'A Defence of Physick': Thomas Reeve's proposed 'fair experiment' on the benefits of tar-water treatment (1744).

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.