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A controlled clinical trial in 1809?
  1. I Milne1,
  2. I Chalmers2
  1. 1Royal College of Physicians, 9 Queen Street, Edinburgh EH2 1JQ, UK
  2. 2UK Cochrane Centre, NHS Research and Development Programme, Middle Way, Oxford OX2 7LG, UK

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    In his 1814 Edinburgh MD thesis (see figure), Alexander Hamilton described an experiment that took place during the Peninsular War to assess the effects of bloodletting. Hamilton and two other army surgeons carried out the experiment, which involved 366 sick soldiers in 1809 in the hospital at Elvas, Portugal.

    “It had been so arranged, that this number was admitted, alternately, in such a manner that each of us had one third of the whole. The sick were indiscriminately received, and were attended as nearly as possible with the same care and accommodated with the same comforts. One third of the whole were soldiers of the 61st Regiment, the remainder of my own (the 42nd) Regiment. Neither Mr Anderson nor I ever once employed the lancet. He lost two, I four cases; whilst out of the other third [treated with bloodletting by the third surgeon] thirty five patients died.”

    No corroborative evidence has yet emerged that the trial actually happened, but it is still noteworthy that Hamilton judged that his description of alternation and standard conditions would impress his examiners.1

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