IntroductionHenry Bracken M.D. (1697-1764) was born in the Horse and Farrier inn, Lancaster, England. He completed his apprenticeship in Wigan and studied at St Thomas' Hospital (London), the Hôtel Dieu (Paris) and Leiden (Holland). Bracken published books on farriery, urological stones and midwifery.AimsTo examine Bracken's 1737 controlled trial of two treatments for rabies in houndsMethodHistorical literature reviewResultsBracken's 'strict enquiry' compared treatments in two groups of 'an equal number' of hounds 'equally affected as far as could be judged' [i.e. at risk of developing rabies]. One received a herbal 'decoction' and the other a 'secret' powder sold by Mr Hill of Ormskirk. Bracken offers quantitative outcomes: 'Five out of Nine of Mr. Hill's died, and those under the [herbal treatment] all recover'd'.ConclusionWe speculate that Mr Hill's powder contained mercury, causing salivation which was mistaken for clinical signs of rabies. Finally, we also examine Bracken's notion of vocation that 'a Man is born a Physician as well as a Poet'. We conclude that it is harder in modern societies for young people to recognise an early inkling towards a career in medicine. Unlike Bracken's 'inborn' calling, vocation today is more likely to be perceived in terms of a 'transaction', e.g. a 'career move' or 'lifestyle choice'.

Torri'r Llech (TLl) (Welsh for 'breaking the rickets') was a bloodletting practice which remained popular in Wales from at least the mid-nineteenth up to the mid-twentieth centuries. The practice involved cutting the ear (pinna) to induce bleeding. Indications were numerous and dynamic. Vernacular medical practices, including bloodletting, have enjoyed a long history in Wales and were influenced by a multitude of conceptual paradigms over the centuries. By drawing on original oral histories, newspaper accounts, as well as existing secondary source material, this article aims to situate TLl within the wider framework of bloodletting practices in Wales and Britain more broadly. In doing so, this paper also considers the ways in which TLl changed over time and how this dynamism proved a persistent threat to the authority of official medical institutions in Wales. By then discussing how TLl itself appeared to draw on diverse conceptual frameworks, it is argued that it may more accurately be defined as a practice within the confines of popular humoralism - a syncretic medical paradigm influenced by humoralism, astrology, Christianity, as well as local belief systems. Ultimately, TLl exhibited remarkable longevity and may have been practised as late as the 1970s-80s in parts of the Upper Swansea Valley, potentially representing the latest example of a humoral bloodletting practice native to the British Isles. This analysis challenges more linear narratives of biomedical ascendancy, showcasing how TLl coexisted with orthodox medicine in a pluralistic medical marketplace in which Welsh patients consistently exercised agency over their own care.

IntroductionPeter Shaw (1694-1763) was an English physician who practised in London and Scarborough, Yorkshire. He was appointed physician to Kings George II and III. Shaw published many medical texts as well as translations of Lord Francis Bacon and Robert Boyle.MethodHistorical examination of Shaw's text A Treatise of Incurable Diseases (1723).ResultsShaw states that 'incurable' conditions offer an opportunity to examine the cause of disease and its treatment. He proposes a model for a comparative trial of 'antidote' for hydrophobia (rabies) in one of two dogs and - if successful - in humans.ConclusionShaw's proposal is an early model for translational medical research from animals to humans to ensure effectiveness and safety. The evidence suggests that Shaw's was an inspiration for Hauksbee the Younger's 1743 proposed 'experimentum crucis' of venereal disease treatments. That is because in 1731 they co-authored 'An Essay for Introducing a Portable Laboratory'. Furthermore, Hauksbee reveals that Shaw was actively involved in early enquiries into the efficacy of his venereal medication. Due to shared roots in Lichfield and an interest in spa water treatment, the authors conjecture that Shaw's comparative approach might have roots in Sir John Floyer's 1702 controlled trial of cold-water on athleticism.

