Speaker 1: Hey, welcome to Stuff to Blow Your Mind. My name
Speaker 1: is Robert Lamb.
Speaker 2: And I am Joe McCormick, and it's Saturday. Going into
Speaker 2: the Old Vault for an episode of the show from
Speaker 2: last year. This one originally published March twenty first, twenty
Speaker 2: twenty three, and it's part three of our series called
Speaker 2: The Washing of the Waters.
Speaker 1: Enjoy Welcome to Stuff to Blow Your Mind, production of iHeartRadio. Hey,
Speaker 1: welcome to Stuff to Blow your Mind. My name is
Speaker 1: Robert Lamb.
Speaker 2: And I'm Joe McCormick, and we're back with part three
Speaker 2: of our series on the Healing Waters, where we have
Speaker 2: been focusing on beliefs held by many people throughout history
Speaker 2: that you could heal various diseases by bathing, by either
Speaker 2: immersing yourself in the waters of say warm or hot
Speaker 2: mineral spring, or sometimes maybe by drinking those waters. Also,
Speaker 2: we talked about the medicinal theories on which some of
Speaker 2: these practices were based, especially in the ancient world, such
Speaker 2: as the ancient Greek and Roman beliefs in humoral theory. Also,
Speaker 2: in the last episode we talked there was a very
Speaker 2: interesting digression you had rob about supposed healing springs that
Speaker 2: have creatures living in them, such as little blood worms
Speaker 2: or fish trapped in the hot waters.
Speaker 1: Yeah, as luck would have it. Here in Atlanta, we
Speaker 1: have a science festival here as well, the Atlanta Science Festival,
Speaker 1: And a very cold morning over the weekend, my family
Speaker 1: went to a talk on carnivorous plants, about some of
Speaker 1: the various carnivorous plants that are found internally in the
Speaker 1: southeastern United States. And at the end of it, the
Speaker 1: children present got to feed the carnivorous plants and they
Speaker 1: were feeding them bloodworms. So wow, it comes around. I
Speaker 1: was like, yeah, I know these guys. I was just
Speaker 1: talking about these guys. These would be, of course, the
Speaker 1: larval forms of the little flies, rather than the proper
Speaker 1: worms that we also discussed.
Speaker 2: But there was no eye squirting, no squirting of the
Speaker 2: worms in the eyes.
Speaker 1: Now, nobody was putting these in their eyeballs.
Speaker 2: Good good, Well, today I wanted to take a look
Speaker 2: actually at the paper that first got me interested in
Speaker 2: this subject, in the subject of beliefs about the healing
Speaker 2: powers of balneotherapy or immersion in the water. And this
Speaker 2: is a medical history paper concerning the spa at Bath Bath,
Speaker 2: a location in southwest England in Somerset that has been
Speaker 2: used as a spa going way back back back into
Speaker 2: at least as far back as Roman times when it
Speaker 2: was the spa of Minerva Sulas. Remember in the previous
Speaker 2: episode we talked about how often these these spa facilities
Speaker 2: built out by the Romans would kind of be under
Speaker 2: the heading of a sort of composite god made of
Speaker 2: like a Roman god like Minerve, and then the local
Speaker 2: deity in this case it would be some kind of
Speaker 2: Celtic goddess named Sulus. So these are merged together. Minervasulus
Speaker 2: rules over the waters of Bath, And yeah, going way back,
Speaker 2: people thought that various illnesses could be healed there. I
Speaker 2: wanted to talk about a paper making a case that
Speaker 2: maybe for one particular disease there actually is a mechanical
Speaker 2: healing property at the spring.
Speaker 1: Oh fascinating. You know, I visited Bath many years ago,
Speaker 1: like fifteen plus years ago, and I believe my wife
Speaker 1: and I went as is kind of like a day
Speaker 1: trip out of London by train and then we took
Speaker 1: one of those bus tours of the city and then
Speaker 1: walked around a bit. But it was really beautiful and
Speaker 1: I remember that you had this great layered feeling of
Speaker 1: history there, like the topography of the city, and like
Speaker 1: the physical building layers of the city revealed, like the
Speaker 1: deep time of the area. I was fascinating totally.
Speaker 2: I would love to go myself, maybe not to get
Speaker 2: in the water, but at least to have a look around.
Speaker 1: Yeah, I don't remember. I mean the tours we were on,
Speaker 1: the tours we could afford at the time. It definitely
Speaker 1: did not have any invitations to get in the water,
Speaker 1: just to like buy coffee mug at the end, that
Speaker 1: sort of thing.
Speaker 2: So the paper I want to talk about is called
Speaker 2: a Trial of the Bath Waters the Treatment of Lead
Speaker 2: Poisoning by an author named Audrey Haywood in the journal
Speaker 2: Medical History, published back in nineteen ninety and this paper
Speaker 2: concerns medical clinical research carried out at what was called
Speaker 2: the Bath General Hospital, which opened in seventeen forty one.
Speaker 2: Now at the time, one of the major missions of
Speaker 2: this hospital facility was to mount what the authors of
Speaker 2: this study called a trial of the waters, which was
Speaker 2: an attempt to record data to test and show whether
Speaker 2: the spa therapy practiced in the pools of Bath, whether
Speaker 2: therapy was actually effective against disease now, as we've talked about,
Speaker 2: people since antiquity have believed all kinds of different things
Speaker 2: that medical complaints could be cured by soaking in spas,
Speaker 2: soaking or bathing in warm mineral springs, sometimes drinking the
Speaker 2: water as well. If you haven't heard the last episode yet,
Speaker 2: you should go check that out first. We talked about
Speaker 2: plenty of examples in there. But the question is why
Speaker 2: did people think that the waters of the spas were
Speaker 2: curing their diseases. In modern times, it has been commonly
Speaker 2: assumed that this was entirely due to the placebo effect.
Speaker 2: To the placebo effect is a beneficial or healing effect
Speaker 2: caused by a treatment that has no actual direct mechanism
Speaker 2: on the condition itself, and thus, and thus the apparent
Speaker 2: healing or improvement is believed to be caused by the
Speaker 2: patient's belief that they are being treated or by their
Speaker 2: expectation of improvement.
Speaker 1: And we've talked about the cebo effect plenty of times
Speaker 1: on the show is and has a measurable effect. It
Speaker 1: is a real thing. And so if nothing else is
Speaker 1: doing anything for you, at least the blacebo effect maybe
Speaker 1: kicking in.
