Mesmerism has had an outsize influence on medicine, despite the rapid rise and fall of its inventor Dr. Franz Mesmer and hostility from the medical establishment. This curious story covers the healing powers of magnets, secret societies in pre-Revolutionary France, fundamental questions about what makes someone alive, and one of the most fascinating medical investigations in history led by a dream team of Benjamin Franklin, Lavoisier, and Guillotine on behalf of King Louis XVI. Plus, a #AdamAnswers about the origin of the phrase “Code Blue.”

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Sources:

• Damton R. Mesmerism and the End of the Enlightenment in France. Cambridge, MA: Harvard University Press, 1968.  
• Dyer R, Mesmerism, Ancient and Modern. Victorian Web.
• Franklin B et al, The Reports of the Royal Commission on Mesmer’s System of Animal Magnetism and other contemporary documents, James Lind Library, translated by Iml Donaldson. Retrieved online at https://www.rcpe.ac.uk/sites/default/files/files/the_royal_commission_on_animal_-_translated_by_iml_donaldson_1.pdf
• Lanska JT and Lanska DJ, Mesmer, Franz. Encyclopedia of the Neurological Sciences, 2014, pp 1106-1107.
• Lanska DJ and Lanksa JT, Franz Anton Mesmer and the Rise and Fall of Animal Magnetism: Dramatic Cures, Controversy, and Ultimately a Triumph for the Scientific Method. Brain, Mind and Medicine: Essays in Eighteenth-Century Neuroscience pp 301-320
• “Mesmerism,” Boston Med Surg J 1837; 17:185-187
• Normandin S, Visions of Vitalism: Medicine, Philosophy and the Soul in Nineteenth
  Century France, October 2005
• Shermer, M, Testing the Claims of Mesmerism: The First Scientific Investigation of the Paranormal Ever Conducted. Skeptic, retrieved online at https://www.skeptic.com/eskeptic/10-09-22/
• Sollberg, G. Vitalism and Vital Force in Life Sciences – The Demise and Life of a Scientific Conception
• Weckowicz TE and Liebel-Weckowicz HP, 7 Nineteenth Century: Vitalist-Mechanist and Psychic-Somatic Controversies. Advances in Psychology, Volume 66, 1990, Pages 109-152

Transcript

This is Adam Rodman, and you’re listening to Bedside Rounds, a monthly podcast on the weird, wonderful, and intensely human stories that have shaped modern medicine, brought to you in partnership with the American College of Physicians. If you are a member of the ACP, you can get CME/MOC points for listening to this episode by going to www.acponline.org/BedsideRounds.This episode is called “Animal Magnetism,” and it’s about the curious story of the rise and fall of Dr. Franz Mesmer. Along that way, we’re going to talk about the healing powers of magnets, secret societies in pre-Revolutionary France, fundamental questions about what makes someone alive, and one of the most fascinating medical investigations in history led by a dream team of Benjamin Franklin, Lavoisier, and Guillotine on behalf of King Louis XVI.

Anyone who listens to this show — or has dared to speak with me about medical history or philosophy in person — knows that my favorite time period in medical history is the Paris Clinical School — the generation of physicians starting roughly with the French Revolution whose work generated many of the intellectual precepts and structures that still shape modern medicine to this day. Don’t worry — I’m not going to talk about Rene Laennec again. Instead, I want to introduce you to a tableau of what happened immediately prior — medicine in the waning days of the Ancien Regime. Parisian medicine and culture of the 1780s was a heady period of new ideas in science, pseudoscience, spiritualism, and mysticism, a cauldron of new ideas that was ready to bubble over. In retrospect, this was the end of the Enlightenment, the chaos between the end of one intellectual era and the beginning of another. It was an era very different from our own — but important to understand, seeing how much it shaped our modern world. So to start this episode, I want to show you as best I can, starting in media res. We will be taking advantage of the magic of podcasting to travel back in time exactly 236 years ago to glance first hand at the most popular — and most controversial — medical treatment of the 1780s. So, listeners, please make sure you’re up-to-date on your time travel vaccination schedule — I recommend your typical Hep A and B, yellow fever, typhoid, polio, and of course, smallpox. Malaria prophylaxis is recommended, but it’s December so if you forgot your chloroquine don’t sweat it too much. Try not to talk to much to locals, since inappropriate contact might permanently alter the space-time continuum. And here we go …

