The bioethics of medicine changes over time. A contemporary doctor would not treat people without their consent, for example. However, that medical practice was common in Europe and America as late as the 19th century, at least for part of the population. Slaves were treated without their consent, since a slave owner’s consent was considered sufficient. Worse yet, slaves often endured painful procedures, such as amputations or gynecological treatments, without the benefit of anesthesia.
A history of the medical treatment of slaves is a chilling lesson in the importance of bioethics, the practice of creating standard medical procedures to ensure that all patients are treated with equal respect. Slaves received less humane treatment due to the inherently racist belief that they didn’t feel pain as acutely as their masters.
In some cases, medical treatments become unacceptable because they reveal inherent, incorrect sociocultural biases. In other cases, such as the cases on this list, medical procedures become less common because they’re either ineffective or extremely dangerous, even when they are performed successfully. Some of the medical procedures on this list are effective, but all of them would be painful for even the bravest patient.
Trepanation, the practice of putting a hole in a human skull by cutting, scraping, or using a hand drill, was regarded as a versatile medical procedure until the end of the 16th century. Once wrongly believed to correct head injuries, preeclampsia, and eclampsia, and treat chronic pain, the technique is now used solely when a surgeon drills a hole in a patient’s skull to access a brain lesion or a brain tumor. In 1972, Peter Halvorson drilled a hole three-eighths of an inch wide into his own head. He claimed the procedure cured his depression, though he offered no medical proof. In most cases, trepanation isn’t self-inflicted.
Unlike trepanation, which is still considered to be a medically valuable procedure in some cases, contemporary doctors and psychoanalysts consider lobotomies both unethical and ineffective. Portuguese neurologist Egas Moniz developed the lobotomy procedure, which was adopted by other doctors with minor alterations. After anesthetizing the patient, a surgeon drilled a pair of holes into either the top or the side of the head. The surgeon then inserted a sharp instrument, such as an ice pick, into the hole and swept it from side to side, severing connections between the frontal lobe and the rest of the patient’s brain. Moniz first performed the procedure on patients who were exhibiting obsessive behaviors, which he believed were caused by fixed circuits in the brain. However, lobotomies were also used to treat other conditions, such as phobias and schizophrenia. The problems? First, various mental health conditions affect the brain differently, so the effectiveness of a lobotomy will vary based on a patient’s diagnosis. Second, even contemporary scientists don’t perfectly understand all of the neural mechanisms that make a human brain function. A surgeon performing a lobotomy with an ice pick was certainly severing connections within a patient’s brain. Unfortunately, neither the doctor nor the surgeon could verify which capabilities the patient might lose once those connections were severed.
Perhaps the best example of the devastating effects of an ineffective lobotomy is the case of Rosemary Kennedy. In 1941, Kennedy, the sister of John F. Kennedy, had a lobotomy. Before the procedure, Rosemary — who was 20 at the time — had the cognitive abilities of a fourth grader. A psychiatrist who was present during Rosemary’s lobotomy asked her to tell him stories during her procedure. The surgeon only stopped scraping her brain once she could no longer talk. Rosemary’s communication abilities were delayed before her lobotomy. After her lobotomy, they were nonexistent. She could only say a few words, and she could no longer walk.
9. Humor Therapy
Humor therapy, which was practiced until the 19th century, was based on the belief that the human body contained four fluids, or humors: blood, yellow bile, black bile, and phlegm. Illnesses were caused by an imbalance in one or more of the four humors. Humor therapy primarily consisted of three treatments: massages, emetics, and bloodletting. Bloodletting is a treatment that’s still used for a few conditions, such as hemochromatosis, a genetic disorder affecting iron metabolism, polycythemia vera, a stem cell bone marrow disorder, and porphyria cutanea tarda, a group of disorders of heme metabolism with an abnormality in iron metabolism. Unfortunately for many patients treated before the 19th century, unnecessary or excessive bloodletting can be fatal.
When George Washington, the first U.S. president, woke one morning with a sore throat, he requested bloodletting. His attending doctors drained five to seven pints of his blood in less than 16 hours. (A healthy adult has between nine and 12 pints of blood in his or her body.) Washington ceased to suffer from a sore throat four days after his bloodletting, because he died.