Speaker 2: Right, So that could be an explanation for why people
Speaker 2: maybe would go soak in the water and think, oh my,
Speaker 2: whatever got better.
Speaker 1: Now.
Speaker 2: In the ancient world, there were mechanistic theories of why
Speaker 2: the spa would cure you. One example among many is
Speaker 2: again humoral theory, the theory that, oh, your fluids are
Speaker 2: out of balance. You know, maybe you've got too much
Speaker 2: blood or too much yellow bile, not enough phlim or something,
Speaker 2: and you could deal with these imbalances by calibrating the
Speaker 2: two sort of like slider knobs on your body, and
Speaker 2: those knobs were wet and dry and hot and cold
Speaker 2: because wet, dry, hot, and cold were each correlated with
Speaker 2: one of the humors.
Speaker 3: So like, oh, I don't have it in front of
Speaker 3: me now, but I think maybe like blood was like
Speaker 3: hot and wet or something, or maybe cool and wet.
Speaker 3: I don't know anyway, So you know, if you have
Speaker 3: too much of one of those things, you adjust the
Speaker 3: hotness or coldness or dryness or wetness of the body
Speaker 3: in order to get yourself back in balance. Now we
Speaker 3: know today that this is not actually how the body works.
Speaker 3: This is an obsolete theory. It does not accurately describe
Speaker 3: where disease comes from. But having the belief in it
Speaker 3: may have led again to placebo effect. People are thinking
Speaker 3: that they've got a correct way of addressing disease, so
Speaker 3: they're at least having an expectation of improvement.
Speaker 1: Yeah, it's like I'm not doing nothing. I'm doing something.
Speaker 1: I'm following the advice or the you know, or I'm
Speaker 1: being treated by an expert in their field, and you know,
Speaker 1: it takes some of the pressure off, and it puts
Speaker 1: you in a situation where you're expecting some level of healing,
Speaker 1: You're expecting some sort of positive outcome.
Speaker 2: Hey, what explains that The common modern understanding of this
Speaker 2: historical practice, as quote the pleasurable activity of immersion in
Speaker 2: more mineral water has social and psychological benefits but no
Speaker 2: physiological vests. And this probably is true for the majority
Speaker 2: of miracle cures people think that they received at the SPA.
Speaker 2: But Haywood records that there is at least one condition
Speaker 2: where there seems to be quite strong empirical evidence that
Speaker 2: the SPA was doing something to heal the sick. Now,
Speaker 2: what was that condition? It was what was known as
Speaker 2: colica pictonum, a type of paralysis that you get from
Speaker 2: chronic lead poisoning.
Speaker 1: Hmmm. We've talked about lead poisoning on the show before,
Speaker 1: so that certainly has been a widespread problem in the past.
Speaker 2: We talked about lead poisoning, I think most recently, most
Speaker 2: extensively in an episode called Cupid's Lead and Arrow from
Speaker 2: a few years back that was about Oh, I don't
Speaker 2: even remember what all we got into in that. That
Speaker 2: was one where we did have a digression about lead
Speaker 2: acetate or sugar of lead, known in Roman times for
Speaker 2: its sweet taste. Yeah, you don't want to eat that.
Speaker 2: But Kalica pi tonem paralysis you get from chronic lead
Speaker 2: poisoning has characteristic symptoms. So it starts with what Heywood
Speaker 2: calls abdominal colic, basically meaning abdominal pain, so what a
Speaker 2: lot of people might call stomach pain, but actually your
Speaker 2: stomach is higher up in your torso you pain around
Speaker 2: the guts, the intestines, and then also constipation, the inability
Speaker 2: to move the bowels, and then eventually after that loss
Speaker 2: of ability to control the limbs, but not always with
Speaker 2: concurrent loss of sensation, so sometimes you can feel the limbs,
Speaker 2: but you can't move them or can't move them correctly. Now,
Speaker 2: the interesting thing about Bath is that Heywood writes, because
Speaker 2: symptoms were very well documented when patients were admitted to
Speaker 2: the Bath General Hospital, we are able to look back
Speaker 2: at patients who showed up with this particular condition and
Speaker 2: then keep track through the records of whether or not
Speaker 2: they were cured, which could be measured according to local standards.
Speaker 2: Was supposed to be measured rigorously by documented outcomes like
Speaker 2: full recovery of limb function. Haywood writes that by analyzing
Speaker 2: the records at this hospital, we can see that from
Speaker 2: seventeen sixty to eighteen seventy nine, a span of almost
Speaker 2: one hundred and twenty years, three three hundred and seventy
Speaker 2: seven patients presented at Bath with paralysis from lead poisoning,
Speaker 2: and forty five point four percent of those patients were
Speaker 2: documented as cured fully cured, and then a further percentage
Speaker 2: of them were documented as having shown some improvement. Now,
Speaker 2: it would be much more helpful to evaluate this in
Speaker 2: the context of control groups, right. It would be great
Speaker 2: if we had control groups that received no treatment or
Speaker 2: received a placebo, so we could see is this actually better?
Speaker 2: But there are some reasons for thinking that this recovery
Speaker 2: rate is above chance or placebo levels for the same condition,
Speaker 2: and we'll talk about those later. So Heywood quotes some
Speaker 2: seventeenth and eighteenth century physicians on this condition, colicapictonum, to
Speaker 2: see what they knew about it. There is a doctor
Speaker 2: Rice Charlton. Actually it looks like his name could be
Speaker 2: pronounced Charlatan. I don't know if there's any connection there,
Speaker 2: but he's describing colicapictonum in the second edition of a
Speaker 2: book called Three Tracts on Bathwater that's bath with the
Speaker 2: capital B from seventeen seventy four, and Charlatan writes, quote,
Speaker 2: in consequence of a most obstinate costiveness. Costiveness means constipation
Speaker 2: obstinate costiveness attended with exquisite pain in the bowels. Upon
Speaker 2: the constipation being removed and the pain diminished, the patient
Speaker 2: loses the use of his limbs, the arms, and hands.