So here we are, the Place Vendome, late December 1784. We’re just two blocks from the Tuileries Gardens. If you’ve been to Paris, it probably looks remarkably familiar to you in 1784. Sure, there’s no Ritz Carlton here now, but these elaborate townhouses are still a plaything for a different class of rich. If you’ll look towards the middle of the square, you’ll see the other major difference, other than, of course, the road — see that massive statue of the Sun King, Louis XIV? They don’t know it yet, but in less than a decade, it will be torn down during the Revolution. There’s a massive column honoring Napoleon’s victory at Austerlitz there now.

So we’re going to No. 16, Place Vendome. Interdimensional Google tells me there’s a jewelry store here today, but tonight, we are going to one of Dr. Mesmer’s famous treatment sessions. I’ve already paid the ten Louis fee, so we’ll be fine. Let me knock. (knocking sound effect). And this is Antoine, Dr. Mesmer’s valet. Just up the stairs now. So you’ll notice we’re in a plush salon. Heavy carpets, the windows are all covered with drapes. Astrological charts are draped on the walls. Mirrors strategically placed throughout, to magnify the magnetic energy flowing through that place. And do you hear that music? That’s Antoine on the armonica. Creepy sounding, right? I know we’re here for Mesmer, but a brief aside. The instrument was invented by Benjamin Franklin after he attended a concert by playing wine glasses filled with water. So he invented the armonica, blown and nested bowls that you run your fingers over. It was one of the most popular instruments in Europe — this piece that Antoine is playing was actually written by Mozart! But its popularity waned because of its purported propensity to drive people mad. My intradimensional 4G isn’t very good here, but when we get back, check out the shownotes where I’ve posted some videos.

Okay, okay, let’s go to why I brought you here. Towards the center of the room there’s a oval tub, about two meters in length. It’s covered, but inside is water that has been magnetized by Dr. Mesmer. In chairs surrounding it sit Paris’ finest, lords and ladies of the Ancien regime. And if you’ll look closely, you’ll see there are iron rods extending from the tub, one for each patient. You’ll see that some are gripping it in their hands, but most are holding it towards the sternum.  That’s the most effective place for the magnetic energy to flow into the body. Some of these patients come for daily treatments with Dr. Mesmer. His animal magnetism can treat pretty much any medical condition, from gout to neurasthenia. Ah, here we go — the young lady seated on the far side of the room, she’s started to slip into a mesmeric crisis. There she goes. Her arms and legs are flailing, eyes have rolled back into her head. And now Dr. Mesmer himself — the older gentleman in the white wig — has arrived. Hear his thick German accent? He rarely speaks publicly, and usually lets his intermediaries do it for him. They’re taking her to the Crisis Room in back. I hear that it’s well-padded so these patients won’t hurt themselves. But don’t worry too much about her. After this passes, she’ll feel better than ever. 

Okay, we’ve stayed here long enough, people are starting to look at us. The English probably doesn’t help too much. Other than Jefferson and Franklin, there aren’t too many Americans around these parts. I’m going to head back to the studio. Feel free to look around a bit, and I’ll see you back in 2018. And remember — try not to break the space-time continuum.

Okay dear listener, thank you for indulging me on that time travel. But I think it’s hard to explain Mesmer’s peculiar influence without seeing his treatments how his contemporaries would have. But just who was this curious man, who in the span of only a few years would go from an obscurity, to the most popular and notorious doctor in France, and then leaving the country in shame and exile?

