in French military hospitals, and their use was supported by several ‘persons of noble birth’. One of the surgeons at the Geneva Hospital—Daniel Guyot—had tried the pills previously and judged them successful, so he proposed that they should be used to deal with the situation in Geneva. Moreover, Guyot claimed that the rubbing method was not easy to apply and only successful if the ointment was prepared following a specific protocol, which he doubted was happening in Geneva.