“Somewhere, something incredible is waiting to be known.” – Dr. Carl Sagan
In August of 1810, the English writer, Frances Burney, then living in Paris with her husband, General Alexandre D’Arblay and son, Alexander, developed pain in her right breast. She saw several French doctors. Fearing she may have breast cancer, a right mastectomy was ultimately recommended. The surgery was scheduled for September 30, 1811. In a period where surgery was done without anesthesia, she was given only a 2 hour notice. This was so she wouldn’t be frightened off. The surgery was attended by “7 men in black, Dr. Larrey, M. Dubois, Dr. Moreau, Dr. Aumont, Dr. Ribe, & a pupil of Dr. Larrey, & another of M. Dubois”. She was given some wine cordial after which she lay on the mattress designated as the operating surface. Her face was then covered with a transparent handkerchief. Below is part of her account of what happened:
“When the dreadful steel was plunged into the breast—cutting through veins—arteries—flesh—nerves—I needed no injunctions not to restrain my cries. I began a scream that lasted unintermittingly during the whole time of the incision—& I almost marvel that it rings not in my Ears still! So excruciating was the agony!”
Frances Burney survived the the mastectomy and lived another 29 years, dying at the age of 87. After the operation, she couldn’t think or speak of it for several months, had terrible headaches but had the courage to write an account of it to her sister.
Surgery before the discovery of anesthesia was so barbaric, some surgeons got drunk together with the patient for the ordeal. Surgeons were known to enter the theater with a bottle of wine in each hand – one for the patient and one for the surgeon. John Hunter, an early Scottish surgeon described surgery as ‘a humiliating spectacle of the futility of science’ and the surgeon as ‘a savage armed with a knife’! Techniques that were used to make it bearable for the patients included alcohol, opium, knocking the patient out with a blow to his jaw, rubbing them with stinging nettles and hypnosis. Patients would vomit and aspirate, blood loss was massive and the screams were haunting.
Now surgery is a painless, safe affair thanks to all the advances in anesthesiology, surgery and pharmacology.
Medicine and surgery have come really far from the days of Hippocrates. Matter of fact, they have even come father since a hundred years ago! Beliefs have changed and practices improved due to research. Whole diseases like the small pox have been eradicated even if we have replacements like HIV.
Talking about beliefs, the ancient Greeks, based on the teachings of Plato and Hippocrates, believed a woman’s womb was a separate creature with a mind of it’s own. When a woman did not bear children or abstained from sex, her uterus, hungry for children, could dislodge and float freely about her body causing shortness of air, seizures and mania. Women were advised to marry young and have a ton of kids. For a womb that had already broken free, doctors would “fumigate” the patient’s head with sulfur and pitch while simultaneously rubbing scented oils between her thighs. Why? The womb would flee from the bad smells and move back into its rightful place!
Or take the practice of bloodletting. The practice was common in ancient Egypt and got carried over to the Greeks, with Hippocrates and Galen being huge proponents. It was believed then that the human body contained the four “humors” – blood, phlegm, black bile, yellow bile – each centered in a particular organ—brain, lung, spleen, and gall bladder – respectively. Disease was thought to be from over-abundance of the humor blood so “letting” blood out of the body, brought the humors back in balance and healed the sick. Menstruation was seen as the body’s natural way of bloodletting to balance out the humors.
Now there are conditions like polycythemia vera, where the body produces too many red blood cells. A treatment option is bloodletting (Phlebotomy) and that is done even today. However bloodletting then was done for any and all ailments!
Bloodletting was common practice till the 18th century in Europe and the 19th in the US. As late as 1942, there were medical textbooks with bloodletting as a therapeutic procedure for all sorts of conditions. Dr Benjamin Rush, one of the signatories of the Declaration of Independence, was a fierce proponent of the practice.
The most famous victim of bloodletting in the US is probably the first president, Gen. George Washington. He had been sick and unable to swallow from a severe throat infection for a few days. On December 14, 1799, he asked his physicians to perform bloodletting on him. 124 – 126 ounces (3.75L) of blood was let out over a ten hour period by his physicians. The president weighed about 230 lb (104.5 kg) and was 75 in tall. Since the blood volume in an adult male is 70 ml/kg, his total blood volume was about 7.3 L. This means that, on the day he died, his physicians let out half of his blood volume. We know today that, that amount of blood loss leads to profound hypotension, shock, organ hypoperfusion and death. No wonder the president appeared calm before his death. He was probably in shock!
Luckily, there were men like Pierre Louis (1787-1872) and John Hughes Bennett (1812–1875) whose statistical analysis of medical data then helped put an end to the practice.
It’s not only beliefs and practices that have changed over time but also some drugs used. To mind comes mercury. A heavy metal, it is now known as a very toxic substance. It comes in three forms – elemental mercury, inorganic salts, and organic compounds. The organometallic Methylmercury is the most poisonous. Nowadays, mercury is found mostly in whale and dolphin meat, certain fungicides and skin lightening products.
It causes irreversible damage in fetuses, infants, and young children. It is damaging to the the neurons and causes cerebral infarctions, causing Minimata disease (Ataxia, Visual-field loss, Psychiatric disturbances, Sensory loss and Chronic Paresthesias). It is also toxic to the kidneys. The phrase “mad as a hatter” comes from the times when mercury compounds were used for the production of felt hats and led to the poisoning of the workers in the 18th – 19th centuries. So we can agree that mercury is bad.
Well, the Persians, Greeks and Chinese thought it increased vitality. The Chinese Emperor Qin Shi Huang died after ingesting mercury pills designed to make him immortal! From the 17th to 18th century, a drug called “Blue Mass”, containing 33% mercury was used to treat syphilis tuberculosis, constipation, toothache, parasitic infestations, and the pains of childbirth. From about 1930 till 1999, Thimerosal, a mercury-containing preservative was used in some vaccines. Thankfully, there is great awareness of the dangers of mercury now.
It is definitely a great time to be practicing medicine. Even as we hurtle along, ever adding newer drugs, treatment options and procedures to our armamentarium, lets not forget where we as healers have come from.