Thread by @timecaptales

8 of history's worst medical practices:

1. Trepanning: Drilling a hole in a patient's skull - without any anesthesia, keep in mind - was once considered good medicine. Trepanation is one of the oldest known surgical procedures, dating back as long ago as the Mesolithic era - 10,000 B.C.E., before humans used metal tools. That also places it long before the medical pioneers Hippocrates in ancient Greece and Galen in ancient Rome got their hands on this technique.

Archaic medicine and cures tended to lean more toward mystical and ritualistic than scientific, and the practice of trepanning began in this way. Archaeologists theorize the technique allowed a practitioner to release the evil spirit (demons were considered the root of mental illness) trapped within the patient.

There's evidence it was also used to treat migraines and epileptic seizures, and over the years developed as a neurosurgical intervention for head injuries such as skull fractures and bone contusions.

While it sounds barbaric, there's evidence that many patients survived the procedure. Just be sure not to press too hard when treating skull fractures, warns Galen, or the "patient immediately lose all sensation and becomes motionless”. While that might sound obvious in the 21st century, that observation was an important discovery in anatomy and the human brain.

2. Lobotomy: A descendant of skull-drilling trepanation, doctors introduced lobotomy in the 1930s as a psychosurgery that removed certain brain nerves. Psychiatrists believed these nerves to cause depression, anxiety, and other forms of emotional instability.

Surgeons performed the procedure with a sharp instrument resembling an ice pick, lodged into the sedated patient’s eye socket, and moved back and forth into the brain’s frontal lobes. In the 1940s, mental hospitals in the U.S. were full to the brim, and lobotomies served to decongest them by treating patients with schizophrenia, bipolar disorder, and psychosis.

Despite lobotomy’s horrid nature, the world’s first lobotomist and creator of the procedure, Portuguese neurologist Egas Moniz, received a Nobel Prize in 1949 for his invention. The procedure went on to peak well into the end of the half-century.

By this time, experts introduced the first batch of effective psychiatric drugs, and lobotomy gradually fell into disuse. Interestingly, doctors still practice it today, albeit extremely rarely using more elegant and sophisticated tools. It is only a last resort for patients who have not responded to all other kinds of treatments.

3. Hemiglossectomy for Stuttering: Hemiglossectomy, a surgical procedure that involves the removal of half of the tongue, was historically used as a treatment for stuttering during the 19th century. This drastic method was based on the erroneous belief that stuttering was caused by physical abnormalities of the tongue.

The practice gained some attention after it was performed by German surgeon Johann Frederick Dieffenbach in 1841. Dieffenbach, who had some success with other surgical treatments, believed that by cutting away part of the tongue, he could alleviate the stutter.

Despite the procedure's initial promise, it quickly became evident that hemiglossectomy was not only ineffective but also extremely dangerous and debilitating. Patients often experienced severe pain, infection, and significant speech impairment following the surgery.

Moreover, many did not survive the procedure due to complications. Over time, the medical community recognized the barbarity and ineffectiveness of the practice, leading to its abandonment.

4. Tobacco Smoke Enema: In the late 1700s, tobacco started to arrive on English shores from the Americas. Along with it came 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 so-called pipe smoker London Medic would use the technique on those who fell into the river Thames and were near-drowned. Tobacco smoke enemas were thought to both warm the patient from within and stimulate respiration. The Royal Human Society left resuscitation kits - including the equipment necessary to carry out a tobacco enema - at certain points along the river.

One particularly graphic description from 1746 is described in a paper published in The Lancet. “A man’s wife was pulled from the water apparently dead,” it says.

“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.

As people were using the tobacco enema to treat increasingly serious diseases, the danger to the “medic” also increased.

For instance, if a practitioner were to accidentally breathe in rather than blow out — perhaps during a bout of tobacco-induced coughing — cholera flagellates could pass into their lungs and inflict them, fatally. Thankfully, the introduction of bellows made the job slightly less hazardous.

