14 surprising facts about the history of medicine
How did people in the past treat illness, injury and disease? What medicines did they use? Here, Caroline Rance shares 14 facts from the long and often shocking history of medicine – from the first general anaesthetic to early caesareans and medicinal leeches…
How did people in the past treat illness, injury and disease? What medicines did they use? Here are 14 facts from medicine’s long and often shocking history – from the first general anaesthetic to early caesareans and medicinal leeches…
Some of the earliest named doctors were women
Saqqara is a huge archaeological site about 20 miles south of present-day Cairo. Five millennia ago it was the necropolis for the ancient Egyptian city of Memphis, and remains home to one of the oldest surviving buildings in the world – the step pyramid of Djoser.
A nearby tomb reveals the image of Merit Ptah, the first female doctor known by name. She lived in approximately 2,700 BC and hieroglyphs on the tomb describe her as ‘the Chief Physician’. That's pretty much all that's known about her career, but the inscription reveals that it was possible for women to hold high-status medical roles in Ancient Egypt.
Some 200 years later another doctor, Peseshet, was immortalised on a monument in the tomb of her son, Akhet-Hetep (aka Akhethetep), a high priest. Peseshet held the title ‘overseer of female physicians’, suggesting that women doctors weren't just occasional one-offs. Peseshet herself was either one of them or a director responsible for their organisation and training.
Although the barriers of time and interpretation make it difficult to reconstruct the day-to-day practice of Merit Ptah and Peseshet, female doctors appear to have been a respected part of ancient Egyptian society.
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Cataract surgery was possible in the sixth century BC
One of the oldest known medical textbooks is the Sushruta Samhita, written in Sanskrit in India. Its exact date is tentative, as no original version survives and it is only known from later copies, but the current consensus is that it was written in around 600 BC. Sushruta is thought to have been a physician and teacher working in the North Indian city of Benares (now Varanasi in the state of Uttar Pradesh). His Samhita – a compilation of knowledge – provides detailed information on medicine, surgery, pharmacology and patient management.
Sushruta advises his students that however well read they are, they are not competent to treat disease until they have practical experience. Surgical incisions were to be tried out on the skin of fruits, while carefully extracting fruit seeds enabled the student to develop the skill of removing foreign bodies from flesh. They also practised on dead animals and on leather bags filled with water, before being let loose on real patients.
Among its many surgical descriptions, the Sushruta Samhita documents cataract surgery. The patient had to look at the tip of his or her nose while the surgeon, holding the eyelids apart with thumb and index finger, used a needle-like instrument to pierce the eyeball from the side. It was then sprinkled with breast milk and the outside of the eye bathed with a herbal medication. The surgeon used the instrument to scrape out the clouded lens until the eye “assumed the glossiness of a resplendent cloudless sun”. During recovery it was important for the patient to avoiding coughing, sneezing, burping or anything else that might cause pressure in the eye. If the operation were a success, the patient would regain some useful vision, albeit unfocused.
A ‘tree of life’ tackled scurvy
Trapped in ice near Stadacona (the site of present-day Quebec City) in 1536, Jacques Cartier's ships weren't going anywhere. The crews, holed up in a makeshift fort with little access to fresh food, came down with a disease so gruesome that “their mouth became stincking, their gummes so rotten, that all the flesh did fall off, even to the rootes of the teeth, which did also almost all fall out.” They had scurvy, now known to result from a deficiency of vitamin C. Cartier had no idea what to do.
During his first voyage to Stadacona in 1534, Cartier had kidnapped two young men, Dom Agaya and Taignoagny, taking them back to France as proof that he had discovered a new territory. Now that they were home, the men and their community had every reason not to trust Cartier – an attitude that he interpreted as “treachery” and “knavery”.
In spite of this tension, Dom Agaya showed Cartier how to make a decoction from a tree called Annedda and, although the Frenchmen wondered if it were a plot to poison them, a couple of them gave it a go and were cured within days. After that, there was such a rush for the medicine that “they were ready to kill one another”, and used up a whole large tree.
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The identity of Annedda is not certain but there are several candidates including eastern white cedar and white spruce. Whatever it was, its nutritional benefits resulted in the sailors' complete cure.