Franz Mesmer didn’t initially stand out. The first eight years of his practice in Vienna were by and large pretty typical for the 18th century — he would assess humoral imbalances in his patients, and then do his best with bleedings, purgatives, blisters, and medications. Perhaps the only unique thing in those early years was his medical dissertation, which was about how the movement of the planets affected human health (and which modern historiography has suggested was largely plagiarized). But these were hardly unusual beliefs during this period —  and the Faculty of Medicine in Paris had a department dispatching doctors across the country to link astronomical movements to disease outbreaks. We don’t have a good sense of why Mesmer turned to animal magnetism — while his background was unremarkable, he had married into a rich and politically-connected family, and in fact had even hosted a 12 year-old Mozart in his garden. These are not the makings of a firebrand. But sometime in 1774, Mesmer had a chance encounter with Father Maximillian Hell, who gave him a heart-shaped magnet, which he had apparently used to cure a baroness with intractable abdominal pain.

Mesmer decided to give the magnet a try of one of his most difficult patients, Franzl Osterlin. She was a 28 year-old woman who Mesmer had diagnosed with hysteria. Mesmer described her difficult to treat medical condition: “Since her childhood seemed to have a very weak nervous manned, had undergone terrible convulsive attacks since the age of two, and had an hysterical fever to which was joined periodically, persistent vomiting, inflammation of various visceral organs, retention of urine excessive toothaches, earaches, melancholic deliriums, opisthotonus, blindness, suffocation, and several days of paralysis and other other irregularities”

In July, Osterlin returned to Mesmer with hemiplegia — weakness on one side of her body. Mesmer decided to try the magnets — he attached one to her chest, and another to her feet. Immediately a burning, spreading pain started at the site of the magnets and traveled across her entire body. She begged Mesmer to stop, but he continued the treatment, adding even more magnets as he went. But by the end of her treatment, her symptoms completely disappeared. She was cured. She had several additional relapses but each time she responded immediately to Mesmer’s treatments. 

Mesmer immediately became the talk of Vienna and patients flocked to his clinic for his treatment, which he called “animal magnetism”. This terminology is a bit confusing when it’s translated to English — here “animal” refers to the Latin “animus”, for breath, or “life force” and not, well, a member of the Kingdom anamalia. “Magnetic fluid” normally flowed throughout the human body — it was responsible for all life and health. Disease was caused by blockages in these flows. The physician, by using magnetized materials, could redirect these flows to restore health — hence animal magnetism. Mesmer argued that magnets were actually superfluous — because it was an energy flow, ANYTHING could be magnetized. He claimed to have been able to magnetize paper, bread, wood, silk, leather, stones, glass, water, different metals, wood, men, and dogs. Literally anything. 

I need to have an aside here that Mesmer’s idea of “invisible forces” would not have seemed terribly bizarre to Europeans in the late 18th century. Electricity had been recently described, and demonstrations with Leyden jars were regularly held. I’ve posted a video in the shownotes, but essentially a Leyden jar is a capacitor that sends out bolts of static electricity. Newton’s theories about gravity were widely discussed.  Mesmer was probably most influenced by the physician and chemist Georg Stahl, who had described phlogiston. Phlogiston was an invisible substance that was in a variety of materials, which was released when burned. This was the dominant, and scientific explanation for fire — a physical, though invisible, material that had real effect on the world.

And I think that’s an important distinction to make. Mesmer did not think that this magnetic fluid was supernatural. He was, essentially a materialist. It was very real. In fact, as he became more prominent throughout Vienna, he was called by the Munich Academy of Science to give an opinion on Johann Gassner, a faith healer and exorcist who was gaining notoriety for his dramatic treatments. Mesmer stated that Gassner’s treatments were real and effective — but not because of intervention of God, but rather than Gassner himself had a high degree of animal magnetism which inadvertently caused him to cure disease in suffering patients.

