These 10 Abhorrent Medical Practices from History Will Make You Glad You Live in the 21st Century
These 10 Abhorrent Medical Practices from History Will Make You Glad You Live in the 21st Century

These 10 Abhorrent Medical Practices from History Will Make You Glad You Live in the 21st Century

Larry Holzwarth - January 22, 2018

“The art of medicine,” wrote Voltaire, “consists of amusing the patient while nature cures the disease.” Some of the medical treatments of Voltaire’s day and since haven’t been too amusing however. George Washington was stricken with an infection which in a later day would have been treated with the antibiotics unavailable to his physicians. Armed only with the medical knowledge and practices of the time, they repeatedly bled their patient, further weakening him and no doubt hastening his death. Bleeding was long an accepted medical practice, for a wide variety of complaints, and doctors found it useful for a treatment. Sometimes the patient survived, though it is highly unlikely the ministrations of the physicians contributed to the cure.

There are many medical procedures and practices formerly used to treat patients that added to the discomfort and indignities of being ill, all highly regarded in their day. Trepanning, which is defined below, was used since ancient times to release evil spirits and humors from deranged minds. Mercury, which is a highly toxic heavy metal, was the prescribed treatment for syphilis. The practice of lobotomy was used in cases of mental illnesses; John F. Kennedy’s sister Rosemary was lobotomized in an attempt to control her mood swings at the age of 23, on the advice of her doctors.

These 10 Abhorrent Medical Practices from History Will Make You Glad You Live in the 21st Century
Voltaire, who wrote; “Doctors put drugs of which they know little into bodies of which they know less for diseases of which they know nothing at all.” Wikimedia Wikimedia

Here are some formerly highly regarded medical practices and procedures which have thankfully been abandoned by professionals in the health care disciplines.

These 10 Abhorrent Medical Practices from History Will Make You Glad You Live in the 21st Century
A spring loaded automatic lancet used for bleeding patients. This one dates to the 1820s. Wikimedia

Bleeding the patient

Physicians once subscribed to the theory that the human body contained four fluids, which in the medical literature of the day, such as it was, were called humours. These were blood, bile in two forms – black and yellow, and mucous, or phlegm. Disease occurred when an imbalance in the humours was present. The practice of restoring the proper balance of humours dates to ancient times and remained an important part of the physician’s arsenal of weapons against illness well into the 1800s. Many of the earliest surgical tools were designed to promote the release of blood.

The founder of the art of medicine, Hippocrates, upon whom the oath to do no harm is based, believed that bleeding the patient was equivalent to female menstruation. To Hippocrates, menstruation corrected the imbalance of humours present in the female body. Doctors in the ancient world were unaware of blood circulating, and believed that it grew stagnant when in the extremities leading to illness. Once the Roman doctor Galen discovered that there was blood present in the arteries, which had previously been believed to contain air, he derived a complex system of bleeding patients. Galen’s system included consideration of a patient’s age and overall physical health, the particular complaint being treated, and even the weather, among other considerations.

By the 1600s, physicians in Europe often recommended bleeding to their patients, but the actual procedure was beneath their dignity and was usually performed by barbers, who doubled as surgeons. Through several different methods, including the drawing of blood from veins opened with lancets, cupping, or occasionally the tapping of arteries, blood was withdrawn with the goal of the barber being inducing the patient to faint. Some surgeons used leeches to rid their patients of the bad humours, a practice which continued for centuries.

As early as the 1600s doctors in Europe were demonstrating that the practice of bleeding was of no benefit to the patient in nearly all instances, but doctors continued the practice for another two centuries, often because the medical training and knowledge of the time presented them with no other options and they had to do something. Bleeding was done both when the patient was unwell and as a routine preventative. Bleeding through the application of leeches was especially popular as a prophylactic treatment. Bleeding was even used as a treatment for nosebleeds.

As George Washington lay weakened from a throat infection (widely believed today to have been quinsy) his learned physicians eventually withdrew nearly four quarts of his blood. To be fair, Washington requested the procedure and his doctor’s complied. It may be one reason that his last words were reported to have been, “No, doctor. Nothing more.”

