Modern medicine would likely seem like magic to those who lived in the early 20th century. While medicine in the early parts of the 20th century was far advanced from the medieval days of leeches, most of their treatments were still misguided and often even barbaric by our modern standards. Many of the devices used in this treatments look more like something from a serial killer’s basement than state of the art medical technology. From nightmarish steampunk styled prosthetic limbs to treatment with deadly radium, many of the procedures of the early 20th century would have seemed more like torture than healing.
18. Early Wheelchairs
Wheelchairs have likely existed, in some rudimentary form, since between the 6th and 4th centuries B.C alongside the invention of wheeled furniture. However, they didn’t enter Europe until the 12th century A.D., and these early models were extraordinarily primitive and more akin to wheelbarrows than the modern chairs we have today. The earliest recognizable, self-propelled wheelchair didn’t exist until the 17th century, when German inventors Johann Hautsch and Stephan Farfler independently made several prototypes. Farfler himself was disabled and created what was called an “invalid chair” that consisted of three wheels controlled by various cranks and levers.
Until the 19th century, wheelchairs were primarily used by the wealthy as a means of transport for disabled people. The 19th century saw the rise of cheaper devices made for use in hospital settings to transport disabled patients. These models were more accessible for middle-class disabled people as well. The many disabled veterans left after the US Civil War led to a rise in the production of wooden wheelchairs, which were basically hard wooden seats on wheels. More modern bicycle-like wheels were introduced at the end of the 19th century, but these wheelchairs were still cumbersome and only fit for indoor use.
The collapsible metal tube wheelchair that we use today was not invented until the 20th century. This innovation allowed disabled people far more mobility regarding travel and outdoor use. Electric wheelchairs, rather than self-propelled models, were developed after World War II.
An innovation of the turn of the 20th century was the use of hot, dry air to treat various ailments. Samuel Howard Monell wrote A system of instruction in X-ray methods and medical uses of light, hot-air, vibration and high-frequency currents : a pictorial system of teaching by clinical instruction plates with explanatory text. It was published in 1902 and discussed the various ways in which the new field of radioscopy or fluorography, both early names for X-Rays, could be used to treat ailments ranging from cancer to pain. It also included an entire section on thermotherapy titled “Hot-Air Therapy.”
The manual advises that temperatures of 200° to 280° Fahrenheit may be applied to the whole body, with temperatures of 300° to 380° Fahrenheit used locally. It states that a patient’s body temperature will rise as many as five degrees during this treatment and that protocols must be followed precisely or severe burns may result.
While this treatment is genuinely terrifying and one wonders how many burn patients were a result, thermotherapy is still a part of modern medicine, although at much lower temperatures. Anyone who has received a muscle injury will likely be familiar with the heat packs, heating pads, and possibly even the more modern infrared heating used to apply soothing heat to the affected area.
The galvanic bath was a popular treatment for “rheumatic” or aching, arthritic joints in the early 20th century. The Schnee Four Cell Bath, invented in Germany, was a hit at its invention as it allowed those seeking a galvanic bath treatment to be able to stay clothed, a significant improvement for the speed of recovery and the modesty of those being treated. Those seeking treatment would sit in a chair with their arms and legs each in a separate porcelain tub filled with hot water that would then have low amperage currents sent through the water. There was no risk of electrocution with this model, as all four porcelain tubs were grounded and were not connected to any metal piping.
While the galvanic bath was thankfully a much safer model than previous forms of electric tubs, which required bathers to submerge their entire body in a tank of hot water that was then electrified, there is little evidence that low amperage currents have any effect on aching joints. If anything, the spa-like treatment of sitting with one’s limbs submerged in hot water likely did far more than anything else.
While X-Rays have doubtlessly saved hundreds of thousands of lives both through improved diagnostics and interventional radiographic medicine, early medical use of X-Rays was absolutely terrifying. Discovered by German scientist Wilhelm Röntgen in 1895, the use of X-Rays for medical diagnostics was quickly adopted in the United States. Samuel Monell’s 1902 manual on X-Rays, A system of instruction in X-ray methods and medical uses of light, hot-air, vibration and high-frequency currents : a pictorial system of teaching by clinical instruction plates with explanatory text, displays a lack of awareness of the dangers of X-Rays that, while appropriate for the era, is horrifying with our modern knowledge.
In his opening remarks on the new science, Monell stated, “Thus far there is no action of the X-Rays which is not also a known action of already known forms of electricity.” To the modern reader, we of course no that X-Rays are nothing like electricity and we must shudder to think of the lack of precaution early X-Ray technicians took to protect themselves and their patients from radiation exposure. It is safe to assume, from Monell’s publication, that early X-Ray patients would have been exposed to varying doses of radiation with little to no awareness of any potential dangers or side effects.
