I've been studying medicine for 40 years, and it's beginning to look like something out of science fiction. If you're (maybe) morbidly interested, you'll have to go back in time or watch horror pictures to get your fix. The past of medicine is not pretty. It includes things that are deadly, gross, and just plain stupid. If you look at some of the medical ideas and procedures that we've used on ourselves, you might wonder how we as a species have lived. Get ready to be shocked, pleased, and horrified all at the same time...

Amputation

Before the screw tourniquet was invented in 1718, amputations almost always led to death. During the Napoleonic Wars, for example, sailors who were hurt in intense gun fights would have limbs cut off while they were still awake and without painkillers or anaesthesia. Most of them died from shock caused by losing so much blood and being in so much pain. There was bad hygiene and cleanliness. Surgeons didn't know what caused infections, so they used "dirty" tools and patches over and over again. If an amputee were lucky enough to make it through surgery, they would often die from an illness.

Still, about 31,000 years ago, in the foggy jungles of Borneo, a stone tool cut off a limb and saved the life of a young child [1]. Researchers have recently found proof of the first known surgical amputation. This happened tens of thousands of years ago, long before modern surgery tools, antibiotics, or painkillers were invented.

Bloodletting

Phlebotomy, also known as drawing blood, has been around since the time of the Egyptians. They thought that letting blood out of the body could heal illnesses like the bubonic plague. Some people thought it could even get rid of evil powers. During procedures, one of two ways were usually used: a sharp tool or lancet was used to open a vein, or blood-sucking leeches were used. During the Roman Empire, bloodletting became more common as a treatment. This was likely because of what the influential Galen of Pergamum taught. He wrote more about Hippocrates' idea that the four 'humours' (blood, phlegm, yellow and black bile), or bodily fluids, needed to be in balance for health. In mediaeval Europe, the procedure was used a lot and became the usual way to treat a wide range of health problems.

In the late 1800s, medical studies shot down the practice of phlebotomy. However, it is important to note that modern medicine suggests that bloodletting (donating blood) is linked to positive long-lasting effects, such as feelings of satisfaction, greater alertness, increased wellbeing, etc. [2]. Something I saw for myself while giving blood for my PhD research.

Ancient Egyptian Medicine

People thought that the ancient Egyptians had very advanced medical techniques. They thought that prayer could help with health issues, but they also knew a lot about the body and used natural or practical remedies like herbs. They also gave pretty good medical advice for a lot of diseases. Egyptian society was well organised, and they had tools like writing and math that helped them keep track of and improve their ideas so that others could learn from them.

Still, Egyptian doctors would sometimes recommend strange medicines. It has been found that some orders call for medicines that contain animal dung as the main ingredient. The Egyptians didn't know what kinds of bacteria their patients would be exposed to, which is likely why they caused so many dangerous infections. In the past, people would often bandage large cuts in skin with fresh meat. First, black mud would be put on the burns right away, and then animal waste would be put on them the next day. The Ebers Papyrus has more than 700 cures, magical formulas, and spells meant to keep away monsters that cause illness [3].

The Black Death

Around 1348–1350, the bubonic plague hit England and killed more than a third of the people who lived there. It is thought that the plague was only the seventh major health problem of the time. It killed people and caused a lot of trouble, but it only happened sometimes and didn't have as many long-lasting effects on people as situations that happen all the time [4]. Of course, it left a mark on our collective mind, and the COVID-19 pandemic may have brought it back to life for some.

When compared to today, it's ironic that health in the Middle Ages was mostly an ecological battle against a wide range of infectious pathogens, with social injustice playing a big role. During the plague, doctors didn't know a lot about how to treat people. Common methods included drawing blood, making people sweat, and making them throw up. You could put the flesh of a newly killed pigeon on the area that hurts to reduce the swelling. To do this, the pigeon would have to be cut open and its whole body would be put on the wound. Unfortunately, there has been no modern comparative study to prove that this method works. Not surprisingly, people who got the plague usually died within a few days.

Electroconvulsive therapy

ECT, or electroconvulsive therapy, has been used for a very long time. A lot of people were interested in ECT when it was first discovered because there weren't many other treatments that worked for psychotic illnesses. It came from the idea of using one illness to treat another, which was sparked by the finding that malaria could be used to treat neurosyphilis. In the 1930s, researchers saw more microglia in the brains of people with epilepsy than in the brains of people with schizophrenia. They thought that seizures might be able to help treat mental illness. Some clinical progress was seen when epileptogenic agents were used to cause seizures, but the patients often had a strong fear response and felt very sick.