These 10 Abhorrent Medical Practices from History Will Make You Glad You Live in the 21st Century
With the blanket secured around the neck the fumigator at the patients feat is placed under the blanket, releasing mercury fumes. Wikimedia

Mercury treatment for syphilis

Europe recorded its first major outbreak of syphilis in 1495 and for many years researchers believed the disease to have been brought to the Old World from the New World following the voyage of Christopher Columbus. But this theory does not explain the recorded treatments for the disease which date to the eleventh century in Persia. There is no dispute that its first major outbreak in Western Europe was in the years following Columbus’ return and during the Renaissance it was often referred to as the Great Pox, to differentiate it from another major killer of the day, smallpox.

The use of mercury to treat syphilis dates from around the same time. Mercury was applied to the patient in one or more of several methods, it could be rubbed directly into the skin, taken orally, or sometimes mixed into a plaster which was then applied to the body. Mercury was also heated until it vaporized, with the patient (one begins to see the relationship between the words patience and patients) inhaling the fumes. The application of mercury increased salivation, which was believed by the medical profession to expel the disease from the body. Heavy sweating was also a desired curative effect.

Exposure to mercury had toxic effects, which led to the loss of teeth due to the degeneration of the gums, a minor problem in a time when the loss of teeth due to tooth decay was commonplace. The alternative to the mercury treatments was the disfigurement characteristic of the disease as it advanced, which led to the development of masks and false noses to hide the physical evidence presented by the sufferer.

Later treatments for syphilis included exposing the patient to malaria, since it was believed that the induction of fever helped cure or control the disease. Malaria at the time was incurable, but could be controlled through the use of quinine, and was considered to be an effective option for doctor’s treating syphilis, which of course carried considerable social stigma along with serious health risks.

The many side effects of using mercury to treat syphilis included loss of vision, loss of muscular coordination, speech impairment, trouble walking, loss of hearing, general malaise, loss of teeth, and ulcers on the gums. As time went on many of these symptoms were linked to mercury but it continued to be used as a treatment for syphilis – which was a leading killer in the United States as late as the 1930s – until the widespread availability of penicillin following World War II.

These 10 Abhorrent Medical Practices from History Will Make You Glad You Live in the 21st Century
This mid-16th century illustration is from a book describing surgical techniques and tools. Wikimedia

Trepanning

The idea of trepanning is relatively simple. Evil spirits trapped within the human mind need to be released, and in order to do so an opening must be made in the body to allow them to get out. Since evil spirits seemed to be occupying the mind of the patient, located of course in the head, an opening in the head would offer them the egress they sought through inducing odd or unacceptable behavior in the patient. So the doctor would drill a hole in the head to let them out.

There were other situations in which trepanning was considered to be the optimal treatment. Head wounds often lead to trepanning (also called trepanation) to remove shattered bone fragments or foreign matter left in the skull. Trepanation seems to have sprung up among numerous ancient cultures and locations, including among the ancient peoples of Europe, North America, and Africa.

Surprisingly, given the incidence of infection and the lack of antiseptic procedures and medicines, evidence from a large number of trepanned skulls found by archaeologists indicates that the survival rate for those undergoing the operation was high. By the eighteenth century trepanning was considered to be called for to relieve seizures caused by head injury, or from epilepsy and other illnesses.

Trepanning was a common practice among the natives of Polynesia, as French and English sailors discovered during their voyages of exploration in the South Pacific. Archaeologists have discovered trepanned skulls in the ruins of the Mayan and Aztec civilizations. It was performed by the diverse civilizations of Africa, in Asia, and in Ancient Greece, which culture gave it its name. Trepanning, which is also known as trephination, is derived from the Greek word trypanon, meaning to auger.

Today, the operation is sometimes performed to relieve pressure on the brain resulting from hematomas, but trepanning is obviously no longer indicated for the release of evil spirits. Surgeons no longer refer to the procedure as trepanning, preferring the term craniotomy, and the removed portion of the skull is usually replaced. Nor do trepanning instruments resemble the modern tools available to today’s surgeons.