Many children’s lives were saved in the 20th century by the iron lung, which took over respiration while their paralyzed bodies fought off Polio. The iron lung, also known as a tank respirator or negative pressure ventilator, was invented in 1927 by Philip Drinker and Louis Agassiz Shaw Jr. The iron lung became an all-too-common sight in hospitals during the Polio epidemics of the 1950s in the United States. Many children only needed to use the giant machines for several weeks while their bodies fought off the infection, but some unfortunate children never regained their full nervous system capabilities and had to remain in iron lungs for the rest of their lives.
Life in one of the machines was an extraordinary experience. Those living inside one could only speak during the exhalation phase of the device. Eating and drinking had to be carefully timed to avoid choking during the inhalation phase of the machine. An iron lung patient, Larry Alexander, described the immense impact living in the machines had on the lives and minds of patients, saying, “There was a tremendous psychological element at work in all of us in our relationship to the lung. The metal respirator assumed an almost animate personality and became a symbol of protection and security…. We were incomplete embryos in a metal womb.”
Portable iron lungs, or cuirass respirators, were much smaller versions of iron lungs that worked very similarly. The pressure was applied to and removed from the chest to simulate respiration, just as in the iron lungs, but the pressure was applied to a much smaller area, which allowed the respirators to be portable. However, the limitations were mostly the same with speech only being possible upon the exhalation phase and eating and drinking needing to be carefully timed.
Disability activist and Polio victim Mark O’Brien put to words the experience of living with a permanent respirator in his poem “Breathing.”
Grasping for straws is easier; You can see the straws. “This most excellent canopy, the air, look you,” Presses down upon me At fifteen pounds per square inch, A dense, heavy, blue-glowing ocean, Supporting the weight of condors That swim its churning currents. All I get is a thin stream of it, A finger’s width of the rope that ties me to life As I labor like a stevedore to keep the connection. Water wouldn’t be so circumspect; Water would crash in like a drunken sailor, But air is prissy and genteel, Teasing me with its nearness and pervading immensity. The vast, circumambient atmosphere Allows me but ninety cubic centimeters Of its billions of gallons and miles of sky. I inhale it anyway, Knowing that it will hurt In the weary ends of my crumpled paper bag lungs.
While the strange, wired basins and sleeves of magnet therapy may look alarming, this treatment falls firmly in the realm of harmless placebo. Around the turn of the 20th century, magnet therapy was becoming a huge fad. Magnetic and electric necklaces, rings, bracelets, belts and more were being sold as magical cure-alls in numerous locations, even the legendary Sears-Roebuck catalogs of the era. The Food and Drug Administration (FDA) wasn’t founded until 1906, so the turn of the century was still rife with advertisements boasting miraculous claims that went unresearched by anyone.
After the FDA’s founding, research began on whether or not magnetic fields have any effect upon human health. They also began regulating the hyperbolic panacea claims of health products being marketed to the public. The World Health Organization (WHO) has found no evidence to show adverse effects on health from low levels of magnetism. Some research has found potential benefit in using pulsating electromagnetic therapy on arthritic joints. However, we can safely say that the cure-all electromagnetic devices of the early 1900s were merely snake oil.
The cobalt machine looks somewhat intimidating, but cobalt therapy is actually still used around the world for cancer treatment. Cobalt-60, a radioactive isotope of cobalt, was first used to treat a cancer patient in Saskatoon, Saskatchewan in 1951. In the procedure, a small cylinder of cobalt-60 is loaded into the head of the apparatus. The device is carefully pointed at the patient’s cancerous cells, and beams of gamma rays enter into the patient. The gamma rays kill healthy cells as well as carcinogenic, so the calibration of the machine is incredibly essential. Despite the destruction of healthy cells, the rates of survival for cancer went from 25% to 75% after the introduction of cobalt therapy.
While the United States and other wealthy and scientifically advanced nations have primarily moved on to Intensity-Modulated Radiation Therapy, or IMRT, which uses high-energy electron accelerators to produce X-Rays, many countries around the world still use the Cobalt-60 machines due to their relative ease of use and maintenance and much lower cost.
At the turn of the 20th century, X-Ray devices were the cutting edge of medical technology, with Wilhelm Röntgen only discovering X-Rays in 1895. Medical practitioners were quick to see how the miraculous new photographs produced with X-Rays could be used to diagnose and perhaps even treat numerous ailments. However, little was understood, especially within the medical community, about the dangers of the newly discovered X-Rays. Much like the other recent discovery of radium, all eyes were on the benefits with little thought given to the risks.