Cartier repaid Dom Agaya by kidnapping him again along with nine other people. By the time of Cartier's next voyage – to Canada in 1541 – most of the prisoners were dead, but Cartier informed their relatives that they were living in style in France. The scurvy cure did not gain widespread recognition and the disease continued to claim the lives of sailors for more than 200 years.
If you want a cure for everything, try theriac
Being a king in ancient times was exhaustingly dangerous; there was always someone plotting to get rid of you. So, according to legend, Mithradates (aka Mithridates) VI of Pontus (on the shores of the Black Sea in Turkey) attempted to become resistant to poisons by taking gradually increasing doses. He was also reputed to have conducted toxicological experiments on condemned prisoners, culminating in the creation of mithridate – a medicine that combined all known antidotes in one potent formula.
It didn't work against Roman armies, however, and when Mithradates was defeated by the military leader Pompey in 66 BC, the recipe supposedly arrived in Rome. Emperor Nero's physician Andromachus developed it into a 64-ingredient composition, which became known as theriac. Most of the ingredients were botanical (including opium), but viper's flesh was a notable component.
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In spite of early scepticism, theriac took off as a prized (and expensive) cure-all. By the 12th century Venice was the leading exporter and the substance had a high profile in European, Arabic and Chinese medicine alike. Its fortunes waned after 1745, however, when William Heberden debunked its alleged efficacy and suggested that enterprising Romans had exaggerated the Mithradates story for their own gain.
Even so, theriac remained in some European pharmacopoeias until the late 19th century.
General anaesthesia helped cancer patients at the beginning of the 19th century
Kan Aiya, a 60-year-old woman, had lost many loved ones to breast cancer. She had seen her sisters die of the cruel disease, so when a tumour formed in her left breast she was well aware of the likely outcome. For her, however, there was a chance of survival – an operation. It was 1804 and she was in the best possible place for surgery – feudal Japan.
Seishu Hanaoka (1760–1835) studied medicine in Kyoto and set up a practice in his hometown of Hirayama. He became interested in the idea of anaesthesia owing to stories that a third-century Chinese surgeon Houa T'o had developed a compound drug enabling patients to sleep through the pain. Hanaoka experimented with similar formulae and produced Tsusensan, a potent hot drink. Among other botanical ingredients it contained the plants Datura metel (aka Datura alba or ‘devil's trumpet’), monkshood and Angelica decursiva, all of which contain some potent physiologically active substances.
Tsusensan had quite a kick and if you glugged it down willy-nilly you would probably die, but in the correct dosage it rendered patients unconscious for between six and 24 hours, allowing ample time for surgery.
On 13 October 1804, Hanaoka excised Kan Aiya's tumour while she was under general anaesthesia, going on to operate on at least 150 more breast cancer patients and people with other conditions. Sadly, Kan Aiya is thought to have died of her disease the following year, but had been spared the agony that still characterised surgery in the West.
A ‘leech craze’ hit 19th-century Europe
The medicinal leech has been in use for thousands of years, and is even today considered to be a way of restoring venous circulation after reconstructive surgery. But it was in the early 19th century that the leech really soared in popularity. Led by French physician François-Joseph-Victor Broussais (1772–1838), who postulated that all disease stemmed from local inflammation treatable by bloodletting, the ‘leech craze’ saw barrels of the creatures shipped across the globe, wild leech populations decimated almost to extinction, and the establishment of prosperous leech farms.
Leeches had advantages over the common practice of bloodletting using a lancet – the loss of blood was more gradual and less of a shock for those of delicate constitution. And because Broussais's followers used leeches in place of all the other medicines at the 19th-century physician's disposal, patients were spared some harsh remedies that might otherwise have made them feel worse. In 1822, a British surgeon called Rees Price coined the term sangui-suction for leech therapy.
Ugandan surgeons developed life-saving caesarean operations
In 1884, the caesarean section was not a new idea. It dated from the time of the Caesars, for a start, when Roman law required the procedure to be carried out in the event of a woman's death in childbirth.
Over the centuries, reports occasionally surfaced of caesarean sections saving the lives of both mother and baby, but even after the introduction of antiseptic methods and anaesthesia, caesareans remained a dangerous last resort. So Edinburgh surgeons were surprised to hear a lecture by Robert Felkin, a missionary doctor, about a successful operation that he had witnessed in the African kingdom of Bunyoro Kitara five years earlier.