Despite his professional success, Mesmer won nothing but skepticism from the Viennese medical establishment. He decided to prove himself by curing a “dramatic case”. The ensuing scandal would drive him from Vienna. Theresa Paradis was a blind and talented musician. She had undergone standard — and by modern standards horrific — treatments as a child. Her eyes had been blistered for two months, they had been cauterized, and most disturbing of all, she had received shocks from Leyden jars directly to the eyeballs. After all this, she was deemed incurable. Mesmer began his magnetic treatment, and apparently had some effect. But her mood darkened, and she began to act erratically. The details are juicy and were discussed throughout Vienna.I’m just going to quote directly from Lanksa and Lanska, who have written extensively on Mesmer’s career:

“A fracas ensued between the parents, patient, and Mesmer, with the absurd chain of events reportedly including a convulsion by the patient, an angry mother throwing her headfirst against a wall, a sword-wielding father loudly demanding Mesmer release his daughter, the mother fainting, the servants disarming the father, the father swearing oaths and curses, and a relapse into blindness, vomiting, and rages by the patient.”

Mesmer’s attempt at success devolving into this was embarrassing to say the least, and soon after he left for Paris. His reputation preceded him, and within months he was running a thriving practice that included the highest levels of Parisian society, including Queen Marie Antoinette, Charles-Phillip, who would later be Charles X after the Bourbon restoration, and the Marquis de Lafayette. Mesmer initially set about treating patients like he would in Vienna — using magnetized rods and pushing them right beneath the breastbone. But he quickly had more patients than his thriving practice could handle. He started treating them en masse, first by magnetizing the trees in his garden and then attaching groups of patients to them with an unknotted rope — the knots, of course, would block the flows of magnetic energy. But he soon settled on the ritual that I took you to in the beginning of the show — a tub of magnetized water, which he called a “baquet”, with iron rods sticking out which could be directed either to the chest, or to the affected area. 

Mesmer was a sensation. In the Journal de Paris, Paris’ only daily paper, Mesmer and his treatments were the most written about subject for two years. Counterfeit baquets were sold in the street. He even converted a member of the Faculty of Medicine to his cause — Charles D’eslon, who gave an aura of respectability as he joined Mesmer in treating patients with animal magnetism. In fact, the only thing that even came close to Mesmer in popularity was the obsession with human flight. In 1783, the Montgolfier brothers for the first time launched a human being in a hot air balloon. Soon after ballooning demonstrations were held all over the country. A hundred thousand spectators weeping with emotion came to watch a launching, for example, in Nantes. And not only the literate upper classes were affected. Apparently, a group of peasants greeted ballooners landing in their field was yelling, “Are you men or gods?”

I think it’s this atmosphere — the idea that not only is the world ruled by invisible forces, but that humanity was on the verge of controlling them — that best explains the fascination with Mesmer. Sure, patients around the baquet seemed suspicious. But at those demonstrations of Leyden jars that I mentioned earlier, there was a common parlor trick where participants would interlock hands and then conduct electricity down what was essentially human wire. I’m sure you did that experiment in a Van de Graaf generator in science class. Was the baquet really that different? Parisians were living in a world where invisible gases propelled men into the air, where lightning could be harnessed and recreated on earth, and where old ideas about the four humors and their accompanying treatments could be cast out. It’s this context that led the Journal de Bruxelles to declare, “Mesmerism soon will be the sole universal medicine.”

It’s also this attitude that led the Academy of Medicine and the Academy of Sciences to declare war on Mesmer. Reforms at the end of the Ancien Regime had led to the formal foundation of a Medical Society and Faculty that was responsible for the conduct and training of physicians in the country. Mesmer had initially collected patient testimonials and submitted these to them. Just like in Vienna, they ignored him.

But this time he had Deslon as an in. The two of them proposed honestly a pretty remarkable trial to prove their animal magnetism treatments. They would identify 24 patients divided into two groups, one treated by “ordinary medicine,” so medicines, bleedings, etc, and the other by animal magnetism. Every patient would be examined by the faculty prior to undergoing treatment. And here’s what I find incredibly fascinating — in order to avoid any biasing about “age, temperament, disease, or symptoms,” patients would be randomized by drawing lots! This trial — had it happened — would have been the first randomized controlled trial in history. One of Mesmer’s assertions in this design is that he did not want his methods, which he protected secretly, to be studied, but rather the effects of the treatment on real patients.