These 10 Abhorrent Medical Practices from History Will Make You Glad You Live in the 21st Century
Tobacco smoke enema set as depicted in a Swiss medical book from the late 1700s. Wikimedia

Tobacco Smoke Enema

Tobacco was one of the earliest products of the New World to be welcomed in the Old World. The economy of the first permanent English settlement of Virginia was almost wholly dependent on tobacco. In Europe, physicians were soon touting its health benefits. First observed among the natives in North America, knowledge of the medical use of tobacco made it to England in descriptions from returning ships, and in the logs and diaries of visitors to the New World.

The use of smoke as a therapeutic for various complaints had been practiced for centuries. Incense was used in Biblical times, for instance. Physicians in Europe were soon using tobacco smoke to treat various afflictions. A Spanish botanist, Nicolas Monardes, touted the benefits of the tobacco plant, recommending its use to treat the common cold, gout, stomach disorders, and more than a dozen other complaints including respiratory disease and cancers.

By 1680 a visit to a physician in England for the treatment of constipation or other bowel disorder was likely to include, in addition to the requisite bleeding, a tobacco smoke enema. Tobacco smoke was forced out of a bladder or a device similar to a fireplace bellows, via a rectal tube, into the rectum, to be repeated if necessary, until success was observed through the passage of a stool. Tobacco smoke enemas became popular in England among medical practitioners, again believing that the balance of humours in the body was beneficially altered through its use.

It also became a routine treatment for drowning victims, often used in conjunction with artificial respiration. Smoke was blown into the lungs and rectum interchangeably. A tobacco smoke enema as a means of restoring respiration likely began with the Dutch, where drowning accidents in the canals were frequent, especially at night. It was then carried to England by sailors. By the time of the American Revolution respiration emergency sets were distributed along the Thames River containing smoke enema equipment.

By the early 1800s tobacco smoke enemas were used to treat hernia pain, other abdominal disorders, and even cholera. Their use began to decline when nicotine was defined as a poison capable of having an adverse effect on the circulatory system, although the continued use of tobacco medicinally continued for many years, especially in the form of snuff. That tobacco smoke contained poisons should have been no surprise however. As early as the mid seventeenth century it had been widely used to fumigate buildings.

These 10 Abhorrent Medical Practices from History Will Make You Glad You Live in the 21st Century
Competing brands of shock therapy belts to cure impotence available from Sears. Sears

Electric Shock Therapy for impotence

During the Gilded Age electricity was in vogue, described as a panacea for a great many ills when applied directly to the body. The surge of electricity, in varying degrees of current, was believed to stimulate additional energy within the body. It was considered beneficial in a variety of applications and for men, in two areas which, then and now, a cure was highly desirable. These were male pattern baldness and impotence.

The continued application of “mild” electric shocks were advocated by medical practitioners and manufacturers of the equipment, which could be applied with or without the supervision of a doctor. Newspapers, magazines, and the catalogs of manufacturers and retailers contained all sorts of devices which would stimulate hair growth, many of them in the form of a skull cap to be worn for prescribed periods of time, often to be used along with lotions or other nostrums.

For the problem of impotence, a visit to the doctor would lead to electrodes being placed directly on the dysfunctional body part, and the doctor would apply a series of shocks until a response was observed. It was believed that continued treatments of this nature would re-establish in the unfortunate patient’s body the desired physical response – a form of teaching muscle memory.

One particular vendor marketed a belt which employed a battery and what its advertisements referred to as “suspensory parts” which when worn, could be used to apply a steady current which would induce in the wearer the desired result. The advertisements promised that if the belt failed to deliver the promised results the seller would “forfeit” $5,000, though it did not say to whom the amount would be forfeited. It was manufactured by the Sanden Electric Company of Portland, Oregon.

The use of electrical devices to stimulate the male sexual organ may sound bizarre, but it was actually an improvement over that recommended by French doctors earlier in the nineteenth century. Their prescription was the use of flagellation with a small whip designed for the purpose, of the entire male organ and the surrounding area until the skin overall was red and nearly raw. It was believed that the blood flowing to the area which caused the reddening would also stimulate the desired response.

