Top 10: horrifying Halloween healthcares

As a 40-year veteran of the study, modern medicine is starting to look like science fiction. If you are (perhaps) morbidly curious you will either need to take a voyage into the past to find your kicks (or horror films). Medicine in history is not pretty, ranging from the deadly and disgusting to the downright dumb. A brief foray into some of the medical ideas and procedures we have inflicted on ourselves will have you wondering how we, as a species, survived! Prepare to be astounded, amused and appalled in equal measure...

Amputation

Prior to the introduction of the screw tourniquet in 1718, amputations almost always ended in death. For example, during the Napoleonic wars, sailors injured during fierce gun battles would undergo amputations while awake, without painkillers or anaesthetic. Most died from the shock induced by the extreme blood loss and intense pain. Hygiene and sanitation were poor. Surgeons didn’t understand what caused infection and would operate using ‘dirty’ instruments and often re-use bandages. If an amputee were fortunate enough to survive a procedure, they would often end up succumbing to infection.?

And yet, some 31,000 years ago in the misty rainforests of the island of Borneo, stone tool met bone and a limb was severed and a young life was saved [1]. Researchers recently found evidence for the earliest known surgical amputation, tens of thousands of years before the advent of modern surgical tools, antibiotics, or painkillers.

Bloodletting

Phlebotomy (aka bloodletting) dates back to the ancient Egyptians. They believed that releasing blood from the body would cure diseases such as the bubonic plague. Some even believed that it could cast out evil spirits. Procedures generally followed one of two methods; opening a vein with a sharp object or lancet or by applying blood sucking leeches. Apparently, the popularity of bloodletting as a treatment grew during the Roman Empire, boosted by the teachings of the influential Galen of Pergamum. His writings expanded on Hippocrates’ earlier theory that good health required a balance of the four ‘humours’ - blood, phlegm, yellow and black bile. The procedure was used widely in medieval Europe, becoming the standard treatment for an array of medical conditions.

Although medical studies discredited the practice of phlebotomy in the late 1800s, it should be noted that modern medicine suggests that the procedure bloodletting (in the form of blood donation) is associated with positive long-lasting effects (i.e., feelings of satisfaction, greater alertness, increased wellbeing, etc.) [2]. Something I observed myself when providing blood for my PhD experiments.?

Ancient Egyptian Medicine

Medical procedures practiced by the ancient Egyptians were believed to be highly advanced. Although they believed in prayer as a solution to health problems, they also had a good understanding of the body, used natural, or practical, remedies, such as herbs and would dispense fairly sound medical advice for many conditions. Egyptian society was well-structured, with tools such as written language and mathematics, which enabled them to record and develop ideas, and it meant that others could learn from them.?

Nevertheless, Egyptian doctors would sometimes prescribe peculiar treatments. Various prescriptions have been uncovered where they prescribe medications with animal dung as the main ingredient. The Egyptians had no concept of the bacteria that patients would be exposed to and likely caused many serious infections. It was common practice in the case of major flesh wounds to bandage the area with fresh meat. Burns would be treated with black mud, applied immediately, followed by the application of animal excrement on the second day. The Ebers Papyrus contains over 700 remedies and magical formulas and scores of incantations aimed at repelling demons that cause disease [3].

The Black Death?

The outbreak of bubonic plague in Medieval England circa. 1348-1350 killed over a third of the population. Estimates suggest plague was only the seventh health issue of the age. Although lethal and disruptive, it struck only periodically and had less cumulative long-term human consequences than chronically endemic conditions [4]. And yet, it has placed a scar on our collective memory, one that could well have been awaked (in some) with the current COVID 19 pandemic.

Ironically (when compared with the present day), medieval health was above all an ecological struggle against a diverse host of infectious pathogens; with social inequality being an important contributing factor. Medical knowledge at the time of the plague was limited, common treatments included bloodletting, sweating, and forced vomiting. To treat associated swellings, you might apply the flesh of a freshly killed pigeon to the affected area. This would be done by cutting the pigeon open and placing the entire body on to the wound – there has been no modern-day comparative study to confirm the efficacy of this procedure. Not surprisingly, patients infected with the plague tended to??die within days.

Electroconvulsive therapy

Few treatments have as rich a past as that of electroconvulsive therapy (ECT). The discovery of ECT garnered much interest at a time when there were few effective interventions for psychotic disorders. Its roots lie in the concept of using one disease to treat another, which was spurred by the discovery of malarial therapy for neurosyphilis. In 1930s, researchers observed greater microglia concentrations on pathologic brain sections from patients with epilepsy, compared with patients with schizophrenia, and theorized that seizures could be used to treat psychiatric disease. Some clinical success was achieved using epileptogenic agents to induce seizures but patients would often suffer from sympathetic overdrive and a profound sense of terror.