Doctors thought about using electricity to cause seizures because it would work faster and have fewer side effects. However, one method of putting an electrode in the mouth and another in the anus was found to cause cardiac death. After that, the process was improved by directing the electrical current to the brain. The bad press about ECT is likely due to its early past [5]. At first, ECT caused very violent seizures that broke bones (often spinal) and caused other damage. In order to make the seizures less severe, doctors started giving muscle-relaxing drugs before ECT. This led to another problem: the muscle relaxants made people briefly paralysed, which was scary for the patients. Anaesthesia was first used by doctors to keep patients completely unconscious.

Lobotomy

When I was a young pharmacy student, I met Phineas Gauge (pictured below), a good engineer who had a metal 1 m tamping stick shot through the head and lived. The change in Mr. Gage's personality may have been the inspiration for the lobotomy operation. An ice pick was hammered through the eye socket into the brain and 'wriggled around,' leaving the patient often in a vegetative state. It was one of the cruellest, most infamous medical procedures ever.

Portuguese neurosurgeons made the first lobotomies by drilling holes in people's heads [6]. But the word 'lobotomy' didn't become well known and feared until an American psychiatrist changed the procedure to use an ice pick and hammer. Someone once said, 'I'd rather have a bottle in front of me than a frontal lobotomy.' Which is funny. The 'trendiness' of lobotomies spread like wildfire, and thousands of people had the 10-minute surgery. One of the worst things about it is that most people didn't know about the terrible effects. Before-and-after pictures of the treatment often showed a person who looked crazy in one picture and then the same person looking calm or even smiling in the next. Not many people knew that the person in the 'after' picture was often more zombie than human. People in the medical field eventually spoke out against how horrible lobotomies were. There were several countries that did not allow the practice at all by the 1970s.

Trepanation

The eldest type of surgery (and possibly the bloodiest) should probably come before lobotomy instead of after it. Trepanation, the act of boring holes in the head, was done by people all over the world as early as 7,000 years ago. People thought that it could heal diseases, and it may have been very common in some places. Researchers have no idea how or why this horrible type of brain surgery came to be. Many people think it might have been a tribal practice or even a way to get rid of evil spirits that were thought to be controlling sick and mentally ill people. Many people say it was a normal treatment used to treat epilepsy, headaches, abscesses, and blood clots.

Cave paintings and human skeletons are the main pieces of evidence found by archaeologists. From the late Palaeolithic period to the present day, trephinated heads have been found all over the world. It may have been a routine emergency procedure to clean out bone fragments left behind by skull fractures, as skulls found in Peru suggest. Many of the patients who had the surgery survived. It's likely that the process wasn't fun. There are five main ways to trephinate: making cuts that cross each other in a rectangle (first with obsidian, flint, or other hard stone knives, and later with metal ones); scraping with a flint; using a circular trephine or crown saw to drill a circle of closely spaced holes and then chiselling out the bone between the holes; and scraping with a flint [7].

Mercury

Mercury has been thought of as almost magical for more than 3,500 years, and it has been used in business and medicine to cure illness. Records from ancient Greece, India, Persia, Arabia, and China show that mercury (the liquid metal) was used as medicine. In the second century, Chinese alchemists loved liquid mercury, also known as 'quicksilver,' and red mercury sulphide because they thought they could make people live longer and be healthier. Some doctors even told their patients that if they drank poisonous drinks with mercury in them, they would live forever and be able to walk on water [8]. One of the most well-known people who died because of this promise was the Chinese Emperor Qin Shi Huang, who tried to live forever but failed. After Sir Isaac Newton died, his hair was looked at and found to have a lot of mercury in it. This was likely because he was interested in alchemy. Mercury poisoning has been suggested as a reason for his strange behaviour later in life.

From the Renaissance to the early 1900s, mercury was used to treat syphilis and other STDs. Some reports said the treatment worked to get rid of the infection, but patients often died later from liver and kidney damage caused by the mercury. In traditional Asian medicines, mercury is still very important. It is still used in traditional Chinese medicine.

Cannibal cures

For several hundred years, especially during the 16th and 17th centuries, a lot of Europeans, including kings, priests, and scientists, regularly ate medicines made from human bones, blood, and fat to treat everything from headaches to epilepsy. Few people spoke out against the practice, even though cannibalism in the newly discovered Americas was seen as a sign of being wild. Having headaches, muscle cramps, or stomach ulcers that won't go away? Most likely, your local pharmacist would have given you an elixir with the 'parts' of a close family member or famous person from the area. The Romans thought that the blood of dead gladiators could fix epilepsy, and in the 12th century, druggists were known to keep 'mummy powder' on hand. This was an evil mixture made from ground-up mummies that had been stolen from Egypt. You could never be sure, though, that your love philtre was made from the toe of St. Peter or even 'love-in-idleness,' which is another name for the wild pansy (Viola tricola). This is a bit like how people today fake medicines [9].