So the Faculty of Medicine, of course, acted very reasonably. They completely ignored him, and then expelled Deslon from the Faculty. They appointed their own commission to directly study Mesmer’s methods, rather than his ability to cure patients, and Mesmer refused to meet them. Why should he? As Mesmer pointed out, the “poisons” that the faculty used never needed such testing. Wasn’t the faculty mostly worried about a new threat to their profits? 

In response, Mesmer started his own training program, called the Society of Harmony. It was essentially a subscription service meant for wealthy patrons, modeled after secret societies like the Freemasons. For 100 louis per month, Mesmer would teach the secrets of animal magnetism, which could be spread out into the world. Branches popped up throughout France, and even overseas. Mesmer made himself a very rich man by this method. By 1785, he had collected 343,764 louis from its members.

It was this secret society that likely led to his downfall. At this point, it was 1785, nearing the eve of the Revolution, and all secret societies were eyed with suspicion. The Parisian secret police had been investing the Society of Harmony, though with a pretty much all-aristocratic membership, there was likely little to be worried out. We only have tiny glimpses of what happened in the Society of Harmony’s meetings, but it appears to mostly have been a social club. In the end, the King was compelled to order a Royal Commission, to be led by the Royal Academy of Medicine and the Academy of Sciences, above the complaints of his wife Marie Antoinette who stood up for her fellow Austrian. The medical faculty was more than happy to proceed. They appointed the most prominent physicians and doctors of the day. First among them was Antoine Lavoisier, who had attacked and disproved Stahl’s phlogiston in favor of combustion with oxygen, and along the way pretty much invented modern quantitative chemistry. This is an aside, and I don’t know the veracity of this story, but after the Revolution, Lavoisier staged a mock-trial of phlogiston and Stahl. The charges were read by a handsome young man wearing a sign that said “oxygen,” against an old man in a Stahl-mask labeled “phlogiston.” After the judges read out the verdict — death, of course, by burning — Stahl’s books were thrown into a bonfire. So you can just imagine how much he was itching to get his hands on another faux-invisible force.

Then there was Joseph Ignace Guillotine, the physician best remembered for his eponymous method of execution, despite the ironic fact that he was an ardent opponent of the death penalty, and Jean Bailly, an astronomer who helped describe the Jovian moons. And to lead them, the King appointed Benjamin Franklin, the American minister to France, and already one of the most famous scientists and inventors in the world.

Very quickly, the commissioners settled on a strategy of directly testing and measuring the effects of animal magnetism, rather than the effect on patients. As Franklin wrote in the final report:

“The question of existence is primary; the question of utility is not to be addressed until the first has been fully resolved. Animal magnetism may well exist without being useful but it cannot be useful if it does not exist.”

This was the methodology that Mesmer had previously rejected, and unsurprisingly he again refused to cooperate. The Commissioners therefore turned to Deslon. I should note that Deslon himself wanted to conduct a comparative trial between standard of care and Mesmerism, but when the Commissioners shot this down, he still agreed to participate.

Franklin’s report has been published in several venues, and I’ve linked to it in the shownotes. It’s an easy and fascinating read, and I highly recommend it. All of my quotes here are drawn for it. The Commissioners decided they needed to understand the treatment better before designing an experiment and coming up with a hypothesis to test. So just like we did, they attended several of Deslon’s sessions, and noted the dramatic effects on the patients who were treated with animal magnetism. Franklin wrote with shock, “Nothing is more astonishing than the spectacle of these convulsions; without seeing it, it cannot be imagined: & in watching it, one is equally surprised by the profound response of some of these patients & the agitation that animates others.”

At this point, Franklin and company realized that there was no way they were going to be able to study such a chaotic situation. They were going to have to break the whole process down into easy-to-study pieces. In essence, they decided to run a series of science experiments. The influence here was almost certainly Lavoisier, who had deduced the existence of oxygen by making careful measurements. But what would their hypothesis be?

They started by having Deslon treat them so they could personally observe its effects. Once a week for two-and-a-half hours, the Commissioners would gather around a baquet, the rods resting on their chests, holding an unknotted rope, while Deslon did his work. The Commissioners felt nothing that could be attributed to animal magnetism, and they concluded, “magnetism has little or no effect on a state of health, & even on a state of slight infirmity.”