Medical practitioners looked at using electrical means of inducing seizures, with its quicker onset and fewer side effects – though one approach inserting an electrode in the mouth and another in the anus was found to induce cardiac arrest. The procedure was subsequently refined, focusing the electrical current cranially. The early history of ECT is probably a reason for its bad press [5]. Initially, the convulsions evoked by ECT were violent, causing fractures (often spinal) and other injuries. So, practitioners started administering muscle relaxing drugs before ECT to reduce the severity of the convulsions. This created another issue: the muscle relaxants temporarily induced complete paralysis, in itself terrifying for patients. Physicians began using anaesthesia, allowing patients to remain blissfully unaware.

Lobotomy

As a young pharmacology student I was introduced to Phineas Gage (picture below), a respectable engineer who survived having a metal 1 m tamping stick shot through his head – and lived. Apparently, the change in Mr Gage’s personality was inspiration for the procedure of lobotomy. It was, perhaps, the most brutal, barbaric and infamous medical procedure of all time: an ice pick hammered through the eye socket into the brain and "wriggled around", often leaving the patient in a vegetative state.

The first lobotomy was performed by a Portuguese neurologist who drilled holes into the human skull [6]. But it wasn't until an American psychiatrist adapted the procedure — using an ice pick and hammer — that the term lobotomy became widely known and feared. Writer Dorothy Parker once quipped, "I'd rather have a bottle in front of me than a frontal lobotomy." The ‘popularity’ of lobotomies spread like wildfire, with thousands of people being subjected to the 10-minute procedure. One of the biggest tragedies is that the general public were unaware of horrific consequences. Before-and-after photos promoting the procedure often showed a manic-looking person (before) followed by a photo of the same person looking calm, or even smiling (after). Few knew that, in the ‘after’ picture the patient was often more zombie than human. Eventually, the horrors of the lobotomy came under attack from the medical community. By the 1970s, several countries had banned the procedure altogether.

Trepanation

Humanity’s oldest form of surgery (and possibly its most gruesome) should perhaps precede rather than follow lobotomy. As far back as 7,000 years ago, civilizations around the world engaged in trepanation—the practice of boring holes in the skull. It was believed to be used as a means of curing illnesses and in some areas may have been quite widespread. Researchers can only speculate on how or why this grisly form of brain surgery first developed. A common theory holds that it may have been some form of tribal ritual or even a method for releasing evil spirits believed to possess the sick and mentally ill. Others argue that it was a more conventional surgery used to treat epilepsy, headaches, abscesses and blood clots.?

The main archaeological evidence involves cave paintings and human remains. Trephined skulls have been discovered in locations across the globe, dating from the late Palaeolithic era to this century. Skulls found in Peru hint that it may have been a common emergency treatment for cleaning out bone fragments left behind by skull fractures, and evidence shows that many of the patients survived the surgery. One can only assume that the procedure wasn’t pleasant - five main methods of trephination have been identified: rectangular intersecting cuts (first made with obsidian, flint, or other hard stone knives and later with metal ones), scraping with a flint, cutting a circular groove and then lifting off the disc of bone, use of a circular trephine or crown saw and drilling a circle of closely-spaced holes before chiselling out the bone between the holes [7].

Mercury

Mercury has been considered an almost magical substance for over 3,500 years, and it has been used for commercial and medical purposes to eradicate disease. The medical use of mercury (liquid metal mercury) is well documented in records from ancient Greece, India, Persia, Arabia and China. Second-century Chinese alchemists prized liquid mercury, or ‘quicksilver,’ and red mercury sulphide for their supposed ability to increase lifespan and vitality. Some healers even promised that by consuming noxious brews containing mercury their patients would gain eternal life and the ability to walk on water. One of the most famous casualties of this promise was the Chinese Emperor Qin Shi Huang, following his attempts at immortality. After his death, Sir Isaac Newton's hair was examined and found to contain high levels of mercury, probably resulting from his alchemical pursuits. Mercury poisoning has been postulated as explaining his eccentricity in later life.?

From the Renaissance until the early 20th century, mercury was used as a medicine for sexually transmitted diseases like syphilis. Some accounts claimed the treatment was successful in fighting off the infection, but patients often died subsequently from mercury-induced liver and kidney damage. Mercury still plays an important role in traditional medicines in Asia and continues to be used in traditional Chinese medicine.?

