Tuesday, 31 March 2015

What's Old Is New Again: Medicine's Blast From the Past

And don't throw the past away/
You might need it some other rainy day.

'Cause everything old is new again.

Or so go the lyrics to Peter Allen’s “Everything Old is New Again.” 

Cow Bile & Onions for the Eye

Recent findings by an interdisciplinary team of scientists and Dr. Christina Lee, a scholar of health in Anglo-Saxon England, suggests that Allen’s lyrics may apply to medicine as well. 

Bald’s Leech-book, aka the British Library’s MS Royal 12 D (see also Harley MS 55, ff 1r-3r), has been a matter of scholarly interest for some time.  Compiled in the mid-10th century, possibly in Winchester, the manuscript contains a variety of medical receipts and a description of how to surgically fix a harelip or cleft lip.[1]
A facsimile of a page from Bald's Leechbook from Oswald Cockayne, Leechdoms, Wortcunning and Starcraft of Early England  (1865)
 Lee translated an eye-salve receipt which was then recreated and tested by a team of microbiologists.  As several news articles revealed, the simple salve of garlic and leeks/onion, wine, and cow bile proved extraordinarily efficacious against MRSA or methicillin-resistant staphylococcus aureus.

The BBC article on the discovery concluded that “it seems Anglo-Saxon physicians may actually have practised something pretty close to the modern scientific method, with its emphasis on observation and experimentation.”

Those who have read my work, sat in my classrooms, or know me can guess how I reacted to that rather condescending statement.[2] 


Let’s take a look at some other nonsensical sounding treatments that are still sort of used today, shall we? 

Treating Diarrhea With More Poop

John Hester’s The Pearle of Practise includes a number of very odd and very noisome sounding treatments.  The book sometimes reads like a compendium of horrifying and odd things like treating gout with the wax dripping off a roasted puppy that has been stuffed with black snails and rubbed with saffron.[3]  Or prognosticating whether or not someone would die of the plague by laying a frog on their belly.[4] 

Or the case of an empericke practitioner who cured cancer with “centumpedes” found in English pigs.  These creepy bugs were mashed in ale and consumed causing “a certaine black bugge, or worme to come forth [from the cancerous body] which had many legs, and was quicke and after that the cancker would heale quicklie, with any conuenient medicine.”[5]

Or curing shingles with a plaster of barley, vinegar, and doves dung.[6]  I could probably go on for a while.  Like I said, a veritable compendium of odd things. 

One of the treatments that caught my eye, however, simply stated that in cases of the flux or diarrhea, “diuerse Souldiars in the warres haue beene cured thereof, by setting their fundament in warme Horse dung.”[7]

Yes, diarrhea-ridden soldiers sat in fresh horse poop to cure their diarrhea.

Sounds about as useful as the centumpede cancer remedy, right? 

So have you heard about fecal transplants?

Fecal microbiota transplants or FMT is exactly what it sounds like: the insertion of foreign fecal matter into a patient – through enemas, pills etc. – to treat C. difficile (stomach pains & diarrhea), colitis, and irritable bowel syndrome to name a few.

The donated fecal matter essentially helps to repopulate the patient’s colon with healthy bacteria.

A Hole in the Head

Trepanation inevitably comes up when I’m asked about terrible early modern surgical procedures. It involves drilling a hole into the skull so deeply that the membrane surrounding the brain is exposed. 

We have archeological and textual evidence of prehistoric and premodern trepanned skulls from Asia to the Americas.  Surprisingly, trepanation wasn’t necessarily a death sentence either – many patients survived and their skulls show signs of healing.[8]

But why would anyone need a hole in their head?  Trepanation was sometimes used to treat seizures, skull fractures, migraines, and madness.  The hole was thought to release pressure  

Along with amputation, trepanning was one of the most visibly violent and extreme operations a surgeon could perform. 

Early modern surgical texts mentioned trepanation frequently and even included illustrated how-to sections for more inexperienced surgeons.