In the 1902 medical text, A system of instruction in X-ray methods and medical uses of light, hot-air, vibration and high-frequency currents : a pictorial system of teaching by clinical instruction plates with explanatory text, doctors are instructed in how to become self-taught X-Ray experts. The author denounces the lack of education manuals on the subject and offers a pictorial guide on how to learn to perform X-Rays including the correct dosing of the radiation. Yes, doctors in 1902 were learning how to dose radiation out of an extended pamphlet.
In the photo of the portable X-Ray, it is clear that the doctor and patient both have no safety equipment to reduce radiation exposure. One also wonders if this practitioner was self-taught in the science of X-Rays and how accurate his radiation dosage is.
Early prosthetic limbs were indeed no picnic, especially for those of middle or lower classes. Primitive prosthetic limbs were often quite uncomfortable, with first “peg legs” usually being connected by forcing a joint-like protuberance into a hollowed out cavity made in the stump of a patient’s leg at the time of amputation. Others had to be attached through straps and belts. Early models were also often rigid and contained no articulation, meaning there was no jointing to allow for anything resembling regular movement. While the wealthy and some inventors or artists developed more advanced prototypes with some primitive forms of action, these were out of reach for the average disabled person.
The woman in the photograph appears to have a modified version of an Anglesey Leg, named after the Marquess of Anglesey who lost his leg in the Battle of Waterloo. This leg, a vast improvement over earlier models, included a steel knee joint to allow for better movement. It also had an articulated foot that was controlled with catgut tendons running from the knee to the ankle. Later 19th-century improvements included suction cup attachment for better comfort as well as hiding the catgut tendons under smooth coverings for a more natural appearance.
Much like with wheelchairs, the US Civil War and its massive number of casualties led to a significant advance in prosthetics as well. World War II also led to rapid improvements in prosthetics, as did the disability rights movements of the 60s and 70s.
Hydrotherapy, using water as therapy, has been used by various civilizations for thousands of years. The therapeutic use of baths was recorded in ancient Egyptian, Greek, and Roman cultures. In the 19th century, hydrotherapy became a popular form of treatment for various chronic illnesses and disabilities. For wounds, the application of water was believed to fill in scars and push out the dirty or diseased fluids residing within them. The emergence of pus was referred to as a crisis and was sought through various methods of applying water including baths and compresses.
A strange and unfortunate form of hydrotherapy occurred in the early 20th century. Water of varying temperatures was believed to be an effective treatment for mental disorders and was used extensively in mental hospitals. Hypoactive patients would have cold water applied to them, through bathing, sprays or even being mummified in cold, wet blankets. Hyperactive or lethargic patients would be given warm baths, showers, or towel wraps in the belief that tiring, warming baths would calm them.
Hydrotherapy is still practiced currently, albeit in slightly different ways and for various reasons. Ice baths alternated with warm soaks are a vital part of sports medicine, with evidence that the alternating temperature cycles can help reduce the severity of athletic injuries due to reduced swelling and increased blood flow.
The Bergonic Psychiatric Device, or Bergonic Chair, was a device used to deliver an early form of electroconvulsive therapy (ECT) to mentally ill patients. Electroconvulsive therapy, often colloquially known as electroshock therapy or just shock therapy, involves intentionally inducing seizures with electricity to treat mental illnesses including major depression. While ECT has a long history of widespread (and controversial) use, it is now used as a last-line treatment for only a handful of diseases.
ECT, when used today, must only be given after the informed consent of the patient. It is done just after other treatments have failed or in emergency cases where suicide is imminent without relief from symptoms. The focus on informed consent is due to misuse in the past where patients were shocked without their informed consent, or sometimes without any consent at all. ECT also has a history of having been used as a threat against “unruly” mentally ill patients, especially in the mid 20th century. Ken Kesey’s famous novel, One Flew Over the Cuckoo’s Nest, depicts a fictionalized account of an unruly patient being shocked as a punishment. ECT also has a dark history of being used as part of gay conversion therapy, often against a patient’s will.
The original model of the electroretinogram looks like something out of a science fiction horror novel. The numerous wires going to the eyes make the woman in the photo either look like a cyborg being repaired or a victim of some devious dystopian torture. In reality, it’s just a very early model of a device that is still used today. Today’s devices look far less sinister, being either a handheld device reminiscent of a shop check-out scanner or a single monocle-like lens with a cord that sits over the eye.
This machine was first ever used on an amphibian’s eye in 1865 in Sweden. The procedure was first performed on a human in 1877. However, it wasn’t until the middle of the 20th century that the method became standardized and widespread. Ragnar Granit won the Nobel Prize for Physiology and Medicine in 1967 for his work with the electroretinogram.
The electroretinogram is both the device and the name for the diagnostic test which the machine performs. The test measures electrical activity generated cells in the retina in response to light as a stimulus. The analysis can provide diagnostic information on many retinal diseases, including night blindness and cancer.