Speaker 2: Most commonly, rheumatic pains sometimes attack the limbs before they
Speaker 2: become paralytic. Lead we know is remarkably productive of this complaint. Now,
Speaker 2: outbreaks of symptoms like this had been common in Europe
Speaker 2: for centuries, in fact, going way back, going back to
Speaker 2: Roman times, but for the longest time there was no
Speaker 2: agreement about the cause, so somebody might get that, you know,
Speaker 2: you could recognize what this pattern of symptoms were. It's like, oh,
Speaker 2: you've got the thing where you have abdominal pain, your
Speaker 2: gut's really hurt, and then you can't poop, and then
Speaker 2: your wrist fails and you can't use your arms. Candidates
Speaker 2: for the explanation included unresolved fevers. Just quoting here from
Speaker 2: the paper, over indulgence in acid wines. I don't know
Speaker 2: how much people do they want to indulge in acid wines,
Speaker 2: Like your wine is spoiled, but you really just want
Speaker 2: to get in there.
Speaker 1: I mean, sometimes that's all you have around. I guess,
Speaker 1: I guess that's true.
Speaker 2: No accounting for taste, and other explanations were quote high
Speaker 2: living and passions of the mind.
Speaker 1: So very broad categories, especially on those last two.
Speaker 2: Yes, But actually in the eighteenth century the real cause
Speaker 2: was identified. In seventeen sixty eight, the British physician Sir
Speaker 2: George Baker correctly traced the origin of a particular epidemic
Speaker 2: of colicapictonum. This epidemic was called the Devonshire colic to
Speaker 2: lead poisoning, specifically caused by the widespread consumption of cider
Speaker 2: tainted with lead. He traced it back to where it
Speaker 2: came from and found out, yes, it's from this cider
Speaker 2: that's got all this lead. And when the lead was
Speaker 2: removed from the cider, the outbreak of colicapictonum was alleviated.
Speaker 2: But unfortunately cider was not the only place you could
Speaker 2: get lead. In the eighteenth and nineteenth century, people had
Speaker 2: a vast range of options to explore that would end
Speaker 2: up causing over exposure to lead. There was use of
Speaker 2: lead hardware in the preparation, storage, and transport of food
Speaker 2: and drink. And this is everything from lead pipes and
Speaker 2: lead sinks to lead cooking pots, lead glazed earthenware, pewter plates,
Speaker 2: et cetera. There were lead based cosmetics. There was lead
Speaker 2: as a direct, intentional additive to food and drink, maybe
Speaker 2: as a color rent like food coloring, or as a
Speaker 2: flavor agent. It lead can in some forms taste sweet
Speaker 2: or as a preservative and more on this in a second.
Speaker 2: And then there were also lead salts that were used
Speaker 2: as medicine. In less severe cases, lead poisoning would cause
Speaker 2: a sort of like precursor series of symptoms. So lower
Speaker 2: levels of lead poisoning would cause fatigue, weakness, headaches, and
Speaker 2: what's described as a general malay is just kind of
Speaker 2: a bad feeling of ill health and discomfort that you
Speaker 2: can't really locate the cause of. And while lots of
Speaker 2: people were dealing with minor chronic ill health from these
Speaker 2: baseline levels of lead exposure, some people got even more
Speaker 2: vicious doses of lead, often from occupational exposure, so you
Speaker 2: might see refer to colica pictonum referred to as painters palsy.
Speaker 2: People who were dealing with lead based paints a lot
Speaker 2: in their line of work would have higher levels of
Speaker 2: exposure than everybody else, and then they might end up
Speaker 2: with this form of para. But not just that, there
Speaker 2: was all kinds of manufacturing that involved lead at the time.
Speaker 2: Another major source of high exposure to lead came from
Speaker 2: lead adulterated alcoholic beverages. Again coming back to the example
Speaker 2: of the devonsri colic being based in cider, Heywood writes, quote,
Speaker 2: lead is soluble in such weak acids as the acetic
Speaker 2: acid that's the acid that's in vinegar, formed when alcohol
Speaker 2: is exposed to the air. So alcohol might easily become contaminated.
Speaker 2: This contamination may occur incidentally during distillation when lead is
Speaker 2: leached out of the soldered joints or base metal condensers,
Speaker 2: or accidentally if sour cider or apple must comes into
Speaker 2: contact with the lead, which was often used to repair
Speaker 2: cracks in the cider press. Adulteration could also occur if
Speaker 2: the cider was stored in lead glazed earthenware containers. Poor
Speaker 2: or acid wines were sometimes adulterated deliberately in the Roman
Speaker 2: tradition of using lead acetate as a sweetener improver or fungicide.
Speaker 2: Reading this makes me feel so grateful for modern food
Speaker 2: safety standards and regulations. Oh absolutely, it's just unbelievable reading
Speaker 2: like what went into I don't know, Yeah, but this
Speaker 2: paragraph here from hey what also makes me think of
Speaker 2: the fact that before the real cause was known, some
Speaker 2: people accused those who had this paralysis of indulging in
Speaker 2: quote acid wines. It's like, oh, it's because you drank
Speaker 2: acidic wine that you have the paralyzing colic. Those people
Speaker 2: actually were probably detecting a real correlation but misunderstanding the cause.
Speaker 2: It wasn't the acidic wine but a heavy metal that,
Speaker 2: for a couple of different reasons, is more likely to
Speaker 2: end up in sour wines. It might be added intentionally
Speaker 2: to counteract the sourness, or because the acetic acid basically
Speaker 2: the vinegar that forms in a sour wine was a
Speaker 2: solvent four lead that might come from anything the storage
Speaker 2: containers or the manufacturing equipment.
Speaker 1: Okay, it makes sense.
Speaker 2: So people who got more severe lead exposure, whatever the source,
Speaker 2: whether that's from maybe occupational exposure if you're a painter
Speaker 2: working in one of these factories, or from drinking alcoholic
Speaker 2: beverages adulterated with lead. People with these types of exposure
Speaker 2: could end up not just with the fatigue, the headaches,
Speaker 2: and the malaise, but could end up paralyzed with the
Speaker 2: colica pictonum. And then of course, if the disease progressed
Speaker 2: beyond that, it could lead to convulsions, coma, and death.
Speaker 2: And so that's the background. This brings us back to
Speaker 2: bath the spa. Though bath had been used as a
Speaker 2: medicinal spa since at least as far back as Roman Britain.