The German surgeon, Johannes Scultetus, for example, included a very detailed series of numbered images of a skull being trepanned with additional text.[9]  Both early 18th century writers, Charles Le Clerc and Belloste also included figures with their description of trepanation.  Le Clerc’s image depicts the many layers of bandages he deemed vital to dressing – and thus curing successfully – a trepanned skull.[10]  Belloste also depicted an innovative thin lead plate he used to improve the trepan process by decreased risk of sepsis.[11]

Trepanation underwent something of  a revival in the mid-20th century.  Bizarrely, self-trepanationists such as Bart Hughes advocated the procedure to increase blood flow to the brain and reach a higher state of consciousness.[12]

Today, however, modern surgeons rarely recommend trepanation except in cases of subdural hematoma.  Generally caused by head trauma, blood collects below the dura and increases pressure on the brain – trepanation just releases the pressure, the blood is suctioned out, and the skull piece is (usually) replaced promptly. 

There are a few more: maggots are now used to debride wounds, leeches are used in reconstructive surgery, and the medieval practice of variolation directly led to development of the smallpox vaccine.

Who knows what the past has in store for us?

Let me know what you think here or on Twitter - I'm @medhistorian.

[1]  For more on the manuscript see: M. L. Cameron (1983). Bald's Leechbook: its sources and their use in its compilation. Anglo-Saxon England, 12, pp 153-182.
[2] It wasn’t pretty and involved some ranting with words like epistemology, humility, and incommensurability thrown around.  On a more positive note, however, it did inspire this blog post.
[3] Hester, John.  The pearle of practise, or Practisers pearle, for phisicke and chirurgerie. Found out by I. H. (a spagericke or distiller) amongst the learned obseruations and prooued practises of many expert men in both faculties. Since his death it is garnished and brought into some methode by a welwiller of his.  London: Printed by Richard Field, dwelling in the Black-friers, (1594), 20.
[4] Ibid., 41.
[5] Ibid., 14.
[6] Ibid., 16.
[7] Ibid., 44.
[8] Zanello, Marc et al. “Report of a successful human trepanation from the Dark Ages of neurosurgery in Europe,” Acta Neurochirurgica 157, 2 (Feb 2015), 303-304.
[9] Johannes Scultetus, The Chyrurgeons Store-House, London: printed for John Starker (1674), 111-113.
[10] Charles Le Clerc, The Compleat Surgeon, London: printed for W. Freeman et al (1701), unpaginated image prior to page 1.
[11] Belloste, 78-82.
[12] Please don’t try this.

Tuesday, 10 March 2015

From Orient to Occident Part II: Acupuncture in Victorian England

N.B. This is the second half of a two-part series on acupuncture in Victorian England.  If you haven’t already done so, I’d recommend checking out Part I first.

Just to quickly recap, in the first post I discussed:
1)      acupuncture’s use in Victorian England
2)      acupuncture’s dismissal by reigning medical authorities
3)      Wakley and the Lancet published case studies to prove acupuncture’s efficacy

Wakley and the Lancet’s defense of acupuncture is fascinating – especially when contrasted with their contemporary denunciation of other inexplicable medical treatments like mesmerism, phrenology, and homeopathy.

Mesmerism or animal magnetism was attacked consistently by the Lancet after the infamous Dr. John Elliotson failed to adequately demonstrate the phenomena while in Thomas Wakley’s home.  Phrenology was slowly losing supporters, and homeopathy was almost always attacked as quackery.[1]    
Anonymous pamphlet attributed to Wakley.
Moreover, acupuncture possessed many similar characteristics to both mesmerism and phrenology.  First, all three “cures” were practiced by Dr. Elliotson.  Second, in an age when there was an effort to entrench science within medicine, there was no viable or accepted explanations for how either mesmerism or acupuncture worked. 