These 10 Abhorrent Medical Practices from History Will Make You Glad You Live in the 21st Century
Dr. Walter Freeman (left) and Dr. James Watt performed the lobotomy on Rosemary Kennedy in 1941. Freeman performed hundreds over his career, though he was not a certified surgeon. The Saturday Evening Post

Lobotomy

In May 1941 The Saturday Evening Post ran an article which described a then new form of surgery called psychosurgery. Psycho surgery was described as “…cutting into the brain to form new patterns and rid a patient of delusions, obsessions, nervous tensions and the like.” Lobotomy is a form of psychosurgery which was practiced for more than twenty years, most frequently on women, and has since become a word which is nearly synonymous with barbarism. More than 20,000 were performed in the United States by the early 1950s, more than 50,000 by the time they stopped.

The belief was that by cutting away certain contacts within the brain the mental disorder being treated would be eliminated. The frontal lobes of the brain control cognitive function and the expression of emotions, solving problems, judgment, memory, and other functions of personality. Lobotomies disconnect the prefrontal cortex from the anterior portion of the frontal lobes.

The procedure was recognized to sacrifice personality in the patient in the hope of obtaining relief from mental disorder, and even in those operations deemed successful significant negative results occurred as well. Some symptoms of mental disorder were removed but physical and mental problems were added in nearly all cases. One American physician, Dr. Walter Freeman, performed over 4,000 lobotomies, with nearly 40% of them intended to “cure” homosexual behavior. Freeman referred to lobotomies as “surgically induced childhood.”

One of the most famous patients to undergo a lobotomy was Rosemary Kennedy, the eldest daughter of Joseph Kennedy Sr. and the sister of John F. Kennedy. Rosemary suffered oxygen deprivation at birth and as a result was not as intellectually capable as her siblings. As a teen she developed a stormy and rebelliously headstrong personality. At the request of her father, Dr. Freeman performed a lobotomy on her in 1941. Rosemary became equivalent to a toddler in mental capacity and capability and was institutionalized following the procedure, remaining so for the rest of her life, although she visited the family compound occasionally following the death of Joseph Kennedy Sr.

Lobotomies led to many patients needing to relearn how to eat or even use the bathroom, as in the case of Rosemary Kennedy, who became incontinent following the surgery. Concerns about the negative effects of the procedure outweighing any benefits led the Soviet Union to ban them in the 1950s. By the 1970s several American states had banned the procedure. Although the lobotomies as performed in the 1950s are no longer performed in the United States there are similar procedures being used today.

These 10 Abhorrent Medical Practices from History Will Make You Glad You Live in the 21st Century
This advertisement for Bayer Heroin was aimed at the apothecaries and pharmacists who compounded medicines. Wikimedia

Heroin

The word Heroin was once trademarked by the drug manufacturer Bayer, marketed as a cough syrup, and containing diacetylated morphine, the drug now known as heroin. Bayer did not invent heroin. That was accomplished by Alder Wright at St. Mary’s Medical School in London in 1874. But the German company Bayer did find a commercial use for the drug, naming it Heroin as a brand name from the German word heroisch, meaning strong or heroic.

Bayer marketed the drug as an alternative cough medicine, a safer and more effective choice than those containing morphine or codeine. Heroin was introduced to the market in 1898, and was frequently recommended by physicians as being less addictive than morphine, and a better cough suppressant to boot. Neither morphine nor heroin required a physician’s prescription, they were available over the counter.

Because it was deemed to be less addictive, Heroin was recommended for use by children in controlling coughs and colds. Bayer marketed Heroin to pharmacists and apothecaries, who often mixed and prepared their own cough syrups, lozenges, and other medicines for the use of their customers. Bayer provided instructions describing effective dosage levels directly to the customers, the mixtures were thus prepared based on the pharmacist’s knowledge of the product and the demands of his customer. There was little control by the medical profession, although doctors could and often did make recommendations to their patients to forward to the apothecary.