Speaker 2: According to Haywood, the first documentation of spa therapy being
Speaker 2: used to treat what sounds like chronic lead poisoning comes
Speaker 2: in a book from fifteen sixty eight by an English doctor,
Speaker 2: William Turner, with a title that really lets you know
Speaker 2: what the book is all about. So it's called a
Speaker 2: book of the natures and properties as well as of
Speaker 2: the baths in England, as of other baths in Germany
Speaker 2: and Italy. Very necessary for all these persons that cannot
Speaker 2: be healed without the help of natural baths. Very mid
Speaker 2: sixteenth century book title. So in this mid sixteenth century
Speaker 2: book with a paragraph for a title, Turner chronicled a
Speaker 2: long list of conditions that he said were allegedly cured
Speaker 2: by spa treatment after having surveyed of the use of
Speaker 2: public baths in Germany and Italy. And these conditions included
Speaker 2: quote bruising that cometh by falling or beating, for green
Speaker 2: or new wounds, and for quote old wounds falsely healed.
Speaker 2: But also he said, you know, there's a convergence of
Speaker 2: symptoms that can be healed in these things, and it
Speaker 2: kind of sounds like colica pictonum. I have to say
Speaker 2: the following sentence from Turner is my new all time
Speaker 2: favorite description of constipation. You've never heard constipation in terms
Speaker 2: so evocative. So this is what Turner calls it. He says,
Speaker 2: the vain appetite of going to stool when a man
Speaker 2: can do nothing when he cometh there, the hardness and
Speaker 2: binding of the belly when as a man cannot go
Speaker 2: to the stool without capital p physics. I'm sorry. I
Speaker 2: don't mean to laugh at lead poisoning, which is no
Speaker 2: laughing matter.
Speaker 1: But that that is good. This sounds like upper class
Speaker 1: constipation to me.
Speaker 2: The vain appetite of going to the stool it imagined.
Speaker 2: It makes me think of like the the koles Shov effect,
Speaker 2: Like you're showing that actor just gazing at the toilet
Speaker 2: and you're imagining all of the like wheels turning in
Speaker 2: his head as he yearns.
Speaker 1: Yeah, well he needs the physics.
Speaker 2: I should have looked it up. I don't know what
Speaker 2: that word physics refers to. Does that mean like the
Speaker 2: intervention of physicians or maybe some kinds like pergetive medicine.
Speaker 1: That's what I take it to mean, like you need
Speaker 1: the medical enterprise to intervene.
Speaker 2: Okay, so that's the first part of Turner's description, but
Speaker 2: the text also refers to paralysis of the body and
Speaker 2: abdominal pain, as well as other symptoms that can be
Speaker 2: caused by chronic lead poisonings, such as infertility, spontaneous abortion
Speaker 2: and pregnancy, and even gout. So it's possible that Turner
Speaker 2: is not correct about SPA therapy healing these conditions, but
Speaker 2: it is interesting that he lists a large number of
Speaker 2: symptoms all associated with lead toxicity as among the things
Speaker 2: that can be cured by these spas. So by the
Speaker 2: early fifteen hundred's bath already had a reputation as a
Speaker 2: place that could cure paralysis, and one of the iconic
Speaker 2: images associated with this place and its healing powers was
Speaker 2: a big collection of discarded crutches. But it was noticed
Speaker 2: by physicians even as far back as the sixteenth century
Speaker 2: that there was one particular type of paralysis which the
Speaker 2: waters were better at curing than other types of paralysis,
Speaker 2: and this was what they called palsy after the colic. Again,
Speaker 2: this seems to be referring to the exact same pattern
Speaker 2: of symptoms. It's colic of pictonum. You have severe abdominal pain, constipation,
Speaker 2: followed by weakness and paralysis of the limbs. Just one
Speaker 2: early case study. This is from a report written in
Speaker 2: the early eighteenth century by one doctor Robert Pierce. He
Speaker 2: published accounts of his career in medicine in his memoirs,
Speaker 2: and he wrote of one typical account. He says a
Speaker 2: guy named a reverend mister Pilkington came to him from
Speaker 2: Lincolnshire in sixteen sixty six, and Pierce described this man's
Speaker 2: arms as quote hanging like flails, and said he was
Speaker 2: unable to dress himself or eat on his own. He writes, quote,
Speaker 2: although he was a clergyman, the disease had made a
Speaker 2: quaker of him.
Speaker 1: Oh, I don't know.
Speaker 2: But after he bathed and drunk the water at bath
Speaker 2: for six to seven weeks, he finally regained control of
Speaker 2: his limbs, apparently including the ability to doff his hat
Speaker 2: in greeting, which, based on this writing, seems like was
Speaker 2: considered very important, but at least by this man Pilkington,
Speaker 2: and a bunch of sources from the eighteenth century report
Speaker 2: specific patients who saw improvement at bath. It was people
Speaker 2: with paralysis who happened to be employed as color grinders, pewterers,
Speaker 2: and chemists, all people who would have had exposure to
Speaker 2: lead through their jobs. So it really seems like a
Speaker 2: convergence is happening here, we're seeing a consistent pattern emerging
Speaker 2: in the records of who is getting healed at bath.
Speaker 2: It might be worth noting what was standard treatment at
Speaker 2: the time for people with colic of pictonem other than
Speaker 2: going to bath. Well, sometimes when it was just the
Speaker 2: colic and constipation stage, so just the abdominal pain and
Speaker 2: constant pay, they would prescribe purges and emetics, so these
Speaker 2: would be drugs to help induce stefecation and to induce vomiting.
Speaker 2: Sometimes opiates would be given for pain for paralysis. Additional
Speaker 2: treatments could include confinement to a bland diet and in
Speaker 2: cases after the actual cause was known, removal of the
Speaker 2: person from the lead source. That seems pretty important. So
Speaker 2: what was the treatment at bath? How would that be different? Well,
Speaker 2: this treatment involved bathing in the water, so you would
Speaker 2: immerse yourself up to the neck anywhere between thirty minutes
Speaker 2: and several hours, and this would usually be done starting
Speaker 2: in the morning, with people either standing or sitting on
Speaker 2: stone benches or seats in the water up to their necks.
Speaker 2: Starting in the Tudor period, the water was changed once
Speaker 2: a day, so they would remove the water after the
Speaker 2: baths closed around noon, and then it would take about
Speaker 2: nine hours for the pools to refill. Heywood notes that
Speaker 2: getting there early in the morning was popular because it
Speaker 2: meant that you got cleaner water.
Speaker 1: Just think about that. I mean, it's still kind of
Speaker 1: the deal. Right. The earlier you get to the pool,
Speaker 1: the less less time it's had to absorb certain things,
Speaker 1: it's had, less time for stuff on the bottom to
Speaker 1: get stirred up.
