This post was inspired by a non-medical colleague – initials L.R.  See Hysteria, physician assisted paroxysms and sexual relations which follows up on this post.

The practice of medicine is built on ‘belief’ in treatments. History shows us how misplaced beliefs led to some horrific treatments, mistakes and death. Many of the treatments now considered “weird” or “outdated” were conceived and implemented in an era before the establishment of rigorous scientific methodologies that are now a cornerstone of modern medicine. Here are some fundamental flaws that contributed to the belief in these treatments:

• Lack of empirical evidence: Many treatments were implemented based on anecdotal evidence, observational data, or prevailing theories of disease without rigorous testing. Today, treatments undergo extensive laboratory testing and clinical trials to prove their safety and efficacy before being approved for general use.
• Misunderstanding of disease pathophysiology: Many historical treatments were based on misconceptions about how the body works and how diseases develop. For example, bloodletting was used for centuries based on the theory of humoral imbalance, which is now known to be incorrect. As our understanding of human physiology and pathology has grown, treatments have become more targeted and effective.
• Absence of the concept of placebo effect: In historical times, there was no understanding of the placebo effect, which can make an ineffective treatment seem effective. Modern clinical trials use placebos to account for this effect.
• Lack of regulation: Before the advent of regulatory bodies like the Food and Drug Administration (FDA) in the United States, there was little oversight of medical practices and treatments. These organisations now provide rigorous review and oversight to ensure treatments are safe and effective.
• Lack of ethical standards: Modern medicine is guided by ethical principles like informed consent, respect for autonomy, and “first, do no harm”. These principles were not always followed in the past, leading to the use of harmful and ineffective treatments.
• Limited communication and access to global medical research: Today, global communication networks and databases allow rapid sharing of medical research and clinical guidelines, promoting consistency and quality of care. Historically, medical knowledge was more localised, and practices could vary widely from place to place.

Over the centuries, medicine has evolved from a largely empirical practice to a science-based discipline. As our knowledge continues to expand and our methods become more refined, it is likely that some of the treatments used today will be seen as “weird” or “outdated” in the future. The goal remains the same: to heal, to alleviate suffering, and to improve the quality of human life.

Historical weird treatments (below)