Numerous patent medicines of the day were based on opium products, as well as cocaine. Cough and cold medications and various tonics contained morphine, and the combination of several patent medicines could severely intoxicate the consumer. Doctors frequently recommended laudanum, a compound which contains all of the opium alkaloids, as a painkiller and cough suppressant. It too, was available over the counter, and its use was uncontrolled. During the Gilded Age laudanum was widely recommended by doctors for the treatment of menstrual cramps.

Heroin as a brand was removed from the US market in 1910. In 1914 the United States passed the Harrison Narcotics Tax Act to control the use of opioids, although heroin was still able to be prescribed by physicians. In 1924 the drug was banned from the United States entirely. Heroin is no longer a trademarked name, Bayer lost its rights to many trademarks following the First World War, as part of the recriminations imposed on Germany in the Versailles Treaty.

These 10 Abhorrent Medical Practices from History Will Make You Glad You Live in the 21st Century
Edward Jenner developed the smallpox vaccine after observing that those who had had cowpox were immune to smallpox. Wikimedia

Smallpox Vaccinations

It was once a rite of passage for American children prior to the onset of their academic career to receive a vaccination against smallpox. The vaccine site led to a scab, which after falling off left a scar on the shoulder opposite the patient’s dominant arm. The smallpox vaccine was the first successful vaccination ever developed, and it provided a defense against what was once one of the deadliest and most contagious diseases known.

Initially there was strong resistance against the vaccine, particularly the vaccination of children, which parents feared would lead to the development of the disease itself. In the early days of vaccination several experimenters did contract the disease, some fatally. It took Dr. Edward Jenner to develop the theory that people who had previously caught the disease known as cowpox were immune to smallpox. Jenner’s development of a working vaccine stemmed from his observations.

In Europe compulsory vaccination laws were in place by the 1870s, although always controversial. In the United States the federal government left the matter of vaccination up to the states. Throughout the nineteenth century the pendulum swung back and forth as states made vaccination mandatory and relented, allowing for voluntary vaccination based on individual choice. Some states made it compulsory to vaccinate infants, and refused access to public education facilities for those who were not.

Most doctors recommended the smallpox vaccination, and many states followed their recommendations in requiring it of children prior to the beginning of schooling, whether it be in public or private school. In the United States, smallpox was eventually controlled to the point that routine vaccinations were discontinued in the early 1970s. Military recruits and those planning overseas travel were still required in most cases to be vaccinated.

Today smallpox is considered to have been eradicated, although there are still samples of the virus contained in controlled laboratory storage. Some medical professionals continue to be vaccinated and anti-bioterrorist plans call for a number of doctors, nurses, and other medical professionals be vaccinated as a defense against a deliberate smallpox attack.

These 10 Abhorrent Medical Practices from History Will Make You Glad You Live in the 21st Century
A fountain at the Chapel of St. Fiacre, patron saint of hemorrhoid sufferers, who cured his by sitting on a rock. Wikimedia

Hemorrhoid Treatments

Hemorrhoids can be a relatively minor nuisance, little more than an embarrassment, or a serious problem requiring surgery to correct. They can be internal or external, improve on their own or require intervention, and have been a problem for humans since at least the year 1700 BCE. There is an industry built around the over the counter medicines, suppositories, creams, cushions, appliques, and other methods of contending with the discomfort they cause. The efficacy of nearly all of them is questionable based on scientific evidence, other than as a temporary relief from itching.

There is evidence that hemorrhoids may have at least once been the result of God’s wrath. The First Book of Samuel (KJV) describes a plague of emorods suffered by the Philistines after they seized the Ark of the Covenant. The emorods struck the sufferers in their “secret parts” and was not alleviated until the Ark was returned. The emorods proved fatal for some of the Philistines. Emorods is an archaic word used as the English term for hemorrhoids as recently as the nineteenth century.

Another religious connection is through St Fiacre, who is the patron saint of those suffering from them and whose name is connected to a rock upon which he sat to cure his own hemorrhoids, caused by overworking in the fields. The rock eased his complaint, and in medaeval Europe several rocks of suitable shape and size were said to be the one with the miraculous healing power.