The operation, Felkin reported, was carried out with the intention of saving both lives. The mother was partially anaesthetised with banana wine. The surgeon also used this wine to wash the surgical site and his own hands, suggesting awareness of the need for infection control measures. He then made a vertical incision, going through the abdominal wall and part of the uterine wall, before further dividing the uterine wall enough to take the baby out. The operation also involved removing the placenta and squeezing the uterus to promote contraction.
The means of dressing the incision was also highly developed: the surgeon used seven polished iron spikes to bring the edges of the wound together, tying them in place with bark-cloth string. He then applied a thick layer of herbal paste and covered this with a warm banana leaf held in place with a bandage. According to Felkin's account, the mother and her baby were still doing well when he left the village 11 days later.
Although caesarean operations had been performed in Africa by white surgeons before this date, the procedure appeared to have been developed independently by the Banyoro people – a somewhat discomfiting realisation for a British audience familiar with colonial tales of ‘savages’.
Prehistoric people needed surgery like a hole in the head
In 1865, American archaeologist Ephraim George Squier left Cuzco, Peru, in possession of an ancient Mexican skull given to him by a collector. The artefact was to ignite debate in medical circles on both sides of the Atlantic.
Dating from around 1400–1530 BC, the skull had a rectangular hole in its frontal lobe. Squier shared the find with the New York Academy of Medicine and with French neuroscientist Paul Broca, who showed that the hole had been deliberately made while the person was still alive.
Examples of this ancient practice – trepanning – have since been found worldwide, dating back as far as 10,000 BC. It appears to have developed independently in many cultures, and as a result there's evidence of various methods: scraping the skull with a sharp flint; boring a circle of holes and prising out the resulting disc; creating a 'hashtag' shape of grooves and removing the middle.
But why would people do this? Broca speculated that they were trying to let evil spirits escape from the body. It's a theory that remains popular today, but we should be aware that it rather suited 19th-century white anthropologists to view indigenous cultures as scientifically inferior.
Also possible is that trepanning was a practical way to treat fractures (the ancient Greeks certainly used it this way). With head wounds a familiar consequence of conflict or accident, practitioners might have observed the course of infection and realised that dead bone would eventually disintegrate (if the patient didn't die in the meantime). Removing these fragments manually would have been worth a try. We can't ask ancient communities why they made holes in heads, but their rationale could have been less barbaric than it at first appears.
Ancient Egyptian medical specialists included the 'herdsman of the anus'
Magic, religion and rational science mingled without contradiction in ancient Egyptian healing. A sick person could consult a doctor (called a swnw), a magician or a lay priest – or all three if they felt like it. One practitioner might be both priest and doctor, curing via a combination of medicines, incantations and prayers.
Egypt's system of medicine was the first to be set down in writing, but its history remained obscure until hieroglyphs started being decoded in the early 19th century. Since then, papyri and depictions in tombs have shown that doctors had an extensive knowledge of disease and a rich pharmacopoeia of herbs, animal products and minerals. Prescriptions were prepared according to precise recipes that included long lists of ingredients and their measurements, and took many forms including pills, ointments, inhalations and enemas.
One doctor particularly skilled in administering these enemas was Irenakhty, who lived in approximately 2150 BC. He was doctor to the royal palace and (among several other titles) held the position of neru pehut – herdsman of the anus. His proctological expertise was not a one-off: his predecessor Khuy was another anal guardian, who combined the role with his skills as a dentist to ensure both ends of the pharaoh's alimentary canal remained in tip-top condition.
Plastic surgeons have long been able to offer new noses for old
The loss of a nose – whether the result of punishment, unluckiness in sword-fighting, or disease – has historically led surgeons to try to restore the patient's features and dignity.
The Indian surgeon Sushruta (c600 BC) used a plant-leaf template to dissect a flap of skin from the patient's cheek, leaving it attached by a strip called a pedicle. Twisting it so the wound surface remained downwards, Sushruta would suture it into the place of the missing nose and affix small reed tubes to act as nostrils.
