The obscure ‘quack’ who helped pioneer the modern clinical trial

Brighton and Sussex Medical School and Royal Sussex County Hospital researchers have published an analysis of Francis Hauksbee the Younger’s 1743 “Experimentum Crucis.” In the analysis, the researchers consider the systematic principles proposed by Hauksbee as an early contributor to future scientific medical trials.

Francis Hauksbee the Younger, an 18th-century instrument maker and scientific lecturer, proposed a formal comparative study in 1743 to evaluate the “safety and efficacy” of his medication for venereal disease.

Published as a pamphlet “A Further Account of the Effects of Mr. Hauksbee’s Alterative Medicine,” his plan aimed to compare his treatment against others by organizing a controlled trial. The study included a detailed methodology, patient consent and it called for transparent documentation of patient outcomes.

Controlled medical trials were a rarity in the 18th century, leaving treatments for diseases like venereal infections unverified by systematic comparison. Physicians of the day did not publish trials as we know them today, but rather opinion pieces and testimonials in newspapers that read more like advertising copy to the modern reader.

This was at a time when opium-laced alcohol tinctures were being sold to the public as antidotes for sore throat, colds, bronchitis, and tuberculosis. Toxic substances such as mercury and arsenic, and plant poisons of hemlock and deadly nightshade were commonly considered to have medicinal value.

Hauksbee’s treatment proposal came amidst a growing skepticism toward new medical treatments and accusations against him of quackery by medical practitioners. He sought to address this issue by testing his non-mercury “alterative” medicine against conventional remedies, which often relied on mercury-based salivation therapy, a treatment known for its severe side effects.

In the current study, “‘Experimentum Crucis’: Hauksbee the Younger’s ‘decisive experiment’ for comparing the ‘Safety and Efficacy’ of new medicines (1743),” published in Notes and Records: the Royal Society Journal of the History of Science, the authors detail the methods outlined in Hauksbee’s proposed trial and link it to trials that came after.

In his pamphlet, Hauksbee proposed the selection of 12 patients diagnosed with “curable degrees” of venereal disease. Six patients would receive Hauksbee’s medication, while six would receive standard treatments administered by physicians.

His plan included controlling variables such as diet and accommodation to minimize confounding factors. A requirement for patient consent was included, or as he puts it, without confinement, referring to the practice of medical experimentation on prisoners. Independent observers were invited to inspect and verify patient progress, with results to be documented in a journal and published regardless of the outcomes.

Hauksbee emphasized the importance of transparency, requiring patient cases and outcomes to be available for review and certified by multiple witnesses. Long-term monitoring to determine the achievement of “lasting cures” was a critical endpoint for the study.

There is also a statement on impartiality when Hauksbee writes, “I shall not desire the Publick to stand up for this Medicine any longer than it will stand up for itself,” making it clear that any assessment of outcome should be independent and free of bias.

No evidence exists to suggest that Hauksbee’s study ever took place. The absence of participation from the London medical community and their accusations of quackery may have hindered its execution. While an educated instrument maker and lecturer in mathematics, anatomy, and chemistry, Hauksbee was not a medical physician, with skills more akin to a modern-day researcher, something not yet established in the 1700s.

The current study’s assessment links Hauksbee’s proposed study to James Lind’s scurvy trial in 1747, which successfully took place only a few years later. Lind’s study compared six treatments for scurvy among 12 sailors, and is often regarded as the first modern clinical trial.

The researchers note that Hauksbee’s proposal shares key methodological similarities to the ones later carried out by Lind. Both emphasized the need for group comparisons under controlled conditions and full publication of results.

Hauksbee’s proposal reflected an early attempt to apply systematic principles to medicine and provided an intellectual foundation for Lind’s groundbreaking work.

Though his study remained unrealized (and likely not curative), it demonstrates a forward-thinking approach to clinical testing, independent oversight, consideration of consent and comprehensive outcome reporting transparency. The current study does a good job of lifting Hauksbee from historical obscurity and identifying his role in the evolution of evidence-based medicine.

© 2025 Science X Network