An alternative treatment came at the hands of a physician. Believing the hemorrhoids to be caused by being engorged with blood, a doctor would heat iron rods to a temperature sufficient to cauterize the hemorrhoids, after which the rod would be inserted into the rectum and placed against the hemorrhoid if it was internal. External hemorrhoid sufferers were spared at least the pain of the insertion. The procedure would have done nothing other than that which is done by most of the over the counter treatments available today, that is, amuse the patient while waiting for nature to take its course.

Hippocrates described both a procedure for surgically removing hemorrhoids and a preventative to be taken after the surgery was complete. He recommended Hellebore, a plant which is highly poisonous and which he frequently recommended as a purgative, which in the case of hemorrhoids he likely intended to be used as a combination of laxative and stool softener. The surgery he described is not unlike one of the techniques used today, that of a ligature tying off the swollen tissue, which then dies and drops off harmlessly.

These 10 Abhorrent Medical Practices from History Will Make You Glad You Live in the 21st Century
A patient undergoing insulin shock therapy. The attendant in the back is pouring glucose into a feeder tube. Wikimedia

Insulin Shock Therapy

Also known as insulin coma therapy, insulin shock therapy was a means of inducing a coma in a person suffering from mental disorders. It was developed in Austria in the 1920s and was used to place a patient, usually suffering from schizophrenia but also used for other mental disorders, in a series of comas over a span of several days. The therapy required massive doses of insulin. By the mid to late 1940s it was in regular use in most of the psychiatric hospitals and treatment facilities in the United States and in the United Kingdom.

The treatment was hard on the patient and on the facility providing it, as it required a number of medical professionals to monitor the comatose patient over its course. Small doses of insulin were gradually increased on a daily basis until the level of the coma reached that desired by the physician, at which point the dosages remained at the level indicated. The number of comas to be induced was likewise determined by the experience and skill of the physician. Usually the therapy was stopped after sixty comas, but there were instances of the therapy continuing for more than two years.

The point of the therapy was for the comatose patient to develop seizures, which in the psychiatric profession of the time were considered beneficial for the patient. Because the seizures could occur before entering the coma as well as when in the comatose state the patient required continuous monitoring to prevent injury caused by out of control limbs, thrashing around, or swallowing the tongue.

Among the psychiatric profession the efficacy of insulin shock therapy was debated. Its founder believed it to be more than 80% successful in the treatment of schizophrenia. Detractors believed that it did nothing other than possibly encourage remission of the illness in patients which would have gone into remission on their own. Some believed that it enhanced the efficiency of electroshock therapy when the two procedures were used interchangeably. By the early 1950s British doctors were arguing against its use. In the United States patient’s committed by legal action were often forced to undergo both insulin shock therapy and electroshock therapy.

Most patients selected for insulin shock therapy had a prognosis which indicated that their treatment was likely to be successful, allegedly required because of the intensive nature of the treatment and the demands it placed on the hospital staff. Hospitals simply couldn’t afford to tie up limited resources on patients who were unlikely to improve. This alone skewed the results. When another British study revealed that the same results obtained with insulin could be had by coma induced through barbiturates (without seizures) it placed insulin shock therapy in further doubt. By the 1970s it was no longer considered a useful treatment for mental disorders and its use has been discontinued in the United States.

 

Sources:

Bloodletting Over the Centuries. Gilbert Seigworth.

Encyclopedia of Ancient Greece. Nigel Wilson

Pox: Genius, Madness, and the Mystery of Syphilis. Deborah Hayden

Syphilis and the Use of Mercury. The Pharmaceutical Journal

History of Medicine Volume I: Primitive and Ancient Medicine

Tobacco in Folk Cures in Western Society. Katherine Kell

Two Millennia of Impotence Cures adapted from Impotence. Angus McClaren

The Saturday Evening Post, May 24, 1941.

Rosemary, the hidden Kennedy daughter by Kate Larsen, The New York Times.

Yes, Bayer Promoted Heroin for Children. The Business Insider

The Smallpox Story: Life and Death of an Old Disease. A.M. Behbehani

King James Bible: I Samuel Chapter 5

The Insulin Myth, The Lancet. H. Bourne

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