Similar procedures re-emerged in Renaissance Italy, when surgical families the Brancas and the Vianeos developed methods of creating a new nose from the skin of a patient's arm. It was worth these practitioners' while, however, to keep the details secret to ward off competition. In 1597, Gaspare Tagliacozzi, professor of anatomy at Bologna, brought nasal reconstruction out into the open by publishing De Curtorum Chirurgia per Insitionem, which aimed to describe rhinoplasty scientifically and educate other surgeons about it.
Tagliacozzi's operation involved making parallel incisions in the skin of the upper arm and drawing a linen dressing underneath the flesh. After about 14 days, he cut the flap at one end; another 14 days allowed the flap to mature and he then engrafted it to the patient's nasal cavity, using a system of bandages to keep the arm and face together. After another fortnight, he separated the arm from the nose (much to the patient's relief) and shaped the graft accordingly. But after Tagliacozzi's death in 1599, the operation failed to become mainstream. It was not until the late 18th century that European surgeons realised new noses were still being created in India.
A letter to the Gentleman's Magazine in 1794 told of an Indian army bullock-driver called Cowasjee, who was captured by the sultan and punished as a traitor by having his nose and one hand severed. An unnamed Mahratta surgeon skilfully moulded a new nose from the skin of Cowasjee's forehead. British surgeon Joseph Constantine Carpue drew upon these reports to begin nasal reconstructions in 1814; his work revived interest in rhinoplasty and helped western surgeons catch up with their Indian counterparts.
Smoking was good for you
The words 'cigarettes' and 'health' are now unlikely bedfellows. Nineteenth-century medical cigarettes for asthma, however, were part of a long history of inhalation therapy that continues in the inhalers of today.
Ideas about the causes of asthma changed over the centuries, so the inhalation of herbal smoke fell in and out of favour depending on the prevailing theory. By the end of the 18th century, however, asthma was being interpreted as a 'nervous' disease caused by spasms of the bronchi. Into this receptive medical environment came the plant datura stramonium, or thorn-apple. Already known in the US, people in Britain began smoking it between 1802 and 1810, after a similar remedy, datura ferox, was brought back by an East India Company physician. Joseph Toulmin, a surgeon from Hackney, substituted the more easily obtainable datura stramonium, gaining relief from his own asthma. Word quickly spread about the new remedy.
At first, stramonium was smoked in ordinary tobacco pipes. It was possible to grow it oneself and dry the roots and stalks (although not the leaves, which have a dangerous narcotic effect). By the middle of the 19th century, smoking was socially acceptable and ever easier with the introduction of cigars, then cigarettes (and matches). Commercial brands of stramonium cigarettes fitted nicely into this context and were not seen as a quack remedy – doctors recommended them as a convenient way of inhaling the drug.
In the early 20th century the spasmodic model of asthma gave way to the concept of allergic inflammation, and this made smoking seem less appropriate. At the same time, new drugs such as ephedrine provided an alternative to the potentially hallucinogenic stramonium. As the dangers of tobacco smoking became more apparent, medicated cigarettes fell out of favour – but, for a while, stramonium had played an important role in bringing relief to those struggling to breathe.
Kellogg’s ‘asthma cigarettes’. (Reg Innell/Toronto Star via Getty Images)
The first African-American female doctor graduated at the height of the American Civil War
In May 1869, a doctor addressed the annual meeting of the New England Anti-Slavery Society. Slavery had been abolished in 1865, and the doctor expressed strong hopes for the future for black people. She also gave a prescient warning: it would “take earnest labour on the part of their friends to secure them all their rights.” The speaker was Rebecca Crumpler, the first African-American woman to graduate as a physician. She devoted her career to improving the health status of black people living in poverty, especially women and children.
Crumpler was born Rebecca Davis in Christiana, Delaware, in 1831. She married Wyatt Lee in 1852, settling at Charlestown, Massachusetts. There, she worked as a nurse for local physicians, and these employers supported her successful application to the New England Female Medical College. Her husband died of tuberculosis in 1863 but she persisted with her studies and graduated the following year as 'doctress of medicine.' She briefly practised in Boston before travelling to St John in New Brunswick, Canada, where she married Arthur Crumpler in May 1865. She is now remembered as Rebecca Lee Crumpler, although she does not appear to have continued using the name Lee after her second marriage. Sadly, no identifiable photos of her have survived.
