“Who is so dense as to maintain… that all [the defendants’] witchcrafts and injuries are phantastic and imaginary, when the contrary is so evident to the senses of everyone?”
~Heinrich Institoris and Jakob Sprenger, Malleus Maleficarum (1486)

Malleus Maleficarum (‘The Hammer of the Witches’) is a book published in the late 15th century in both Germany and England. It is a polemic against those who held that witchcraft didn’t exist, or that it wasn’t the threat that the authors perceived. It is also a ‘how to’ guide for magistrates who wished to ferret out witches in their jurisdictions and prosecute (i.e., kill) them to the fullest extent of the law.

By the late medieval epoch, knowledge of witches was not new. But earlier treatises on witchcraft often framed it as a misguided pagan activity – nothing that a few days of public humiliation in the stocks and penance couldn’t cure. But after Malleus was widely read – thirteen editions were printed by 1520, thanks to the newfangled printing presses then available –the hysterics increased and civil prosecutions multiplied in many locales. Interestingly, the book was not used by the Church’s formal Inquisition – the Vatican even condemned many of its pearls – but Malleus was employed widely in secular courts which were less familiar with the Holy See’s formal teachings on demonology.

You recall what they say about knowing just enough to be dangerous?

Western religion being as it was and is, the root of all of this was sex. Women were barely contained nymphomaniacs, so it went, and those who let their passions loose and had intercourse with Lucifer promptly became witches, leading to all manner of hexes and curses, poisons and potions, pestilence, infanticide and other murders, and the stealing of penises (no joke on that last one). Thus, while there were sometimes male witches identified (not sure how those were created) it meant that half of the human population was teetering on the brink at any given moment of being co-opted by Beelzebub. That made for a lot of potential raw material for witch prosecutions.

Clerics, jurists, and authors began to take sides, and over time not everyone bought the party-line on witches. As noted, the Church expressed grave doubts about the contents of Malleus (but was either unwilling or unable to suppress its application). Cruentation (the belief that a dead body bleeds or exhibits lesions in the presence of a murderer or witch) was thought by some to be unreliable as an evidentiary standard. In the late 16th century was published by Reginald Scot The Discoverie of Witchcraft (1584), a tome referenced by no less than Shakespeare, in which the author Scot countered that the public oft had been fooled when it came to witches by ignorant superstitions, the mental derangements of observers, and charlatans. Father Friedrich Spee was a prominent German Jesuit who argued against witch trials, as then being conducted, in his work Cautio Criminalis (‘Precautions for Prosecutors’) in the early 17th century; he believed that the torture employed did not produce truthful confessions. At the same time, Inquisitor Father Alonso Salazar y Frias in Spain examined who was being burned and over what supposed transgressions; what Salazar found looked to him like many false accusations, confessions extracted through torture, and ‘evidence’ lacking all credibility. He couldn’t say bluntly that witches didn’t exist, but he did change the rules of evidence. Starting after 1610 in his jurisdiction in Spain, accusations of witchcraft had to be supported by some independent observations. And, said Salazar, there would be no more use of torture to extract the ‘truth.’ Predictably, prosecutions in both civil and ecclesiastic courts began to decline.

This didn’t happen overnight. While the skeptics of witch trials were in the minority at first, their numbers grew. The last legal witch conviction and execution took place in Switzerland in 1782 – the place where the first had also occurred in 1427.

Institoris and Sprenger would have scoffed in 1486 at the notion that dangerous witches aren’t everywhere. Three hundred years later, the last witch was judicially put to death in Europe. Today, few if any individuals lie in bed at night in fear of witches or missing parts of their anatomy.

Mindsets don’t change quickly. But they do change.

When I was in my medical training, Hormone Replacement Therapy (HRT) was the gospel. It was felt in most medical quarters to be the answer to a host of age-related problems that befall post-menopausal women – everything from stress incontinence to absent libido, and from osteoporosis to winkled and thinning skin was to be prevented by the administration of nature’s wonder-substance, estrogen (along with a progestin chaser for those still with an intact uterus).

HRT remained the gospel for years… until one day it wasn’t.

The Women’s Health Initiative of NIH, in 2002, was performing meta-analyses of data on patients taking HRT, and that massive review set off alarms when it was found that there was heightened risk of breast cancer, heart attacks, and stroke in older patients on HRT, despite the earlier touted health benefits. Suddenly what we had learned in training was heresy. The number of women taking HRT dropped precipitously, and the relatively few still taking HRT are almost always given the regimen for time-limited treatment of menopausal symptoms, not as the permanent fountain of youth that it represented in the 1980s and 1990s.

In my own specialty there are many such examples – lobotomies and insulin shock treatments of the early 20th century come quickly to mind. Even more recently than those barbarisms, when I was a new attending, a novel antipsychotic hit the market: Janssen’s Risperdal. It was said to have none of the nasty side effects of the older antipsychotics, and could be quickly and aggressively titrated for patients in which fast relief from psychosis was needed. Janssen even made up a little jingle: “Risperdal 1-2-3-BID,” earworming that the recommended manner by which to dose the Rx was 1mg twice a day followed by 2mg twice a day followed finally by 3mg twice a day, all over a rapid 72 hours from start to maintenance dosing.

I know I did this many times in practice.

Now I know of no one who would attempt to do this.

Experience taught us that Risperdal is in fact fraught with potential side effects, recommended doses are now less than half the previous average 6mg daily advertised, and the titration is usually accomplished in a much slower and deliberate manner.

It’s funny what you learn when you question dogma and actually stop, look, and listen.

There is a scene in Star Trek IV (1986) in which the crew of the Enterprise lands in 20th century San Francisco. In the one act, the ship’s doctor, McCoy, is shown talking to an old woman in a hospital waiting room, and she tells him that she’s there for kidney dialysis. He exclaims with surprise, “dialysis..! they’re still doing that?!?” He then gives the woman a pill from his 26th century doctor’s bag, and in a later shot we see the same woman dancing down the hall as she leaves the hospital, obviously cured by a treatment modality that does not yet exist and which our feeble minds cannot yet grasp.

While witchcraft and modern medicine might seem wholly disparate, I note the above because I wish I could live long enough to see with bemusement what, from our own ‘advanced’ age, will be viewed with incredulity and amazement in the future.

And in the meanwhile, be very wary of those who preach orthodoxy without some pretty convincing data.

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