Case studies and experiments could take acupuncture only so far  – recorded cures via traditional acupuncture were professed to succeed in less than half of the cases in which it was employed.[2]

So we reach a bit of a conundrum.  Why didn’t Wakley and the Lancet portray acupuncture the way they treated mesmerism or homeopathy?

I would suggest that it’s simply because acupuncture needles were adaptable.

Both mesmerism and phrenology could be disproved as phenomena and thus rejected.  Acupuncture, however, in part because the Europeans were unsure as to how and when it should be used, required both wide and repeated experimentation.  Due to this experimentation, the procedures of, and occasions for acupuncture were widened considerably and changed along with the shifting medical trends of the period.

Perhaps in response to the calls for trials and experimentation, acupuncture began to be used for a wider variety of diseases in the 1830s.  In addition to the traditional cases of rheumatism, sciatica and lumbago, medical practitioners began to use acupuncture to treat cases of dropsy, hydrocele, ascites and ganglions.[3] 

Dropsy (1817)
All four of these ailments involve the accumulation of fluid.  Dropsy or oedema as it is now known commonly occurs in the ankles, hydrocele is an accumulation of liquid in a sac near the testes, ascites cause abdominal swelling due to fluid accumulation, and ganglions, also fluid filled sacs, tend to occur on the top of the wrist or foot. 

The “acupuncture” used in these cases, however, differs considerably from that practiced in the Orient.  Rather than the insertion of needles into the skin to stimulate nerves and relieve pain, acupuncture was now used to puncture cysts and release the accumulated fluid. 

This likely occurred for several reasons: first, the needle was a very visible and material object; the focus on it and its function paralleled the value and focus placed on surgical instruments at the time.  Second, as is still partially true today, they simply did not understand how acupuncture worked and thus tested its efficacy in as many cases as seemed plausible.

A more marked modification involved the coupling of electric therapy with acupuncture. 

Yes, that is as horrific as it sounds.

The treatment was reported by the Lancet as early as the 1820s, but was not recorded in any high numbers until the 1870s.

Electricity had been used in English medicine throughout the eighteenth century.[4]  The Lancet, however, only noted its use coupled with acupuncture in eight articles during the course of the nineteenth century.  The first three of these were published during the 1820s and 1830s.[5]  

Dispensing of medical electricity. Oil painting by Edmund Bristow, 1824.
The first instance was a case study of a physician who used galvano-acupuncture to treat “paralysis of the lower extremities, produced by curvature of the spine.”  The patient, a young girl who had been paralyzed for several months, consented to have acupuncture needles inserted into her back – the article states that they were driven into her spinal cord – and have these “brought into contact with the wire of a voltaic pile.”[6]  

Shockingly, the therapy was a success and the girl was able to walk again. 

The last case was recorded in 1830 and detailed the use of “electro-puncture” that is, acupuncture coupled with a galvanic battery, to treat successfully two cases of dropsy.[7]  Our knowledge of how often this treatment was used is hampered by the lack of articles published on the subject.  While the Lancet did publish one article in 1848 calling for the use of galvano-acupuncture in cases of asphyxia, it was merely a suggestion and did not include either case studies or even claims of successful use.[8]  It was not until 1879 that the periodical began publishing any significant number articles treated by galvano-puncture.

18thC French use of medical electricity.
During the late nineteenth century, physicians expanded their use of electricity as a medical treatment.   Both those on the medical fringe and regular hospital practitioners were extolling the virtues of electricity in curing a wide variety of ailments. 

It could be said that acupuncture, due to its coupling with electricity, underwent a renaissance in the latter decades of the nineteenth century.  While cures via traditional acupuncture left much to be explained and could not be professed to succeed in a half, or even a third, of the cases in which it was employed, the “advances of science” at least ensured that these electrical practitioners understood the basics of what they practiced.