We present proposals for two controlled studies of medical treatments published in 1683 by the Anglo-Dutch physician Gideon Harvey (1639-1702). First is a controlled trial of Jesuit's (cinchona) bark with and without bitter additives. Second is a comparison of two 'parallel' towns in Essex, England, where conditions ('air') and disease burden are similar. The latter is the earliest proposal of what today is called a cluster-controlled study, i.e. comparing interventions in two established populations. This methodology only re-emerges in the twentieth century and is key to interventional research in medicine, public health, education, and international development. There is no evidence that Harvey's cluster-controlled trial ever took place. His proposals arose from bitter conflict with London's College of Physicians. Harvey's proposals for 'plain and necessary instructions, rules, and remedies in one single sheet [of paper]' echo Bacon's call for physicians to standardize their erratic treatments. New evidence is examined to reinterpret Harvey's historical legacy solely as a 'prater' and 'quack'. This is most evident in James Lind's 1753 high praise for Harvey's writing on scurvy. We also present new information about Harvey's biography including his 1639 baptism as a 'subject & mldr; of ye King of Great Brittaine resident in the Haghe'.

Purpose Genitourinary (GU) complications are frequent among prostate cancer (PCa) survivors and can substantially affect quality of life. While patient-reported outcome measures (PROMs) capture these issues in detail, they are resource-intensive and limited in scale. This study evaluated linked electronic health records (EHRs) to characterise GU complications in PCa survivors and their sociodemographic variations. Methods We conducted a population-based retrospective cohort study using linked primary care, secondary care, and cancer registry data in England. Men aged ≥ 56 years with a primary PCa diagnosis (2010–2016) who survived 18–42 months post-diagnosis were included. GU events were identified from coded symptoms/diagnoses, prescriptions, and procedures. Multivariable logistic regression assessed associations with sociodemographic and clinical factors. Results Among 10,651 survivors (mean age 72 years; 95% White; 52% without comorbidity), urinary events were recorded in 34% and sexual events in 13%. Urinary complications were more often documented in men with prior symptoms, Black ethnicity, localised disease, multimorbidity, antidepressant use or receiving androgen deprivation therapy, radiotherapy, or without recorded treatment. Sexual complications were more frequent in younger, Black men, those with prior symptoms, antidepressant use, or undergoing radical prostatectomy. Compared with PROMs, EHR-derived rates were lower. Conclusions Triangulating symptoms, prescriptions, and procedures reveals real-world patterns of GU complications and healthcare engagement often missed in trials, with recording rates varying by age, deprivation, ethnicity, prior symptoms, and treatment type. Implications for Cancer Survivors: Many GU complications are under-recorded in structured EHRs, reflecting differences in help-seeking or reporting. Improving coding and integrating PROMs could enhance data completeness for research, monitoring, and equitable, patient-centered survivorship care.

IntroductionIn 1744, the English physician Thomas Reeve ('T.R.', b.1700-1780) published two proposals for controlled trials of tar water treatment, a 'universal' medication promoted by Bishop George Berkeley (1685-1753).MethodsQualitative analysis of historical medical texts.ResultsIn his 'defence of physick', Reeve questions Berkeley's clinical evidence and calls for a 'fair experiment' with a 'competent number' of patients (i.e. 20), half of whom should receive tar water. Participants should be 'of the same Age, Sex, Constitution and Country, of the same way of living, and of the same Temperament'. Treatment must be 'at the same Time and Place', circumstances employed in Lind's 1747 scurvy trial. Reeve also proposes a simple two-patient trial to compare smallpox treatment with and without tar water.DiscussionIt is tempting to see Reeve's proposals as an influence upon James Lind's 1747 scurvy trial. Evidence that could support this lies in Lind's consideration of both tar water and Berkeley's book within his 1753 treatise on scurvy. Likewise, Reeve's call to keep a 'faithful register' of clinical outcomes offers a possible link with Hauksbee the Younger's 1743 proposal for an 'experimentum crucis' of treatments for venereal disease. The contribution of Thomas Reeve to the development of controlled trials (including the 'morality' of withholding effective treatment) deserves greater recognition.