Next, they used the same methodology on actual patients. They selected seven commoners and seven aristocrats. Three of the commoners reported having some healing effect, and none of the aristocrats did. They attributed this different to the commoners being willing to please, and concluded that animal magnetism “seemed to be worthless for those patients who submitted to it with a measure of incredulity [and] that the Commissioners . . . did in no way feel the impressions felt by the three lower-class patients”.

And with these studies, they had their null hypothesis — that the dramatic effects of mesmerism were caused by the “imagination” of patients.

Now that they had a hypothesis, they ran a remarkable series of experiments. In the first, they told a woman that Deslon was standing behind a closed door and would mesmerize her. He was not, but within a minute she had a full on crisis. In another, they invited a woman who was previously magnetically sensitive to a job interview, and had Deslon mesmerize her for 30 minutes through a closed door. Nothing happened. Then they told her about the experiment, and again within minutes she had a crisis.

In what was probably my favorite experiment, Deslon magnetized an apricot tree in Benjamin Franklin’s yard. They then led a blindfolded, magnetically sensitive man and he was told to hug each tree. He hugged four nonmagnetized trees in a row and developed worse and worse symptoms, until he collapsed unconscious 24 feet from the magnetized tree. 

After these and several more experiments, the commissioners concluded that the effects of animal magnetism were due to imagination and the subject’s own expectations. The report was disseminated widely — 20,000 copies were distributed throughout the country, and the effects of Mesmer were catastrophic. With weeks, he went from being the object of fascination and admiration to scorn and ridicule. He was satirized in plays, pamphlets, and the popular press. And the Faculty of Medicine now systematically went about expelling anyone who practised his methods. Thomas Jefferson, the United States’ representative to France, and a supreme rationalist who loathed Mesmerism, summed up the situation in his journal on February 5, 1785, when he wrote  “Animal magnetism dead, ridiculed.” In fact, Mesmer stuck around for about another eight months after the publishing of the report, but he soon left for Switzerland, where he would live the rest of his life in relative obscurity. 

What are we to make of Mesmerism today? It still has a large effect on our language — we will talk about “magnetic” or “mesmerizing” personalities, and the phrase animal magnetism is still used, though with a considerably different definition. And the story has been interpreted in many ways. Scientists and skeptics, for example, see Franklin’s commission as an unblemished victory for reason. Stephen Jay Gould, the famous evolutionary biologist, called the Commission’s work  “an enduring testimony to the power and beauty of reason,” a “key document in the history of human reason,” and said that “it should be rescued from its current obscurity, translated into all languages, and reprinted by organizations dedicated to the unmasking of quackery and the defense of rational thought.”

In the same vein, Mesmer is condemned to have been a quack. Quackery is always hard to define — a doctor who might be mainstream in one period, can be a quack in another. If, for example, I start treating my patients with pneumonia with bloodletting, I would be rightfully condemned, but in the early 1800s I would be at the cutting-edge of medical practice. And Mesmer certainly had many features that we associate with quacks — he sold a universal panacea, he had elaborate rituals, and he greatly enriched himself.

But mesmerism is also, in many ways, the beginning of the scientific study of psychotherapy. After all, by all accounts, Mesmer was able to treat, and even cure patients who were not helped by the traditional medical system. In fact, this was Deslon’s counter-argument to the Commission, “[If] Mr. Mesmer had no other secret than that of making the imagination act to produce health, would not that be a marvelous benefit? If the medicine of imagination is the best, why shouldn’t we practice it?” And long after the Commission’s report, mainstream physicians found his methods useful. In the Boston Medical and Surgical Journal in 1837, an enthusiastic letter write advocates mesmerism essentially for anesthesia, making painful procedures like lithotomy possible in the those waning days before ether. And when James Braid developed his new treatment of hypnosis, he did so by basing it on the scientific study of Mesmer’s animal magnetism. At a more fundamental level, even today there are many patients who have sometimes severe and disabling symptoms that are not well-treated with traditional therapy — so-called psychosomatic illnesses, as an example. Mesmerism certainly didn’t harm these patients, and it appeared to help. Even Franklin agreed with this assessment, mentioning in the closing of his report, “If these people can be persuaded to forbear their drugs in expectation of being cured by only the physician’s finger or an iron rod pointing at them, they may possibly find good effects tho’ they mistake the cause.”