For physical illnesses

1. Bloodletting: Also known as exsanguination, this is probably one of the most famous. For thousands of years, physicians believed that many ailments were the result of an imbalance in the body’s “humours” (blood, yellow bile, black bile, and phlegm). Bloodletting was done to balance these humours and was often performed using leeches. The American president you’re referring to is likely George Washington. In December 1799, George Washington fell ill with a throat infection, and the common treatment protocol of the time was followed, which included bloodletting. Washington’s physicians removed a substantial quantity of blood over several sessions, some sources suggest as much as 40% of his total blood volume. Given the severity of his condition and the considerable amount of blood loss, he passed away shortly afterwards. While bloodletting was a standard treatment during Washington’s time, its utility was generally overestimated. It was used for a wide array of conditions based on the humoral theory, which proposed that illnesses were caused by an imbalance in the body’s four humours: blood, phlegm, black bile, and yellow bile. Modern medical science has long since discredited this theory, and bloodletting is now known to be harmful for most diseases and conditions. Today, bloodletting is used very selectively and scientifically, for conditions like haemochromatosis and polycythaemia, which involve an overabundance of iron or red blood cells in the body, respectively.
2. Mercury: In various cultures and at different times, mercury was used to treat a range of conditions, from syphilis to constipation. However, mercury is highly toxic and likely caused more harm than good.
3. Mummy Powder: In the Middle Ages, powdered mummy, also known as “mumia”, was used as a treatment for many different ailments. It was thought that the properties that preserved the mummy could also help to preserve health in the living.
4. Animal Dung: Various types of animal faeces have been used medicinally throughout history. For instance, crocodile dung was used as a contraceptive in ancient Egypt, and the dung of various animals has been used in poultices and treatments for wounds and bites.
5. Urine Therapy: Urine has been used in medicine throughout history, for both diagnostic and therapeutic purposes. It has been drunk, applied to the skin, and even used in enemas. Some cultures still practice urine therapy today, although it has no proven health benefits and can be harmful.
6. Radon Therapy: In the early 20th century, radon was seen as a cure-all and was used to treat conditions ranging from arthritis to cancer. It was even sold in health drinks. However, radon is a radioactive material and exposure can cause severe health problems including lung cancer.
7. Snake oil: “Snake oil” is a term that originates from the 19th-century American practice of selling cure-all elixirs in traveling medicine shows. Snake oil salesmen would falsely claim that the potions would cure any ailment, from minor conditions like hair loss to serious diseases like cancer. The term “snake oil” itself comes from an interesting cultural exchange. Chinese laborers working on the Transcontinental Railroad in the 1860s would rub oil, derived from the Chinese water snake, on their joints after a long hard day of physical toil. The oil was rich in omega-3 acids and did help to reduce inflammation. The Chinese workers’ use of the oil sparked interest, and soon many people were selling their own version of snake oil. Unfortunately, the snake oil sold by these charlatans did not contain actual snake oil. Instead, they were often made from mineral oil, beef fat, and red pepper, along with various other ingredients, and had no medicinal properties. The term “snake oil” has since become synonymous with quackery, the promotion of fraudulent or ignorant medical practices. It is now used metaphorically to describe products with questionable or unverifiable quality or benefit.
8. Tobacco Smoke Enemas: In the 18th century, a common treatment for a range of ailments including respiratory problems was a tobacco smoke enema. The patient would have a tube inserted and then tobacco smoke would be blown into the rectum. The practice died out as knowledge of the harmful effects of tobacco increased. It was also used as a resuscitation method for drowning victims. The idea was that the nicotine in the tobacco would stimulate the heart to beat stronger and faster, thereby helping to revive the person. A tube would be inserted into the rectum, and smoke would be blown into the tube, either manually or using a bellows. The treatment was popular enough that devices for administering tobacco smoke enemas were placed along the River Thames in London. By the late 19th century, however, this practice had been largely abandoned as it was realised that it wasn’t effective. Beyond resuscitation, tobacco smoke enemas were also believed to be a cure for various conditions like colds, headaches, hernias, and abdominal cramps. Tobacco itself has a long history of being used medicinally, despite its harmful effects on health. Today, it is known that tobacco smoke is harmful, and the idea of using a tobacco smoke enema to treat any condition would be considered not only ineffective but also dangerous. Modern resuscitation techniques are much safer and more effective.
9. Corpse Medicine: In the 16th and 17th centuries, people believed that consuming parts of a dead body could cure diseases. These “remedies” included powdered skull to treat stroke and “mummy” (an extract made from the flesh of the dead) for bruising.
10. Gold Cure: In the late 19th and early 20th centuries, a “cure” for alcoholism involved ingesting gold chloride, thought to suppress the craving for alcohol. But gold is a heavy metal and can cause poisoning.
11. Stomach-Washing: In the 19th century, it was popular to treat various illnesses by flushing the patient’s stomach with warm water pumped in through a tube. This was thought to cleanse the stomach and improve health.
12. Mouse Paste: In Ancient Egypt, a treatment for toothache involved mashing a dead mouse with other ingredients and applying the paste to the affected area. Similarly, the Romans used mouse brains as a teething remedy.
13. Heroin for Coughs: In the late 19th and early 20th centuries, heroin was marketed as a safe, non-addictive substitute for morphine, and was used in over-the-counter remedies for coughs. We now know heroin to be highly addictive and dangerous.
14. Smoking for Asthma: In the 19th century and even into the 20th century, doctors sometimes prescribed smoking stramonium (a plant in the nightshade family) to alleviate asthma symptoms.

