6<\/span> A \u2018leech craze\u2019 hit 19th-century Europe<\/h3>\n<\/div> 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 Fran\u00e7ois-Joseph-Victor Broussais (1772\u20131838), who postulated that all disease stemmed from local inflammation treatable by bloodletting, the \u2018leech craze\u2019 saw barrels of the creatures shipped across the globe, wild leech populations decimated almost to extinction, and the establishment of prosperous leech farms.<\/p>\n
Leeches had advantages over the common practice of bloodletting using a lancet \u2013 the loss of blood was more gradual and less of a shock for those of delicate constitution. And because Broussais\u2019s followers used leeches in place of all the other medicines at the 19th-century physician\u2019s 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<\/em> for leech therapy.<\/p>\n A woodcut from a 1639 treatise by Joannis Mommarti depicting a woman applying a medicinal leech to her forearm. In the early 19th century the medicinal leech soared in popularity, says Caroline Rance. (Photo by Everett Collection Historical\/Alamy Stock Photo)<\/span><\/figcaption><\/div>\n 7<\/span> Ugandan surgeons developed life-saving caesarean operations<\/h3>\n<\/div> 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\u2019s death in childbirth.<\/p>\n
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.<\/p>\n
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.<\/p>\n
\n
The first surgical treatment of breast cancer performed under general anaesthetic by Seishu Hanaoka (1760-1836) in 1804 (colour litho), Japanese School (19th century). (Private Collection\/Archives Charmet\/Bridgeman Images)<\/span><\/figcaption><\/div>\n<\/div>\nThe 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\u2019s account, the mother and her baby were still doing well when he left the village 11 days later.<\/div>\n
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 \u2013 a somewhat discomfiting realisation for a British audience familiar with colonial tales of \u2018savages\u2019.
8<\/span> Prehistoric people needed surgery like a hole in the head<\/h3>\n<\/div> 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.<\/p>\n
Dating from around 1400\u20131530 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.<\/p>\n
Examples of this ancient practice \u2013 trepanning \u2013 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\u2019s evidence of various methods: \u00a0scraping the skull with a sharp flint; boring a circle of holes and prising out the resulting disc; creating a \u2018hashtag\u2019 shape of grooves and removing the middle.<\/p>\n
But why<\/em> would people do this? Broca speculated that they were trying to let evil spirits escape from the body. It\u2019s 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.<\/p>\nAlso 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\u2019t die in the meantime). Removing these fragments manually would have been worth a try. We can\u2019t ask ancient communities why they made holes in heads, but their rationale could have been less barbaric than it at first appears.
9<\/span> Ancient Egyptian medical specialists included the \u2018herdsman of the anus\u2019<\/h3>\n<\/div> Magic, religion and rational science mingled without contradiction in ancient Egyptian healing. A sick person could consult a doctor (called a swnw<\/em>), a magician or a lay priest \u2013 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.<\/p>\nEgypt\u2019s 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.<\/p>\n
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<\/em> \u2013 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\u2019s alimentary canal remained in tip-top condition.<\/p>\n\n
Reconstruction of an ancient Egyptian relief from the Temple of Kom Ombo, showing a collection of surgical instruments. (Photo by DeAgostini\/Getty Images)<\/span><\/figcaption><\/div>\n<\/div>\n 10<\/span> Plastic surgeons have long been able to offer new noses for old<\/h3>\n<\/div> The loss of a nose \u2013 whether the result of punishment, unluckiness in sword-fighting, or disease \u2013 has historically led surgeons to try to restore the patient\u2019s features and dignity.<\/p>\n
The Indian surgeon Sushruta (c600 BC) used a plant-leaf template to dissect a flap of skin from the patient\u2019s 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.<\/p>\n
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\u2019s arm. It was worth these practitioners\u2019 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<\/em>, which aimed to describe rhinoplasty scientifically and educate other surgeons about it.<\/p>\nTagliacozzi\u2019s 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\u2019s 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\u2019s relief) and shaped the graft accordingly. But after Tagliacozzi\u2019s 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.<\/p>\n
A letter to the Gentleman\u2019s Magazine<\/em> 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\u2019s 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.<\/p>\n\n
Engraving from Tagliacozzi\u2019s \u2018De Curtorum Chirurgia per Insitionem\u2019, showing rhinoplasty surgery in which the patient\u2019s nose was attached to a flap of skin on his upper arm. (Photo by DeAgostini\/Getty Images)<\/span><\/figcaption><\/div>\n<\/div>\n 11<\/span> Smoking was good for you<\/h3>\n<\/div> The words \u2018cigarettes\u2019 and \u2018health\u2019 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.<\/p>\n
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 \u2018nervous\u2019 disease caused by spasms of the bronchi. Into this receptive medical environment came the plant datura stramonium<\/em>, or thorn-apple. Already known in the US, people in Britain began smoking it between 1802 and 1810, after a similar remedy, datura ferox<\/em>, was brought back by an East India Company physician. Joseph Toulmin, a surgeon from Hackney, substituted the more easily obtainable datura stramonium<\/em>, gaining relief from his own asthma. Word quickly spread about the new remedy.<\/p>\nAt 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 \u2013 doctors recommended them as a convenient way of inhaling the drug.<\/p>\n
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 \u2013 but, for a while, stramonium had played an important role in bringing relief to those struggling to breathe.<\/p>\n
Kellogg\u2019s \u2018asthma cigarettes\u2019. (Reg Innell\/Toronto Star via Getty Images)<\/em><\/sup><\/div>\n 12<\/span> The first African-American female doctor graduated at the height of the American Civil War<\/h3>\n<\/div> 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 \u201ctake earnest labour on the part of their friends to secure them all their rights.\u201d 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.<\/p>\n
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 \u2018doctress of medicine.\u2019 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.<\/p>\n
With the American Civil War over, Crumpler went to Richmond, Virginia, to work for the Freedmen\u2019s 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 \u2018nurse\u2019, receiving $10 per month. As she later explained, however, this part of her career was the \u2018real missionary work\u2019 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.<\/p>\n
Her A Book of Medical Discourses<\/em> (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\u2019s health would improve their lives within a difficult context. 13<\/span> The tapeworm doctor could expel your unwanted passengers<\/h3>\n<\/div> The beef tapeworm, taenia saginata<\/em>, 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 \u2013 unless, that is, its host decides to evict it.<\/p>\n
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