My own view is a little more complex. I don’t think we can dismiss animal magnetism as a pseudoscience. Mesmer, I think, is the logical, and even necessary conclusion to a medical era that had dominated for millennia. Stripped of the ritual and medical controversies, Mesmer actually advocated a view of life and disease that was becoming incredibly popular, and very much a scientific proposition — that is, vitalism. The whole discussion on vitalism is quite philosophical and relies on ideas about Cartesian dualism, but in medicine, the idea is that there is a fundamental “vital” force that differentiates living from non-living. This was traditionally identified as “pneuma” in the Western medical tradition, but also with Qi in the Chinese. However, by the 18th century, this force was identified as being very real, if immaterial, like gravity and electricity. In this nosology, disease is caused by disruptions to this vital force, and treatment has to be focused at restoring the flow. 

In contrast, the traditional Western nosology was based on ideas about balance and imbalance in constituent body humors, with treatments — like bleeding, blisters, and purgatives, designed to rebalance the body. But by the late 18th century, while their popularity still dominated, the intellectual basis for humorism was largely in the process of being demolished, as it became increasingly clear that all of human health could not be explained by four body humors. What, then, could cause disease?  Many of the commissioners — Guillotine and Bailly among them — advocated essentially the same view as Mesmer about vitalism and invisible forces. It is a mistake, then, to dismiss animal magnetism as pseudoscience.

As for his treatments — I find it hard to condemn a man who literally advocated for a randomized controlled trial in the year 1780. The Commission’s experiments were clever and in their own way groundbreaking — but keep in mind, the standard of care that they were defending was literally applying blisters and electric shocks to a blind child’s eyeballs. Those were never subjected to any sort of testing like what was done to Mesmer. What I find most troubling, I think, is the idea that Mesmer was brought down by the bright light of science. In fact, it was probably because he formed a secret society in the last days of the Ancien Regime, as well as managing to piss the medical establishment off. His demise was political, not a victory for unbiased science. Science was just the weapon the establishment decided to wield. 

Vitalism, of course, is alive and well today. Much of what today constitutes alternative medicine — homeopathy, osteopathy, and chiropractic — were originally nosologies based on vitalist ideas. In fact, I originally set about to write this episode about the birth of what is generally called alternative medicine, before going down the Mesmer rabbit hole. So, like I often say, that will have to wait for a future podcast.

So I hope you enjoyed this tableau into the last days of the Ancien Regime, before the birth of a new type of medicine. That’s it for the show — but first, it’s time for a #AdamAnswers!

#AdamAnswers is the segment on the show where I answer listener questions about medicine, no matter how obscure. Today, from Yoav Karpenshif, we have, “Why are “code blues” blue? Why is this such a universally accepted code for cardiac arrest?”

What a great question! I’m using as my reference the book Unplugged by William H. Colby, a lawyer and bioethicist who has argued for right-to-die before the Supreme Court. His book is wonderfully written, with many interviews with some of the founders of critical care. He recounts how the first medical ICU in the country was actually started at Bethany Medical Center in Kansas City, Kansas by Dr. Hughes Day, a cardiologist. Dr. Day was distressed that his heart patients on medical wards were not getting the new innovations of “closed-chest massage”, or what we today call CPR, and defibrillation, or electric shocks to the heart, fast enough, which was leading to unnecessary deaths. He took over an area of the hospital that had been a ward for the low income elderly, and developed a “coronary care unit” that should sound familiar to anyone who has worked in a modern hospital — individual, glass rooms, an EKG monitor in each, and a central monitoring station in the middle staffed by specialized nurses who knew how to immediately interpret the strips for arrhythmias. And another innovation that has become standard throughout hospitals — the ward had two “crash carts” that were stocked with an ambubag to help breathe for a patient, defibrillator paddles, a bed board, and endotracheal tubes. Fun fact — the term crash cart came because these early, heavy defibrillators had an unfortunate tendency to cause the whole cart to tip over when rushing around a corner. It is from these crash carts that the term “Code Blue” came from — when a patient would go into an arrythmia, the monitoring nurses would announce a “Code Blue” over the loudspeaker, which would bring an emergency team to resuscitate the patient. And why Blue? Dr. Day wrote that he came up with terminology because of the cyanotic blueish pallor of patients who needed resuscitation. However, other doctors felt that the phrase came from the fact that the crash carts were both painted a metalic, gunmetal blue — Colby, the author, interviewed Dr. Robert Potter, who had been an intern in the CCU in its first year, and whose father, a metal worker, had actually made the carts, and he gave this history.