For mental disorders

1. Physician assisted paroxysms: The treatment was known as ‘physician assisted pelvic massage‘ – which was a euphemism for clitoral masturbation.  Many physicians in the 19th century used “pelvic massage” as a treatment for what was then diagnosed as “female hysteria.” At the time, “hysteria” was a catch-all diagnosis for a range of symptoms in women, including anxiety, irritability, and “excessive” sexual desire. These pelvic massages often resulted in “hysterical paroxysm” — what we’d now recognise as an orgasm. This was thought to alleviate the woman’s symptoms, at least temporarily. Because of the cultural and societal norms of the Victorian era, it was considered a medical treatment rather than a sexual act. This practice also led to the invention of the vibrator, initially as a medical device to aid physicians in administering this treatment more easily and without causing themselves hand fatigue. The history of vibrators and their transition from medical devices to sexual aids is an interesting aspect of the history of both medicine and sexuality. It is important to note that the understanding of women’s health, both mental and physical, was quite limited and often biased during this time period. The concept of “female hysteria” has since been discredited, and medical ethics and the understanding of female sexuality have evolved significantly.
2. Trepanning: This is the practice of drilling holes into a person’s skull. It was believed that this could relieve pressure or let out evil spirits causing mental illness. Amazingly, many people survived this treatment, as evidenced by trepanned skulls from ancient times.
3. Dancing Mania or Dancing Plague Treatments: During outbreaks of the “Dancing Mania” in Europe between the 14th and 17th centuries, people would dance uncontrollably for days or even weeks. Various strange treatments were proposed, including more dancing to cure the disease.
4. Insulin Coma Therapy: Used mainly in the 1930s to 1950s, this treatment involved inducing comas in patients with schizophrenia by giving them large doses of insulin. The idea was that the coma would “reset” the brain. However, the procedure was dangerous, often leading to death, and was abandoned once antipsychotic drugs became available.
5. Fever Therapy: Developed by Julius Wagner-Jauregg, a psychiatrist who won a Nobel Prize for this work, fever therapy involved infecting psychiatric patients with malaria to induce high fevers. This was thought to alleviate symptoms of mental disorders like schizophrenia and bipolar disorder. However, the treatment was risky and led to a number of deaths.
6. Hydrotherapy: In the 18th and 19th centuries, hydrotherapy was commonly used for treating mental disorders. Patients would be subjected to baths of varying temperatures, jets of water, and even wrapped in wet sheets to “calm the mind.” While the term hydrotherapy nowadays is associated with the therapeutic use of water in a variety of non-invasive treatments, historically it involved a range of practices including the therapeutic use of baths, showers, douches, and wraps. One form of hydrotherapy, sometimes referred to as “water cure,” involved submerging patients in baths of water or wrapping them in wet sheets, and sometimes even using high-pressure jets of water. There were many different methods, and some did push the limits to what would be considered safe and ethical today. The intention behind historical hydrotherapy was usually to calm patients or to expose them to extreme temperatures to provoke a physiological response, but these treatments were often administered without a clear understanding of their effects, and without the strict ethical guidelines and patient consent requirements that exist today. [In the modern day, safer forms of hydrotherapy are used for physical therapy and relaxation. They’re typically non-invasive and can include treatments like whirlpool baths, hot and cold compresses, and water exercises. These treatments can be quite effective for certain conditions, such as arthritis, muscle strains, and certain types of neurological conditions.]
7. Moral Treatment: In the 18th and 19th centuries, the “moral treatment” approach was popular. It was based on the idea that mental illness was caused by a lack of moral discipline and that patients could be cured through a regime of strict routine, work, and leisure activities. This was often coupled with physical punishment for noncompliance.
8. Restraint Therapy: This involved physically restraining patients for extended periods. This could involve straightjackets, chains, or even cages. This was often done more for the convenience of those running the institution rather than any therapeutic benefit.
9. Psychic Driving: Developed in the 1950s by psychiatrist Dr Ewen Cameron, this involved playing recorded messages to patients hundreds of thousands of times in an attempt to alter their behaviour. The method is now considered unethical due to its invasive nature and potential for abuse.
10. Rotational Therapy: Developed by Charles Darwin’s grandfather, Erasmus Darwin, in the 18th century. Rotational therapy involved placing a patient in a chair or swing suspended from the ceiling and then spinning that chair at various speeds for different lengths of time. The idea was that this rapid spinning would alter the patient’s circulation or induce dizziness to such a degree that it would somehow rearrange or adjust the contents of their mind, helping alleviate their mental health symptoms. In the 19th century, this method was adopted and further promoted by American physician Benjamin Rush, who is often referred to as the “Father of American Psychiatry.” He designed a special chair, known as the “Gyration or Rotational Chair,” for this purpose. However, like many early psychiatric treatments, rotational therapy was largely ineffective and could be quite harmful. The therapy could induce nausea, increase anxiety, and cause a number of other unpleasant side effects.