Speaker 2: That's a good point. Oh you're a swimmer, yeah, do
Speaker 2: you try to get there early when you can.
Speaker 1: I'm generally a morning swimmer, not for these reasons, just
Speaker 1: for scheduling reasons. But yeah, there have been times where
Speaker 1: I'm like, oh, they just closed the pool for a
Speaker 1: week and now they're reopening. Everything's nice and clean. I
Speaker 1: want to get in. I'm going to be Monday morning,
Speaker 1: first thing to get my shot at that clean, clean pool. Nice.
Speaker 2: Do you have like waterproof earbuds or something. Do you
Speaker 2: listen to music when you swim or I don't even
Speaker 2: know if that's the thing.
Speaker 1: Honestly, no, it is. I see plenty of people do it.
Speaker 1: I just I've never done it.
Speaker 2: Yeah, well they so, Heywood says in this paper that
Speaker 2: sometimes there was music or other stuff to entertain people
Speaker 2: while they were bathing. I guess if you're just supposed
Speaker 2: to sit in the warm water for three hours up
Speaker 2: to your and there's no music or anything that might
Speaker 2: get boring.
Speaker 1: Well it makes sense. And you know, I see the
Speaker 1: same thing reflected in the YMCA pool that I go to,
Speaker 1: Like there's there's often some sort of aquatic aerobics class
Speaker 1: going on, there's music playing. And I was just thinking
Speaker 1: of this when you mentioned earlier, like the social aspect
Speaker 1: of of of healing at baths and spas. That's something
Speaker 1: I think I often fail failed to think about. But yeah,
Speaker 1: that's one of the advantages of going to any kind
Speaker 1: of group exercise scenario is that, yeah, you're doing some
Speaker 1: level of physical exercise, you're being guided in that physical exercise,
Speaker 1: but then you are in the company of other people,
Speaker 1: and you're going to get at least some level of
Speaker 1: social boost.
Speaker 2: That's true, and I'm sure there was a lot of
Speaker 2: socializing going on, especially since I would guess a lot
Speaker 2: of the people bathing together. Probably you know, people came
Speaker 2: there for different reasons, but probably a lot of them
Speaker 2: had similar complaints. It sounds like and you know, you
Speaker 2: can really have a long conversation if you have like
Speaker 2: the same medical problem as somebody else. That can that
Speaker 2: can really be a bonding experience.
Speaker 1: Yeah. And there's also seems like a high probability that
Speaker 1: you would have encountered people from your industry, other color grinders,
Speaker 1: other pewterers, and other chemists, in addition to people being
Speaker 1: treated for other maladies. Of course.
Speaker 2: Exactly, so, so that's soaking in the water. What about
Speaker 2: drinking the water? So Heywood rites quote drinking the water
Speaker 2: became more acceptable after sixteen fifty when a clean supply
Speaker 2: was provided which came directly from the spring. And then,
Speaker 2: referring to that physician from earlier Pierce, Pierce claimed that
Speaker 2: quote advantage has been found by drinking it, referring to
Speaker 2: the bathwater, especially in the bilious chalicks. I think that
Speaker 2: means collis and the usual effect of them loss of limbs.
Speaker 2: Interesting again, I like singling out the people who have
Speaker 2: the colic of pictonum as the ones who benefit from
Speaker 2: drinking the water, and Heywood rights. One to two pints
Speaker 2: were consumed each morning in divided doses. The patients chose
Speaker 2: to drink much larger amounts, but this was frowned upon.
Speaker 2: This taking us back to Plenty again, who was talking
Speaker 2: about the people who get in the spring and then
Speaker 2: they just want to drink it until you can't see
Speaker 2: their jewelry anymore.
Speaker 1: The distrust of too much hydration.
Speaker 2: So Bath gained a reputation for healing throughout the second
Speaker 2: half of the seventeenth century, though at the time it
Speaker 2: had not yet been revived as a luxurious spa retreat.
Speaker 2: Haywood says that the journey there was kind of treacherous
Speaker 2: and accommodations were pretty dank. It was like, you know,
Speaker 2: it was not fancy yet. But by the eighteenth century,
Speaker 2: the physicians of Bath were convinced that the waters could
Speaker 2: cure a number of diseases, including colicapictonem that and word
Speaker 2: of these cures kind of spread around the country, attracting
Speaker 2: a lot of attention. So people were making the journey there,
Speaker 2: in some cases like royal people, but there were also
Speaker 2: some doctors from outside Bath that were skeptical, including Richard Meade,
Speaker 2: a physician to King George the Second. So well, there
Speaker 2: was impetus to put together a sort of large collection
Speaker 2: of data of like a study that would really convince
Speaker 2: people to come there for treatment. And there's a whole
Speaker 2: section of this paper that I'm not going to get
Speaker 2: into because it concerns the medical aspects less, but it
Speaker 2: is very interesting. It's about the founding of the Bath
Speaker 2: General Hospital and what some of the kind of cold,
Speaker 2: cruel economic realities of that were. That like, a lot
Speaker 2: of this may have been driven by locals around Bath
Speaker 2: wanting their businesses to benefit from people coming to the
Speaker 2: springs for medical treatment, but also them having a problem
Speaker 2: that like a lot of the people who are coming
Speaker 2: here for healing are poor, and we don't want just
Speaker 2: poor people, so we want to find a way to
Speaker 2: get the poor people out of the city and get
Speaker 2: rich people coming. So some less than savory sort of
Speaker 2: abuse of the concept of charity here, But this does
Speaker 2: lead to this large collection of data at the hospital,
Speaker 2: and Heywood notes some very interesting measures that were put
Speaker 2: in place for the evaluation of clinical results at Bath.
Speaker 2: One thing was treatment was regulated, so you're trying to
Speaker 2: make sure that patients were getting basically the same thing,
Speaker 2: they were getting treated in the same way. Also, because
Speaker 2: to quote from Haywood quote, at that time, medical practitioners
Speaker 2: were notoriously over optimistic when assessing the results of their
Speaker 2: own treatments. Because of this, they had outcomes of treatment
Speaker 2: assessed by a committee of doctors rather than only by
Speaker 2: the one doctor who had managed the case in question.
Speaker 2: So you're not getting to just like ride up the
Speaker 2: outcomes on your own patients.
Speaker 1: All right, that's good, spreading it around a little bit. Yeah.