In the early 1800s, tobacco was shown to cause damage to the heart, and the tobacco enema fad thankfully began to decline.

5. Gum Lancing: In the old days, infant mortality was sky high; and much of the time, the reason for death was wholly unknown. Children frequently died at 6 months to 2 years of age, which, coincidentally, was around the time their first teeth were coming through.

The medical minds of the day thought this might not be a simple coincidence, so they concluded that the process of teething was also the cause of infant death.

In England and Wales in 1839, for instance, over 5,000 deaths were attributed to teething. Even by 1910, the figure was 1,600.

So, how did physicians combat the evils of teething?

Unfortunately for those children involved, they developed a wide array of interventions, including bleeding, blistering, and placing leeches on the gums. In some cases, they even burned the back of the baby’s head.

During the 16th century, French surgeon Ambroise Paré introduced gum lancing, and this became the preferred method. A paper published in The Lancet explains just how popular lancing baby’s gums became: “John Hunter would lance a baby’s gums ‘up to 10 times.’ J Marion Sims treated his first patient, a baby of 18 months old: ‘as soon as I saw some swelling of the gums, I at once took out my lancet and cut the gums down to the teeth.'”

The author continues, “The physician Marshall Hall wrote that he would rather lance a child’s gums 199 times unnecessarily than omit it once if necessary and he instructed his students to do it before, during, and after the teeth appeared, sometimes twice a day.”

It is as yet unknown how many children died from infections that likely developed following such procedures.

Lancing petered out, but it did not disappear for a surprisingly long time. Even as late as 1938, a dentistry textbook offered instructions for gum lancing a teething child.

6. Plombage: Before tuberculosis was treated with chemotherapy and antibiotics, doctors used plombage thoracoplasty, also known as collapse therapy, to forcibly collapse the lungs and allow the organ to rest and heal faster.

The practice, which emerged in the 1930s, required creating a cavity under the upper ribs and filling that space with paraffin wax, rubber sheets, ping-pong balls, and other materials that put pressure on the lungs to keep them from inflating. Unsurprisingly, patients experienced a whole range of serious complications affecting the lungs and even the esophagus, heart, and skin.

Surgeons pulled the plug on plombage thoracoplasty in the 1950s, after which few of the last wave of patients made it out alive long after the surgery. Today, doctors still use the treatment for certain conditions, such as empyema, in which pus collects between the lungs and inner surface of the chest wall.

However, it is important to note that plombage thoracoplasty has never been evaluated with randomized trials, so it remains a step in the dark for the medical community.

7. Mercury: Mercury is notorious for its toxic properties, but it was once used as a common elixir and topical medicine. The ancient Persians and Greeks considered it a useful ointment, and second-century Chinese alchemists prized liquid mercury, or “quicksilver,” and red mercury sulfide for their supposed ability to increase lifespan and vitality.

Some healers even promised that by consuming noxious brews containing poisonous mercury, sulfur and arsenic, their patients would gain eternal life and the ability to walk on water. One of the most famous casualties of this diet was the Chinese Emperor Qin Shi Huang, who supposedly died after ingesting mercury pills designed to make him immortal.

From the Renaissance until the early 20th century, Mercury was also used as a popular medicine for sexually transmitted diseases like syphilis. While some accounts claimed the heavy metal treatment was successful in fighting off the infection, patients often died from liver and kidney damage caused by mercury poisoning.

8. Bloodletting: Ancient physicians such as Hippocrates believed that humans consisted of four “humors,” or bodily substances. These substances were black bile, yellow bile, phlegm, and blood. They believed that if any of these humors became unbalanced, illness would arise. To cure the illness, the humors had to become rebalanced.

Illnesses such as fevers were often attributed to having “too much blood,” so bloodletting was required to restore the humors back to their normal balance. Physicians would typically choose an easily-accessible vein and allow some blood to drain out of the sick person into a container for disposal.

Some physicians later turned to leeches to do the dirty work for them, leaving the leeches on the skin of the patient to have their blood sucked out slowly through their skin.