People believed that since the human body can heal itself, it could also help heal another human body. This led to the medical trade and drug use of human body parts and fluids. By eating the body parts of a dead person, the patient also ate a part of their energy, which made them healthier and more alive. The type of medicine usually matched the illness. For example, skulls were used to treat headaches and human fat for muscle pain. But getting new supplies could be a very unpleasant process. People who were sick would sometimes even go to killings in hopes of getting cheap body parts.

The smoke from tobacco (This has to be a favourite)

In the late 1700s, tobacco began to come to England from the Americas. As with any problem that needs a solution, people selling 'the leaf' quickly looked for ways to make money off of what they thought were its healing powers. No one smart came up with the idea that tobacco smoke could cure a lot of different illnesses when used as a treatment. A tobacco smoke enema is exactly what it sounds like: smoke is blown up the patient's rectum.

For people who might fall into the Thames and be 'near-drowned,' the Royal Human Society left resuscitation kits with tools for a tobacco enema at different places along the river. People believed that tobacco smoke enemas would warm the patient from the inside and help them breathe. In an article from 1746 that was published in The Lancet, it says, 'A man's wife was pulled from the water apparently dead.' This very graphic description makes people wonder if The Lancet's publishing standards have gotten worse over the last 250 years [10]. There was a lot of different suggestions, so a passing sailor offered his pipe and told the husband to put the stem into his wife's rectum, cover the bowl with perforated paper, and 'blow hard.' Amazingly, the woman came back to life. As soon as people heard how helpful they were, they started using tobacco smoke enemas to treat everything from cholera and headaches to typhoid and stomach cramps. It looks like adding lungs made the job a little less dangerous.

As surprising as it may seem, the tobacco enema trend started to fade in the early 1800s, around the same time that proof started to show that tobacco was bad for the heart. You can still smoke it, though, which is scary as hell.

Many of these strange and interesting medical practices are no longer used, which is a good thing. But science is still amazing. One way to treat haemochromatosis (iron build-up) is to draw blood. Before antibiotics came along, maggot treatment was used to clean up wounds, get rid of dead tissue, and stop gangrene. It lost popularity, but it came back when antibiotics became less effective. When maggots were used in medicine for the first time in 2004, the FDA said it was a legal medical device. Medical studies showed that maggots placed on surgical incisions helped to clear more dead tissue from the sites than surgical debridement - though who knows which the patient might prefer. In a similar vein (sorry), the thought of ingesting someone else’s excrement might turn your stomach, but new medical treatments are using faeces-filled pills to treat gut infections caused by the germ Clostridium difficile – repopulating the intestines with beneficial bacteria. Finally, although viola tricolor is not able to induce love, extracts from the plant have been shown to be anti-microbial and cytotoxic.

In conclusion, the only advice I can give to the squeamish (assuming you got this far), is don’t look too closely or ask too many questions. Happy Halloween!

References

1. Maloney, T.R., Dilkes-Hall, I.E., Vlok, M. et al. Surgical amputation of a limb 31,000 years ago in Borneo. Nature 609, 547–551 (2022).
2. Nilsson Sojka B, Sojka P. The blood-donation experience: perceived physical, psychological and social impact of blood donation on the donor. Vox Sang. 2003 Feb;84(2):120-8.
3. Hallmann-Mikołajczak A. Papirus Ebersa. Ksiega wiedzy medycznej egipcjan z XVI wP.N.E [Ebers Papyrus. The book of medical knowledge of the 16th century B.C. Egyptians]. Arch Hist Filoz Med. 2004;67(1):5-14. Polish. PMID: 15586450.
4. Robb J, Cessford C, Dittmar J, Inskip SA, Mitchell PD. The greatest health problem of the Middle Ages? Estimating the burden of disease in medieval England. Int J Paleopathol. 2021 Sep;34:101-112.
5. Suleman R. A Brief History of Electroconvulsive Therapy. Am J Psych Res J. Published Online:10 Sep 2020
6. Charleston LJ. An ice pick to the brain: The horror of the frontal lobotomy.
7. Gross GC. A Hole in the Head: A History of Trepanation.
8. Zhao M et al. Mercury and Mercury-Containing Preparations: History of Use, Clinical Applications, Pharmacology, Toxicology, and Pharmacokinetics in Traditional Chinese Medicine Ethnopharmacology Front. Pharmacol., 02 March 2022
9. Dolan M. The Gruesome History of Eating Corpses as Medicine. The Smithsonian Magazine. May 6, 2012.
10. Lawrence G. Tobacco smoke enemas. April 2002.