In any event, in 1964, Bernard Lown — who might be the coolest living physician; he invented cardioversion, founded the International Physicians for the Prevention of Nuclear War, and accepted the Nobel Peace Prize on its behalf — traveled to Bethany Hospital as he sought to open a cardiac care unit at the Brigham Hospital in Boston. Many of their innovations — including the “Code Blue” — were exported. And the rest is history. As CCUs spread throughout the world, a “code blue” became the standard name for a patient needing cardiac resuscitation, including in non-English speaking countries. Code Blue isn’t the only emergency code in regular use for cardiac arrest — a “code 99” is used at some institutions (like the Portland VA where I did my residency). 

Well Dr. Karpenshif, I hope that answers your question — “code blue” comes from Bethany Hospital in 1964, where it spread all over the world. An aside, Bethany, despite its legacy, closed in 2001, and was completely razed. Today, it’s home to the Bethany Community Center and park.

If you, dear listeners, have any burning questions that you want to submit to #AdamAnswers, tweet them to me on Twitter, @AdamRodmanMD.

That’s really it for the show! I hope you enjoyed the episode. I clearly had a lot of fun making it. But I also think it’s an important story. The more I read about Mesmer, the more I realized that the usual ways we contextualize him miss a lot of nuance that has relevance for the way we practice medicine today. The Royal Commission and Franklin Report are usually held up as the power of science to dispel pseudoscience and superstition. And they are — the experiments are some of the first to put a scientific methodology to studying medical treatments. But it’s also true that Mesmerism was almost certainly more effective than many of the treatments advocated by members of the Royal Commission, if only in that it relied on “imagination” rather than purgatives and bloodletting. This theme will be revisited by Hahnemann and the homeopaths just a few decades later. The lesson, for us, I think, is that science is inherently political, even when it comes to as simple a decision as what we study (for example, mesmerism, and not bloodletting). That’s not that to say that it’s not the best method we have to uncover truth, but that scientists and the people funding them are human beings, with their own biases and agendas. In this case, it’s Louis XVI hoping to undermine a potential secret society, and the Faculty of Medicine, hoping to get rid of a thorn in their side. But the same is true in our own time as well. I think it’s telling that even mainstream physicians didn’t abandon mesmerism, even with the Commission’s report, like the Boston surgeon trying to use it for anesthesia. That’s, in many ways, indicative of the task of the modern physician — to interpret scientific evidence the best we can, while being aware that if anything, the possibilities for bias, especially financial bias, are higher than ever, all while hoping to help our patients. 

Sorry, that got pretty heavy. If you want more Bedside Rounds, all of the episodes are on the website www.bedside-rounds.org, and on Apple Podcasts, Spotify, Stitcher, or the podcast retrieval method of your choice. I’m also on facebook at /BedsideRounds. I’m very active on Twitter @AdamRodmanMD, where I tweet mostly about medical history and evidence-based medicine. Come say hi!

All of the sources are in the shownotes. 

And finally, while I am actually a doctor and I don’t just play one on the internet, this podcast is intended to be purely for entertainment and informational purposes, and should not be construed as medical advice. If you have any medical concerns, please see your primary care provider.