Speaker 2: Yeah. They hoped that this would lead to quote, irrefutable
Speaker 2: proof of the efficacy of the bath waters for healing.
Speaker 2: Now I think irrefutable proof is a little over enthusiastic there,
Speaker 2: but these are good measures to put in place, certainly
Speaker 2: compared to the standards of the day. So this is
Speaker 2: not a double blind, randomized controlled trial that would really
Speaker 2: wouldn't become a standard until the twentieth century, but pretty
Speaker 2: good for the time. Another thing was that it was
Speaker 2: agreed that no patient would qualify as quote cured if
Speaker 2: they still had any trace of the original symptoms they
Speaker 2: showed up with, and they enforced pretty high standards of
Speaker 2: record keeping. Okay, so what did the treatment at bath
Speaker 2: consist of? Well, First, and very important to note, patients
Speaker 2: were extracted from their regular environment for their stay in Bath,
Speaker 2: which means they were almost certainly cut off from the
Speaker 2: original source of lead toxicity lead exposure, and this in
Speaker 2: itself is important to keep in mind because for all
Speaker 2: we know, this alone could be causing major improvements.
Speaker 1: Yeah, getting them just away from their regular everyday exposure
Speaker 1: to land.
Speaker 2: And that could be in most cases either occupational or
Speaker 2: from food and drink. And on that last note, they
Speaker 2: were given plenty of fresh food at bath and this
Speaker 2: included home brewed beer made there. The additional drinking of
Speaker 2: alcohol beyond what was provided by the hospital was forbidden,
Speaker 2: so this was another way to cut off additional lead exposure.
Speaker 2: They were often given a purging medication to treat constipation.
Speaker 2: Bathing was generally three days a week in the manner
Speaker 2: previously described. So you know, you go sit or stand
Speaker 2: in the water. You keep your head above the water line,
Speaker 2: but it goes up to your neck and then again,
Speaker 2: patients would often drink one to one and a half
Speaker 2: pints of the spring water a day, maybe divided into
Speaker 2: two different doses, and in some cases they might like
Speaker 2: sort of pump the spring water over the paralyzed limb. So, anyway,
Speaker 2: what are the results if we look back on them historically.
Speaker 2: The results are pretty interesting. By analyzing the records kept
Speaker 2: at Bath General Hospital, it seems there is a pretty
Speaker 2: good reason to think that the SPA therapy at Bath
Speaker 2: was doing something to relieve the symptoms of this disease,
Speaker 2: in particular of Colica pictonum. The paper includes a table
Speaker 2: compiling stats on patients admitted to the Bath Hospital from
Speaker 2: seventeen fifty one to seventeen fifty eight. Out of one thousand,
Speaker 2: five hundred and ninety patients total, one hundred and eight
Speaker 2: of them were admitted with symptoms indicating that they had
Speaker 2: paralysis due to lead toxicity. Those can be further broken
Speaker 2: down into paralyzed patients who had occupational exposure to lead.
Speaker 2: There were thirty seven of those including readmission, and patients
Speaker 2: with the Devonshire colic meaning paralysis that was preceded by
Speaker 2: severe abdominal pain and constipation, and there were seventy one
Speaker 2: of these including readmissions. In the cases of patients with
Speaker 2: occupational exposure, fifty nine percent were completely cured and ninety
Speaker 2: two percent were improved. In the case of patients with
Speaker 2: Devonshire colic, forty two percent were completely cured and ninety
Speaker 2: three percent were improved. Now, my initial action to this
Speaker 2: was that's interesting. But without a control group receiving no
Speaker 2: treatment or placebo treatment, or without different treatment groups to compare,
Speaker 2: how can we know it was the bathwater and the
Speaker 2: immersion that was actually leading to these cures. So what
Speaker 2: if simply maybe being away from the lead exposure on
Speaker 2: its own would produce the same rates of recovery. Well,
Speaker 2: that is possible, But the author considers that and offers
Speaker 2: some evidence based on their referral letters correlated with each
Speaker 2: patient's case in hospital records that may give us more
Speaker 2: confidence than the results. So talking about the specifically the
Speaker 2: workers who had occupational exposure to lead, most of them
Speaker 2: came from London or the region in the southeast of England,
Speaker 2: and Heywood writes, quote, fifteen had already been admitted to
Speaker 2: one of the London hospitals but had not responded to
Speaker 2: treatment there. They were referred to the Bath hospital as
Speaker 2: quote incurable treatment. In Bath, eight were cured and the
Speaker 2: other seven were said to be improved. These results support
Speaker 2: the view that the treatment in Bath had something special
Speaker 2: to offer, as in London they would also have been
Speaker 2: removed from exposure to lead and given purges emetics and
Speaker 2: a bland diet apparently to no avail. So interesting here.
Speaker 2: This still doesn't prove it, but it seems we have
Speaker 2: a kind of crude analog of a control group based
Speaker 2: in the treatment histories from these patients' referral letters. So
Speaker 2: in many cases they had already been removed from the
Speaker 2: lead and received other treatments for a long time in
Speaker 2: different hospitals and shown no improvement. So this is still
Speaker 2: not as good as a real control group for a
Speaker 2: number of reasons. For example, one I just thought of
Speaker 2: is that it's not concurrent, so like, you know, the
Speaker 2: previous treatment that they got the other hospitals happened before
Speaker 2: and then they came to Bath afterwards, So maybe the
Speaker 2: cumulative time away from lead exposure could contribute to be
Speaker 2: outcomes at Bath and so forth. But interesting results nevertheless.
Speaker 1: Yeah, Yeah, and results that would seem to some degree
Speaker 1: to point back to questions about the water, like what
Speaker 1: is it about the waters of Bath or what they're
Speaker 1: doing with the waters of Bath that may or may
Speaker 1: not be having an impact, right.
Speaker 2: That's right. So here's another thing that makes these results interesting.
Speaker 2: The Bath General Hospital records spanned many decades and they
Speaker 2: seem to indicate a consistently higher rate of cure and
Speaker 2: improvement for palsy from Colica pictonum. So again, let exposure
Speaker 2: paralysis than for other conditions such as paralysis from sources
Speaker 2: other than lead poisoning. So it's possible that, you know,
Speaker 2: maybe the Bath General Hospital doctors were using you know,
Speaker 2: they could have been doing all kinds of tricks consciously
Speaker 2: or unconsciously to make their treatments look more effective than
Speaker 2: they actually were. Maybe they were using selective admission policies
Speaker 2: to improve their outcomes, like patients to let into the
Speaker 2: study that seemed more likely to improve, or maybe they
Speaker 2: were just overly positive in assessing outcomes. But if any
Speaker 2: of that were the case, why would the numbers be
Speaker 2: so much better for patients specifically with lead poisoning than
Speaker 2: for all other conditions.