Cannibal Cures

For several hundred years, peaking in the 16th and 17th centuries, many Europeans, including royalty, priests and scientists, routinely ingested remedies containing human bones, blood and fat as medicine for everything from headaches to epilepsy. There were few vocal opponents of the practice, even though cannibalism in the newly explored Americas was reviled as a mark of savagery. Suffering from persistent headaches, muscle cramps or stomach ulcers? Your local apothecary would likely have prescribed an elixir containing the ‘parts’ of a close relative or local celebrity. The Romans believed that the blood of fallen gladiators could cure epilepsy, and 12th century apothecaries were known for keeping a stock of “mummy powder”—a macabre extract made from ground up mummies looted from Egypt. However, somewhat reminiscent of today’s medicinal counterfeiter’s, you could never be certain that your love philtre was actually made from the toe of St Peter or even ‘love-in-idleness’, otherwise known as the wild pansy (Viola tricola).??

The medical trade and pharmacological use of human body parts and fluids arose from the belief that because the human body is able to heal itself, it can also help heal another human body. By consuming the remains of a deceased person, the patient also ingested part of their spirit, leading to increased vitality and wellbeing. The type of cure prescribed usually corresponded to the type of ailment—skull was used for migraines, and human fat for muscle aches—but getting fresh stock could be a gruesome process. In some cases, the sickly would even attend executions in the hope of getting cheap off-cuts.

The tobacco smoke enema (This has to be a favourite)?

Tobacco started to arrive on English shores from the Americas in the late 1700s. As with any problem looking for a solution, pedlars of ‘the leaf’ quickly looked to exploit perceived medicinal properties. Clearly, some wag came up with the idea that, when used as an enema, tobacco smoke could cure a wide range of ailments. As the name suggests, a tobacco smoke enema involves literally blowing smoke up the patient’s rectum.

The Royal Human Society left resuscitation kits — including the equipment necessary to carry out a tobacco enema — at certain points along the river Thames (for those who might fall in and be ‘near-drowned’). Tobacco smoke enemas were thought to both warm the patient from within and stimulate respiration. One particularly graphic description is described in a paper published in The Lancet from 1746 (“A man’s wife was pulled from the water apparently dead”) – raising questions over whether or not The Lancet’s publishing standards have dropped over the last 250 years [10]. The article notes: “Amid much conflicting advice, a passing sailor proffered his pipe and instructed the husband to insert the stem into his wife’s rectum, cover the bowl with a piece of perforated paper, and ‘blow hard.’ Miraculously, the woman revived.” Word of their benefits quickly spread, and people were soon using tobacco smoke enemas to treat everything from headaches and abdominal cramps to typhoid and cholera. Apparently, the introduction of bellows made the job slightly less hazardous.?

Perhaps surprisingly, once evidence started to emerge that tobacco caused damage to the heart, the tobacco enema fad began to decline at some point in the early 1800s. To this day you can still smoke it though – and if that isn’t a nightmare, I don’t know what is.

Fortunately, many of these weird and wonderful medical practices have died out. However, medicine remains amazing. For example, bloodletting is used to treat haemochromatosis (iron overload). Maggot therapy, once used to clean injuries, remove dead flesh and prevent gangrene, fell out of favour with the advent of antibiotics, only to emerge again with the advent of antibiotic resistance. In 2004, the FDA approved the use of maggots in medicine as a valid 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!

Tim Hardman?is Managing Director of?Niche Science & Technology Ltd., a bespoke services CRO based in the UK. He is also Chairman of the?Association of Human Pharmacology in the Pharmaceutical Industry, President of the?European Federation for Exploratory Medicines Development?and an occasional commentator on science, business and the process of drug development.

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). https://doi.org/10.1038/s41586-022-05160-8

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. doi: 10.1046/j.1423-0410.2003.00271.x. PMID: 12609018.

3 Hallmann-Miko?ajczak A. Papirus Ebersa. Ksiega wiedzy medycznej egipcjan z XVI w P.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. doi: 10.1016/j.ijpp.2021.06.011. Epub 2021 Jul 5. PMID: 34237609.

5. Suleman R. A Brief History of Electroconvulsive Therapy. Am J Psych Res J. Published Online:10 Sep 2020https://doi.org/10.1176/appi.ajp-rj.2020.160103

6. Charleston LJ. An ice pick to the brain: The horror of the frontal lobotomy. https://www.nzherald.co.nz/world/an-ice-pick-to-the-brain-the-horror-of-the-frontal-lobotomy/C2X63F5EDPOOGYJKKSRYMKGZEE/

7. Gross GC. A Hole in the Head: A History of Trepanation. https://thereader.mitpress.mit.edu/hole-in-the-head-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 https://doi.org/10.3389/fphar.2022.807807

9. Dolan M. The Gruesome History of Eating Corpses as Medicine. The Smithsonian Magazine. May 6, 2012. https://www.smithsonianmag.com/history/the-gruesome-history-of-eating-corpses-as-medicine-82360284/

10. Lawrence G. Tobacco smoke enemas. April 20, 2002DOI:https://doi.org/10.1016/S0140-6736(02)08339-3