Strange but still used

1. Maggot Therapy: Also known as maggot debridement therapy (MDT), is a safe and effective method for cleaning non-healing wounds, such as pressure ulcers, venous stasis ulcers, neuropathic foot ulcers, and non-healing traumatic or surgical wounds. Maggots remove dead tissue and kill bacteria, helping to disinfect and speed up the healing process. The maggots used in therapy are typically larvae of the common green bottle fly (Lucilia sericata). These maggots are especially useful because they feed on dead or necrotic tissue, effectively cleaning out the wound, but they generally avoid healthy tissue.Additionally, the maggots secrete substances into the wounds that help fight infection and promote healing. They disinfect the wound by killing bacteria, including MRSA, a type of bacteria resistant to many antibiotics.
2. Leech Therapy: Medicinal leeches are approved by the FDA for use in blood congestion and venous insufficiency, especially in plastic and reconstructive surgery. They help to restore circulation in areas with poor venous drainage, reducing swelling and preventing tissue death.
3. Faecal Microbiota Transplant (FMT): FMT is a well-accepted and highly effective treatment for recurrent Clostridioides difficile infection, a serious condition that can cause symptoms ranging from diarrhoea to life-threatening inflammation of the colon. The procedure helps to restore a healthy community of gut bacteria, which is crucial for overall health.
4. Hyperbaric Oxygen Therapy: Hyperbaric oxygen therapy is a proven treatment for a variety of conditions, including decompression sickness, carbon monoxide poisoning, certain types of infections, non-healing wounds (such as those resulting from diabetes or radiation therapy), and certain cases of tissue death (necrosis). The treatment involves breathing pure oxygen in a pressurized chamber, which increases the amount of oxygen that your blood can carry and promotes healing.
5. Cupping Therapy: While research on cupping therapy is somewhat limited, several studies have found it can be effective for certain conditions. For example, a 2015 systematic review and meta-analysis found cupping therapy to be effective for reducing pain conditions like chronic neck or back pain, herpes zoster, and migraine when compared to no treatment or conventional treatments.
6. Shock Therapy: In the past patients were subjected to electric shock treatments to the brain without modern safeguards. Patients would be subjected to strong electric shocks to induce seizures, which was often terrifying and could lead to memory loss or other cognitive issues. The treatment has been refined and is now known as Electroconvulsive Therapy (ECT) . It is still used today (under anaesthesia and muscle relaxants) as a last line of treatment for severe depression,
7. Lobotomy: While the indiscriminate use of lobotomy as a treatment for various mental disorders has been largely discredited and abandoned, more refined forms of psychosurgery are still performed today, albeit very rarely and typically as a last resort. Psychosurgery is a term that refers to surgical procedures that aim to treat mental illness, usually severe and refractory conditions that have not responded to other forms of treatment. There are different types of psychosurgery, including:
   1. Anterior Cingulotomy: This is a procedure where a small lesion is created in the anterior cingulate cortex. This area is involved in mood regulation and experiencing pain and emotion. The procedure has been used to treat chronic pain, obsessive-compulsive disorder (OCD), and depression that hasn’t responded to other treatments.
   2. Anterior Capsulotomy: This procedure involves creating lesions in the anterior limb of the internal capsule in the brain. It has been used to treat refractory OCD and other anxiety disorders.

Foundations of modern treatment

The process through which modern doctors come to believe in the efficacy of treatments is grounded in evidence-based medicine, a systematic approach to clinical problem solving which allows the integration of the best available research evidence with clinical expertise and patient values. This approach has several key components:

1. Clinical Research: Modern treatments are generally developed based on rigorous scientific research. This begins with preclinical studies, often conducted in a lab setting, and progresses to clinical trials, where the treatment is tested in humans. The clinical trials process is structured in phases, from early-stage trials (Phase 1) that primarily assess safety, to later-stage trials (Phase 2 and 3) that assess efficacy and monitor side effects in larger groups of people.
2. Systematic Reviews and Meta-Analyses: These are high-level studies that aggregate the findings from many individual studies. This can provide a more definitive answer to a research question, as the larger sample size increases the statistical power of the study and allows for greater confidence in the results.
3. Clinical Practice Guidelines: These are recommendations issued by expert panels, usually at the national or international level, that review the existing evidence and provide guidance to practitioners about the best approaches to diagnosing and managing specific conditions.
4. Continuing Medical Education (CME): Doctors are required to continue their education throughout their careers, to stay updated with the latest research and treatment guidelines. This is often facilitated through conferences, workshops, online courses, and medical journals.
5. Patient Values and Preferences: Evidence-based medicine isn’t solely about research evidence. It also involves considering the patient’s individual situation, values, and preferences. What is the patient’s prognosis with and without the treatment? What are their feelings about the potential benefits and side effects? These questions are crucial to making the best decision for each individual patient.
6. Clinical Expertise: Doctors use their clinical expertise to interpret and apply research findings. This involves using their judgement to balance the potential benefits and harms of different treatment options.

In this way, modern medicine ensures that treatments are safe and effective before they’re widely adopted. This process is continuously updated, with new research leading to changes in recommendations and practices over time. The system isn’t perfect, but it is designed to provide the best possible care based on the best available evidence.