Speaker 1: Yeah, because it's the numbers that really perk one's interests here,
Speaker 1: Because if you're just talking anecdotally about like the number
Speaker 1: of abandoned crutches that they have there, it's like, oh,
Speaker 1: that's not very convincing, because there are two majorly compelling
Speaker 1: reasons that a sick person might abandon their crutch, and
Speaker 1: only one of them speaks to the effectiveness of the treatment.
Speaker 2: Yes, that's very good to point out. So again we
Speaker 2: get a little bit of extra confidence just by looking
Speaker 2: at the difference comparing the different conditions in their outcomes.
Speaker 2: So again, all this like it would not prove it
Speaker 2: to the standard of a modern randomized controlled trial, but
Speaker 2: I think there's at least a solid reason to suspect
Speaker 2: that SPA therapy at Bath did have some healing powers
Speaker 2: for people who couldn't doff their hats because of lead.
Speaker 2: And so this was the paper that initially got me
Speaker 2: interested in talking about this. And the paper finally addresses
Speaker 2: the question that might be burning in all of your minds,
Speaker 2: like if this is the case, if it was actually
Speaker 2: effective at curing paralysis from lead toxicity, how does that work? Well,
Speaker 2: Heywood's paper here speculates the first thing is the immersion.
Speaker 2: So a big component of this treatment at Bath was
Speaker 2: spending a lot of time sitting in warm, mineral spring
Speaker 2: water up to your neck, and Heywood argues that this
Speaker 2: in itself could contribute to the outcomes documented at Bath
Speaker 2: General Hospital. And to back this up, Heywood writes about
Speaker 2: how in the nineteen seventies some researchers were doing experiments
Speaker 2: for the Space program for NASA and trying to simulate
Speaker 2: the effects of microgravity, and some of these experiments involved
Speaker 2: having astronauts sit up to their necks in warm water
Speaker 2: for a long time. And Heywood points to a nephrologist
Speaker 2: to named Murray Epstein, who demonstrated in some papers something
Speaker 2: kind of interesting. When you sit around in water up
Speaker 2: to your neck, it makes you pee more. Specifically, not
Speaker 2: just pea more, but it increases the rate at which
Speaker 2: you excrete water, but not just water, also sodium and calcium. Now,
Speaker 2: why on Earth would that be. This is also not
Speaker 2: something that's one hundred percent clear, but there seems to
Speaker 2: be a reasonable explanation, Heywood offers, which has to do
Speaker 2: with water pressure. So like, if your body is sitting
Speaker 2: down below the waterline, you've got water pressing in on
Speaker 2: your skin from all directions. And when that water pressure
Speaker 2: is pressing in on your legs and your abdomen, it
Speaker 2: causes that external flesh to kind of push in some
Speaker 2: blood and interstitial fluid. More fluids are getting pressed into
Speaker 2: the body from the outside, and Heywood writes, quote this
Speaker 2: extracellular fluid moves into blood vessels in the thorax, meaning
Speaker 2: the trunk of the body, producing an increase in central
Speaker 2: blood volume of about seven hundred milli liters.
Speaker 1: Now, it's interesting that this basically comes back to the
Speaker 1: idea of purging fluids from your body, which is something
Speaker 1: that was long thought or understood to have some sort
Speaker 1: of roll in healing the sick.
Speaker 2: Right, and in many cases that might not have done anything.
Speaker 2: But I wonder if this means that in the case
Speaker 2: of lead poisoning, the purges would actually be helpful anyway.
Speaker 2: But to continue here, so Heywood writes, the consequent rise
Speaker 2: in right and left atrial pressures is the stimulus that
Speaker 2: leads to the large increases in urinary volume and sodium
Speaker 2: excretion that are observed during immersion up to the neck.
Speaker 2: This is because sensory receptors for blood volume are apparently
Speaker 2: situated in the right atrium. So this relative central hypervolemia,
Speaker 2: the condition of having extra blood volume extra fluid volume
Speaker 2: in the body deceives the body which reacts as though
Speaker 2: there had been an increase in total body fluid volume,
Speaker 2: not just a reallocation of fluid. So does that make
Speaker 2: sense that I think I'm explaining this right that the
Speaker 2: simplified version is when you immerse your body in water,
Speaker 2: the water squeezes you and essentially squeezes some of your
Speaker 2: extra body fluid into the core of your thorax. It
Speaker 2: squeezes from the outside, so the pressure in the core increases,
Speaker 2: and because the pressure in the core increases, this tricks
Speaker 2: your body's blood volume sensors into thinking the total amount
Speaker 2: of fluid in your body has increased, and thus to
Speaker 2: compensate for this, it kicks off complex chain reactions in
Speaker 2: the the renal system that lead to increased excretion of
Speaker 2: urine and of things that get excreted through urine, sodium,
Speaker 2: and in this case calcium.
Speaker 1: Okay, that makes sense, Yeah, but.
Speaker 2: Why would this have anything to do with lead poisoning. Well,
Speaker 2: Heywood notes that the human body typically tends to handle
Speaker 2: lead and calcium in a similar way. So when there's
Speaker 2: lead in your body, the body treats it kind of
Speaker 2: the same way it treats calcium. And so if this
Speaker 2: is causing increased excretion of calcium through urine, it may
Speaker 2: also be causing increased excretion of lead through urine. And
Speaker 2: in fact, Heywood was involved in experiments that were set
Speaker 2: up at the Immersion Laboratory in the Bristol Royal Infirma
Speaker 2: Infirmatory Infirmary to test this hypothesis, and they in fact
Speaker 2: did find that urinary lead excretion goes up when the
Speaker 2: body is immersed. So they tested this out on experiments
Speaker 2: with modern lead workers who were not suffering from symptoms
Speaker 2: of lead poisoning, but still had lead levels much higher
Speaker 2: than the mineral population in their blood. These workers were
Speaker 2: subjected to three hour sessions of soaking up to their
Speaker 2: necks in water that was thirty five degrees celsius or
Speaker 2: ninety five degrees fahrenheit, and the experiments found that the
Speaker 2: immersion did indeed cause them to pee out higher levels
Speaker 2: of lead than people normally do. Oh wow, okay, Heywood
Speaker 2: writes quote. The total amounts excreted during one three hour
Speaker 2: immersion period are small compared to the total body lead,
Speaker 2: which is predominantly tissue bound. Okay, so not like free
Speaker 2: in the blood, but bound up in tissues. Heywood goes on. However,
Speaker 2: if these immersions were continued to the extent described in
Speaker 2: the Bath hospital records i e. Three Times a week
Speaker 2: for twenty four weeks, an appreciable proportion of the total
Speaker 2: body lead would be removed. We can therefore suggest that
Speaker 2: this was a mechanism through which traditional bath spa therapy
Speaker 2: could have operated. So that's fascinating. Just sitting immersed in
Speaker 2: the warm water currently could help you get more lead
Speaker 2: out of the body faster than you would doing anything else.