With the American Civil War over, Crumpler went to Richmond, Virginia, to work for the Freedmen's Bureau, a government agency assisting freed slaves and impoverished white people in the former Confederate states. Despite her degree, she is listed in the records as 'nurse', receiving $10 per month. As she later explained, however, this part of her career was the 'real missionary work' to which she felt called. Serving a population of 30,000 black people emancipated from slavery yet still experiencing violent discrimination, she focused on assisting the poorest families.
Her A Book of Medical Discourses (1883), was one of the earliest medical publications by an African-American writer, and specifically spoke to a female readership. Crumpler realised that knowledge is power and that encouraging women to be active in protecting their own and their children's health would improve their lives within a difficult context.
The tapeworm doctor could expel your unwanted passengers
The beef tapeworm, taenia saginata, can grow to over 20 metres long in the human intestines. As is also the case with its shorter but meaner cousin, the pork tapeworm, it absorbs nutrients from the contents of the digestive system and can survive peacefully for years – unless, that is, its host decides to evict it.
In late 19th and early 20th-century America, the tapeworm provided a profitable career for itinerant practitioners, who travelled from town to town, parting people from their intestinal inhabitants. Such 'tapeworm specialists' are not exactly a much-fêted part of the history of medicine, but their activities give an insight into the healthcare options available to rural communities.
When treated by a worm doctor, you would have to fast for a day to get the worm hungry, then take a teaspoon of the essential oil of male fern in a cup of warm milk. After this, you lay down for a few hours before taking a draught of castor oil, turpentine and croton oil – the latter being toxic and a drastic laxative. The spectacular effects of this mixture can readily be imagined.
Some tapeworm specialists were showmen, impressing the punters by displaying preserved 'worms' of enormous length. These were more likely to be fakes made from animal entrails than the real thing, so the tapeworm doctor became a fairly disreputable character. He's unlikely to be commemorated with a statue outside a hospital or a reverent biography detailing his selfless quest for medical progress, but he was part of the colourful variety of healthcare providers to whom the average person could turn when unable to afford a physician.
Plague and inequality joined forces at the turn of the 20th century
The word 'plague' sounds inherently medieval, but the Third Plague Pandemic finished within living memory. Previous pandemics had wiped people out indiscriminately, but this one disproportionately affected those living in poverty, highlighting the global health inequality that has been worsening ever since.
The Third Pandemic emerged in China in the 1850s and crossed international borders during the 1890s. From Hong Kong in 1894, rats infested with plague-carrying fleas starting travelling the world on colonial supply ships, taking their lethal bacteria to every inhabited continent.
The bacterium – yersinia pestis – was isolated the same year (1894) by Alexandre Yersin and Kitasato Shibasaburō, who independently found it within days of each other. In 1898 Paul-Louis Simond established rat fleas as the vector, or transmitter. As the disease spread to international ports, however, public health officials responded with quarantine programmes that isolated suspected sufferers on the assumption that the disease could pass from one human to another.
Draconian measures by the British government in India led to political unrest; in the United States, existing anti-Asian prejudice fed on the disease's Chinese origin. When plague reached Cape Town via Argentina in 1901, its first victims were black dockworkers. South Africa's colonial government used this as a pretext to remove the African population of District Six, forcing them under armed guard to a location outside the city at Uitvlugt (Ndabeni). Segregation, which had been regularly mooted on ostensible health grounds for the previous two decades, began in earnest.
The Third Pandemic killed around 15 million people, the majority in India and Africa. The disease's pandemic status officially ended in 1959, but plague has never been eradicated, and although yersinia pestis remains susceptible to the antibiotic streptomycin, multi-drug resistant strains occasionally surface. Let's hope future historians do not have to analyse a Fourth Plague Pandemic.
Caroline Rance blogs at www.thequackdoctor.com about the history of medical advertising and health fraud. Her book The History of Medicine in 100 Facts (Amberley Publishing, 2015) explores medicine's history in bite-sized topics, from prehistoric parasites to the threat of antibiotic resistance. You can follow Caroline on Twitter @quackwriter and on Facebook at www.facebook.com/quackdoctor
This article was first published by HistoryExtra in 2015
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