The man in the photo is not being re-educated by the ministry of love or any other sinister organization. Instead, he is merely having his brainwaves measured in a very early rendition of the electroencephalogram (EEG.) An EEG is a test that measures the electrical activity of the brain, colloquially known as brain waves, to look for abnormalities. EEGs are commonly used for epilepsy, head trauma, and other brain diseases.
German psychiatrist Hans Berger performed the first EEG test in 1929. He published a manuscript “On the Electroencephalogram of Man” that laid out the foundation for EEG tests as we know them today. His findings were genuinely shocking at the time, and it took him almost ten years to convince his fellow physicians that his results were legitimate. However, by the middle of the 20th century EEGs were a widely used test with the focus now being on improving hardware rather than disputing Berger’s work.
Modern EEG set-ups don’t look terribly different than the photo. Numerous small discs with wires are pasted to the scalp. Despite the intimidating appearance, EEGs are painless and can often even be done on an outpatient basis. The EEG is also considered a minimal risk test, as no sensations or shocks or applied the electrodes record activity. One of the few documented side effects is seizures triggered by the flashing lights of the machine or the deep breathing required while taking the test.
In the 1930s, Italian physician Dr. M. Matarasso pioneered a method for removing freckles that literally required freezing them and digging them out of your face. He would freeze a patch with carbon dioxide, or dry ice, and then use a small dagger-like device to loosen and peel the pigmentation off of the face. Within a week or two, the skin would heal freckle-free. The procedure is similar to how plantar and regular warts are treated, with liquid nitrogen or other freezing element applied in a process called cryotherapy.
Not only is the apparatus on the woman in the picture somewhat intimidating, but cryotherapy is quite painful. The application of the cold stings a great deal, and the subsequent death of tissue is quite painful. One cannot even imagine how painful an entire face of such treatment must be! Hopefully, the woman in the photo only had a few removed at a time, not her full cheeks.
The sick child in the photo looks like he’s an Ebola patient being kept isolated from his caretakers at the hospital. In reality, he’s merely sitting in an oxygen tent. Oxygen tents are used to provide an oxygen-rich environment for patients who are having difficulty breathing, whether from a chronic disease like asthma or an acute illness like whooping cough, also known as pertussis. Oxygen tents are used in hospitals and can also be used in an outpatient or home setting when needed.
While they are less common today than they once were, oxygen tents are still used in situations where an oxygen mask or respirator may be difficult to wear or too uncomfortable for the patient. The oxygen tent allows the patient to be relatively unencumbered, as evidenced by the surprisingly happy looking child in the photo, but they do need to be kept sealed to keep the oxygen saturation high enough to be therapeutic. As with all oxygen treatments, one needs to be careful about sparks and open flames due to the combustible nature of oxygen.
Radium was considered, in the early 20th century, to be a borderline mythical panacea. The novelty of a glow in the dark substance led many to believe it was almost magical, and it quickly made its way into many health and beauty products and was marketed as a cure-all. While various charlatans and snake oil salespeople attempted to profit off of radium, the medical community believed that there were legitimate curative uses for the newfound radium.
It was believed, at the turn of the century, to be bactericidal, meaning that it would kill bacteria. It also was thought to be superior to the newly discovered X-Rays in the treatment of small areas of the body. The bactericidal nature, as well as its targeted use, led to radium being used to treat tuberculosis. It was also sometimes applied to the skin to treat disorders such as lupus and rodent ulcer. In Germany, experimentation was done with inhaling radium as a treatment for various illnesses. Radium in bath water was also used to treat gout and arthritis.
Once the incredible dangers of radium were finally realized, and more important, acknowledged, radium quickly fell out of favor for medical uses. Today, it persists only in a few particular cases, such as the treatment of cancers that absorb iodine.
Scoliosis is a relatively common condition, affecting about 3 percent of people, in which the spine has a sideways curve, often resembling the letters s or c. Scoliosis varies widely in severity, with some patients having minor curves that can be corrected through braces while others have severe deformity causing curves that require surgical correction. In the 19th century and early 20th century, braces would have to be based on plaster casts. While the woman in the photo may look like she’s being tortured, she’s actually being fitted with a plaster mold on which her brace will be based. Layers of linen or gauze are being wrapped around her, which will then be dampened with plaster material. Once the plaster mold dries, it will be cut off and used to cast the brace.
In current times, computer-aided drawing (CAD) software is used to design braces with non-invasive and easy measurements being all that is required of patients. This technology removed the need for plastering in adults. However, plaster casts may still be used in cases of infant scoliosis as it has been shown to successfully eliminate the need for bracing later in life when treated early.
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