Asylum patients suffered especially brutal medical treatments, such as hydrotherapy. From the 17th century through the 20th century, people with cognitive disabilities, mood disorders, and psychiatric disorders were confined to asylums. Though asylums were supposed to function as treatment facilities, many treatment techniques seem inhumane by contemporary standards. Hydrotherapy was a water treatment most frequently used for patients with depression, insomnia, or suicidal thoughts. The water was either very hot or very cold, depending on what condition was being treated.
There were three methods of hydrotherapy. Sometimes a patient was forced to sit in a bathtub full of water, confined to the bathtub through the use of restraints. Sometimes a patient was “mummified,” wrapped in wet towels. Sometimes a patient was stripped and hosed. A treatment could last for several hours, putting the patient at risk for hypothermia or hyperthermia. Hydrotherapy was dangerous, dehumanizing, and ineffective.
7. Acne Radiation Therapy
Acne radiation therapy is more dangerous than the condition it was developed to treat. Radiation therapy is a medical treatment wherein beams of intense energy are used to shrink cells in a target area. It’s still used to treat many types of cancer, as most medical professionals agree the risk of developing secondary cancers is outweighed by the possibility of putting a primary cancer into remission. Acne, however, is not a life threatening condition.
The possibility of developing cancer isn’t an acceptable level of medical risk for someone undergoing acne treatment. Doctors now know that patients who received acne radiation therapy, a treatment that was used in Western medicine until the 1990s, have a higher risk of developing thyroid cancer, skin cancer, and breast cancer as a result of having radiation applied to their faces and necks.
6. Tobacco Smoke Enemas
Tobacco was a popular English import in the 18th century, shipped to England from its colony in Virginia. The Native American tribes in Virginia used tobacco to treat many conditions, and sometimes the treatment was administered as an enema. Dr. William Hawes and Dr. Thomas Cogan of the Royal Humane Society advocated the use of the technique in England. Specifically, they claimed tobacco smoke enemas could revive people who had nearly drowned. The doctors would send a pipe smoker to insert an enema tube with rubber tubing attachments and blow tobacco smoke up the rectum. (If you’re wondering, yes: this is where the common saying comes from.)
The tobacco smoke was falsely believed to warm the body and stimulate respiration. A tobacco smoke enema never harmed a drowning person. Nor did it save one. However, the treatment eventually became so popular it was used to treat headaches, respiratory failure, colds, hernias, abdominal cramps (when administered with chicken broth), typhoid fever, and cholera. Treating infectious diseases could be dangerous for the pipe smoker, as he could be infected with cholera if he inadvertently coughed or inhaled while delivering an enema. In 1811, English scientist Ben Brodie ended the widespread practice of administering tobacco smoke enemas, because he discovered nicotine was harmful to the heart.
5. Lancing Gums
The pain experienced by teething babies has been a consistent concern for much of medical history; even Hippocrates wrote about it. Teething is obviously physically painful. The infant’s suffering was sometimes retroactively believed to be causal in cases of infant mortality. However unjustified, this fear sometimes led parents to seek treatments for teething itself, including lancing the gums.
A common practice for most of the 20th century, infants’ gums were cut open (lanced) so that the infant’s teeth could be removed. While teething is painful, it isn’t dangerous. Lancing, on the other hand, could cause gum infections, especially if the procedure were performed with an instrument that hadn’t been sterilized.
The term “lithotomy” was coined by the Greek surgeon, Ammonius of Alexandria. Roughly translated, it means, “cutting stone.” Until the 19th century, lithotomy was the standard procedure for removing calculi (stones) from the bladder, kidney, or urinary tract. Lithotomy was effective, provided one survived the operation. A patient would lay on his or her back, feet apart, while the surgeon passed a blade through the patient’s perineum — the flesh between the genitalia and the anus. Once the blade struck a stone, a surgeon usually inserted his fingers into the patient’s anus or urethra to remove the stone. All of this was done without the benefit of anesthesia, of course. (Say it with us: “Nope nope nope nope nope.”)