IntroductionLord Francis Bacon's (1561-1626) was fascinated by the phenomenon of 'putrefaction', which he saw in 'moulds' on food, 'mosse…of the Earth, and Trees' and the process of disease in living creatures. By observing the development of mould, Bacon deduced that certain 'aires' and 'seats' (places) were more healthy than others.AimTo interpret Bacon's ideas about putrefaction.MethodQualitative examination of Bacon's texts, especially 'Sylva Sylvarum'.ResultsBacon proposes comparing the speed of putrefaction between pieces of 'raw flesh' of the 'same Kinde and Bignesse' in different settings: 'within Doores' and 'abroad [outside]' as well as 'some height above the Earth' and 'upon the Flat [i.e. surface] of the Earth'. Thus, Bacon sought to identify more healthy 'seats of dwelling' …'for [residential] Lodges, and Retiring Places for Health'.ConclusionBacon's experiments represent early landmarks in two fields of medical research: evidence-based public health measures to improve housing and (by calculating 'post-mortem interval') forensic pathology. These contributions appear to have been overlooked, despite informing Sir John Pringle's 1752 treatise on military medicine. Bacon called for 'new learning' and his forensic approach highlights a need to engender the 'medical detective' in modern students of medicine.

Francis Home (1719-1813) was a Scottish physician and medical author. Here we consider his biography and three brief accounts of experiments on viper (i.e. adder flesh) broth in the treatment of skin disease ('Herpes or Lepra Gracaeorum'). After a fortnight of treatment one patient was improved but not cured (discontinued due to lack of vipers), one 'almost cured' but refused further treatment at 'disgust' of discovering its contents, and one dismissed cured. The second case constitutes a basic 'cross-over' model as it led to comparison of viper with snail broth in the same patient. Home concluded that viper broth was beneficial for skin disease but his findings did not lead to wider adoption of the treatment. His reported clinical benefits likely arose from improved hydration, protein and cessation of other treatments. Home does not discuss his small sample size or present quantitative outcomes. Home's methods were not influenced by Lind's (1753) methodology for comparing treatments. As both were Edinburgh-trained Scots who served in the British military forces, this reveals the limited communication between clinicians of the day. Home appears to have faced many practical challenges, including accessing vipers, motivating patients' participation and the risk of concomitant treatment with other drugs.

Thomas Lewis Mackesy (1790-1869) was an Irish surgeon celebrated in his home city. Born in Waterford in Ireland, he apprenticed under his father, an apothecary, before undertaking the London College of Surgeons examination in 1809. Successful, he trained as an assistant surgeon before joining the Royal Artillery. After several years, he returned to his native city, where he worked at the Leper and Fanning hospitals as a surgeon, and married the first of three wives in 1813. Sadly, she died only five years later, leaving two young sons. In subsequent years, Mackesy continued practising medicine but extended his scope to politics and social causes. He became mayor of Waterford in 1841 and worked as both a magistrate and Poor Law guardian, focusing on public health. He received recognition for his work, being the first doctor outside Dublin to be elected president of the RCSI (Royal College of Surgeons in Ireland). Trinity College Dublin also awarded him an honorary degree, earning him the title M.D. honoris causa. Thomas Lewis Mackesy died on the 8th of April 1869 from complications of kidney disease. A blue plaque commemorating his life and influence can today be found on Lady Lane, in Waterford city.

James Henry (1798–1876) was a Dublin physician and classical scholar best remembered for his translation of Virgil’s Aeneid. Little is recorded about his medical practice. To describe Henry's 1843 proposal for a controlled trial of treatment for ‘the itch’. Qualitative examination of historical medical journals. Henry suggests taking twelve patients and treating six with cold-water treatment and six with standard treatment (sulphur). Henry’s proposal sets out four general principles for selecting diseases to study the alleged benefits of cold-water treatment. First, the condition should be one upon which it is safe to experiment. Second, the disease should be ‘visible and tangible, and… cannot be simulated or misrepresented, or misunderstood’. Third, it should have no spontaneous recovery. Finally, there should already be a ‘certain [i.e. proven] remedy’. Henry had published in 1834 on sulphur as a laxative. By calling for twelve participants, it is possible that Henry’s proposal was influenced by the writing of Francis Hauksbee the Younger (1743) and James Lind (1753). Although there is no evidence that Henry’s trial ever took place, his proposal and principles for selecting a disease to study reveal a critical and ethical mind. It also constitutes a notable landmark on the journey towards formal controlled trials.