Speaker 1: Yeah, and this of course working in congress with not
Speaker 1: having a whole bunch of lead flooding into your system
Speaker 1: through your occupation or other environmental causes exactly.
Speaker 2: So you're removed from the original exposure to lead, you'd
Speaker 2: have less lead coming in, and you're increasing the rate
Speaker 2: at which lead is going out.
Speaker 1: Okay, but there's some other amenities to factor in as
Speaker 1: well though, right.
Speaker 2: That's right. So, as I mentioned, you know, the patients
Speaker 2: at bath in addition to being removed from the source
Speaker 2: of lead and having the immersion, they also got good food,
Speaker 2: so that may have been a factor. They got gentle
Speaker 2: exercise that may have been a factor as well. So
Speaker 2: it's hard to know for sure with historical cases like this,
Speaker 2: because you know, you can't you're not running the test yourself.
Speaker 2: You can't isolate all the variables. You can only deal
Speaker 2: with the data we have from history. But in this case,
Speaker 2: I think you could totally plausibly make the argument that
Speaker 2: that the immersion was really doing something for the people
Speaker 2: with lead poisoning. It was doing something more than just
Speaker 2: getting them away from the original lead exposure. Now there
Speaker 2: was another interesting part of this, that's the immersion, which
Speaker 2: Heywood treats as probably the main explanation. But what about
Speaker 2: drinking the mineral water. Again, hopefully not two levels described
Speaker 2: by plenty where your rings disappear, but the level generally
Speaker 2: prescribed to drink was like one point five to two
Speaker 2: pints a day. And Heywood notes that water from the
Speaker 2: mineral springs of bath has elevated levels of calcium and iron,
Speaker 2: and citing a study by Mahaffe from nineteen seventy three,
Speaker 2: Heywood observes that calcium and iron deficiency actually increase the
Speaker 2: body's tendency to absorb lead, and calcium and iron deficiency
Speaker 2: increase the toxicity of lead that is already present in
Speaker 2: the body. And this has been shown to the extent
Speaker 2: that calcium and iron supplements have been suggested as partial
Speaker 2: treatment for infants with higher than average level of lead
Speaker 2: in the blood. So it's possible that the mineral water
Speaker 2: pints that patients at bath were drinking. That was helping
Speaker 2: out as well.
Speaker 1: Yeah, And I mean on top of that, if they're
Speaker 1: if you're having to if you're having to pee more
Speaker 1: because of your soakings in the warm waters, you need
Speaker 1: to be drinking more water as well, Like you need
Speaker 1: to stay hydrated, right, And this is something I saw
Speaker 1: reflected in some papers. Will probably discuss in the next
Speaker 1: episode that, like, if nothing else, staying hydrated on clean
Speaker 1: water like that alone is beneficial for the body, like
Speaker 1: because if nothing else, you don't want whatever is going
Speaker 1: on with your body to be exasperated by also having
Speaker 1: some sort of dehydration scenario going on as well.
Speaker 2: Yes, exactly. Hydration incredibly important, so that plays a role
Speaker 2: as well. Though I want to be clear this is
Speaker 2: not should not be taken as a general endorsement of
Speaker 2: drinking mineral spring water, which could have all kinds of
Speaker 2: things in it. So it seems like in these these
Speaker 2: people were probably doing all right, but you don't want
Speaker 2: to be drinking water from sources you're not sure.
Speaker 1: Or safe, right right, right, Yeah, but nothing else, like
Speaker 1: iuld say how much I wonder on a case that
Speaker 1: case basis, like how much of that person's normal liquid
Speaker 1: intake would have been confined to like beers for example,
Speaker 1: versus you know, they're still having beer. They're having good
Speaker 1: beer when they go to bath, but then they're also
Speaker 1: having a large amount of water as well in addition
Speaker 1: to that beer. So it seems like there would be
Speaker 1: a net positive there.
Speaker 2: Yeah. So I would say in conclusion, while bathing in
Speaker 2: a SPA probably does only work via placebo effect on
Speaker 2: a number of the conditions we've talked about throughout the
Speaker 2: series so far, on the conditions it was used to
Speaker 2: treat throughout history. I think this paper makes a very
Speaker 2: interesting case that when it came to paralysis from lead poisoning,
Speaker 2: SPA therapy was genuine medicine.
Speaker 1: Yeah, it's fascinating, very fascinating. All right, Well, we're going
Speaker 1: to go ahead and close out this episode on that note,
Speaker 1: but we will be back in a part four on
Speaker 1: baths immersion and also drinking of naturally occurring spring waters,
Speaker 1: thermal waters, et cetera. We still have some other important
Speaker 1: topics to discuss here, so come back for that. In
Speaker 1: the meantime, we'll just remind you that our core episodes
Speaker 1: of stuff to blow your mind publish on Tuesdays and Thursdays.
Speaker 1: On Wednesdays we do a short form artifact or monster fact.
Speaker 1: On Mondays we do listener mail, and we're already getting
Speaker 1: some great listener mail about the Bath episodes, by the way.
Speaker 1: And then on Fridays we do Weird House Cinema. That's
Speaker 1: our time to set aside most serious concerns and just
Speaker 1: talk about a strange film.
Speaker 2: Huge thanks to our audio producer JJ Posway. If you
Speaker 2: would like to get in touch with us with feedback
Speaker 2: on this episode or any other, to suggest a topic
Speaker 2: for the future, or just to say hello, you can
Speaker 2: email us at contact at stuff to blow your Mind
Speaker 2: dot com.
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