Joannes Lethaeus, the subject of a 1655 painting by Dutch painter Carel van Savoyen, became famous for using a kitchen knife to remove his own bladder stone. The procedure of lithotomy is no longer used, but the position a patient took for the procedure is still a part of standard medical practice. The lithotomy position is the default position used for childbirth and gynecological exams.
A symphysiotomy, a medical procedure used to facilitate a difficult birth, might still be used in a country where a Cesarean section was disallowed or the necessary tools to perform one were not available. During a symphysiotomy, a doctor unhinges and severs a woman’s pelvis in order to deliver a child. The procedure often has longterm, damaging effects on a mother’s body. Most symphysiotomy patients experience pelvic pain for three to six months after the procedure. Patients report lifelong pelvic joint pain, difficulty walking, and urinary incontinence.
Ireland’s doctors performed symphysiotomies until 1984; women who endured the procedure are protesting the Irish government’s destruction of their medical records, records they say reveal the brutality of a procedure performed without their consent. Symphysiotomies are still performed, primarily in Africa. However, the United Nations Human Rights Committee has ruled that the procedure violates a woman’s right to freedom from torture and inhumane and degrading treatment.
2. Malarial Therapy (Pyrotherapy)
Before penicillin was discovered in 1928, infections a contemporary doctor would easily treat could be psychologically and physically damaging to a patient. Syphilis was one such infection. If syphilis were left untreated, a patient would develop neurosyphilis when the infection crossed the blood brain barrier. Neurosyphilis was characterized by a fatal, progressive degeneration of the patient’s nervous system. Symptoms of degeneration included seizures, ataxia, speech deficits, paralysis, mania, depression, violent behavior, paranoia, memory loss, delirium, disorientation, and apathy.
Psychiatrist Julius Wagoner Jauregg pioneered malarial therapy, also called pyrotherapy. He deliberately gave syphilitic patients blood infected by malaria. (Soldiers returning home after fighting in World War I were often infected with malaria.) Once they were given infected blood, patients started exhibiting symptoms consistent with infection. Most importantly, they had high fevers. A fever is a body’s natural method for killing infection. Malarial therapy was effective. Jauregg earned the Nobel Prize for Medicine in 1927 for his medical innovation. However, malarial therapy only affected neurosyphilis, because neurosyphilis was caused by an external pathogen invading the brain. Because Jauregg’s cure was sometimes successful, his successors used malarial therapy to treat schizophrenia, bipolar disorder, psychomotor cortical irritation syndromes, post-Parkinson’s encephalitis, and psychoses of epilepsy. Like neurosyphilis, these conditions are related to the brain. Unlike neurosyphilis, the aforementioned conditions aren’t germ related. Therefore inducing a fever, the body’s natural response to invading germs, has no effect on the patient.
1. Insulin Comas
Sometimes, a contemporary doctor places a patient into a medically induced coma. A medically induced coma gives a traumatized brain time to heal, without cuing the body to restrict blood flow to damaged sections of the brain. These comas are carefully monitored by professionals. Ideally, they are reversible. In 1927, Austrian psychiatrist Manfred Sakel accidentally placed a patient he was treating for opioid addiction into a coma by giving him an overdose of insulin. Opioid addicts exhibited the restless pacing and disorganized thought patterns often associated with mental disorders. Sakel noted that when he gave these patients high doses of insulin, their blood sugar quickly dropped, inducing a coma. When the patients awoke, they no longer exhibited psychotic behaviors. Of course, they had never been exhibiting psychotic behaviors. They had been exhibiting addictive behaviors.
Because of his incorrect belief that insulin could affect the behavior of patients with psychological disorders, Sakel began putting patients with schizophrenia into insulin comas. Sometimes, he would put one patient into several comas in one day. The patients invariably gained weight, since insulin pushes glucose into cells. Those who survived still risked permanent brain damage. The brain absorbs 70% of the body’s glucose, so rapid changes in the body’s glucose level can permanently affect the one’s ability to process complex information. Sakel considered this a worthwhile risk, since a brain damaged patient was often a less confrontational patient.