The Washing of the Waters, Part 3

Published Mar 21, 2023, 8:52 PM

The idea of healing via immersion in sacred or special waters dates back to prehistory, and it’s still alive and well in the modern world. In this episode of Stuff to Blow Your Mind, Robert and Joe consider the myth, history and reality and healing waters. (part 3 of 4)

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

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