In addition to the adaptation of acupuncture needles in electric therapy, it is also plausible that the continuing success of acupuncture could be linked with Victorian ideas on pain and need to control the body; the infliction of pain was seen in a positive light.[9]  As one article noted in a rather matter of fact manner, patients “watch with interest the insertion of the needles into their muscles and the transfixing of their limbs; welcoming the return of sensibility, even in the shape of pain, as a longed for boon.”[10] 

Another, in relation to sciatica, criticized traditional methods of acupuncture that only pierced the skin.  The practitioner stated that it was far more effective to pierce the nerve and that “the patient can always tell when the nerve has been pierced by pain shooting down the leg.”[11] 

From the 1820s to the 1890s, acupuncture in Britain had come a long way.  From the relatively painless therapy so extolled in the 1820s and 1830s, there emerged two far more painful treatments that better suited the scientific and medical environment.

To sum up the two blog posts: 
1) The changing representations of acupuncture in the Lancet have revealed a treatment that first served the periodical’s purpose in professionalizing medical practice.  The manner in which the ancient “cure” worked was a mystery to the Victorian medical practitioners.  The Lancet fully encouraged experimentation with this mystery treatment and included successful case studies in its defence.   
2) Acupuncture even became one of the many issues involved in the verbal sparring between the College of Physicians and professionalizing radicals such as Thomas Wakley.   
3) Perhaps in response to the periodical’s encouragement, and in part reflective of the push to entrench science within medicine, acupuncture was soon used for an even greater variety of ailments.  Despite its widened scope, it was never (in the Lancet at least) placed on the same level as many other baffling treatments such as mesmerism. 

Two possible reasons have been forwarded to explain this: First, in the 1830s, while acupuncture was used to treat ailments such as hydrocele, dropsy and ascites, it is evident that this was merely a logical extension of the needle’s form and function.  After all, if the acupuncture needle could be used to pierce the skin, why should it not be used to pierce cysts? 

Second, during the latter half of the nineteenth century, acupuncture was transformed to fit the needs and trends of the current medical marketplace.  It was first coupled with electricity and may had its life further extended by the burgeoning need to discipline the Victorian body. 

By the end of the century, acupuncture had transformed from a little known Oriental treatment to one with an Occidental – or rather a decidedly Victorian – veneer.

Let me know what you think here or on Twitter - I'm @medhistorian.

[1] For more on this, see John Epps, The Rejected Cases; With A Letter to Thomas Wakley on the Scientific Character of Homeopathy, London, Sherwood and Co. (1845); Lancet 58, 1464 (1851), 285.
[2] The words “cure” and “succeed” have to be viewed critically.  What did it mean to be “cured” of lumbago?  Was acupuncture a “success” for treating immediate pains?  Or did it dismiss entirely chronic pains? Lancet 97,2487 (1872), 567.
[3] See for example: Lancet 27, 703 (1837), 750; 28,713 (1837), 194-196; 28,721 (1837), 486-487; 29,743 (1837), 313; 115,2947 (1881), 285; 134,3436 (1889), 13-14.
[4] This was not just an English fad, other periodicals shared French and Italian experiments with electro-acupuncture i.e. Popular Science Review 10,38 (Jan 1871), 329.
[5] There are references to both galvanic and faradaic acupuncture.  Multiple articles, however, suggest the superiority of galvanic acupuncture i.e. Lancet  114,2926 (1879), 455; 114,2927 (1879), 499-502.  Iwan Rhys Morus writes more about this in Shocking Bodies: Life, Death & Electricity in Victorian England (2011).
[6] Lancet 6,157 (1826), 719.
[7] Lancet 13,335 (1830), 614-616.
[8] Lancet 51,1293 (1848), 636-637.
[9] See Iwan Rhys Morus, “Bodily Disciplines and Disciplined Bodies: Instruments, Skills and Victorian Electrotherapeutics,” Social History of Medicine 19,2 (2006), 241-259.
[10] Lancet 114,2927 (1879), 502.
[11] Lancet 141,3633 (1893), 860-861.