Doctor's Review: Medicine on the Move

November 20, 2017
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Fear of medical mechanics

It wasn’t MDs that patients minded so much as the tools they used

A physician’s white coat may be enough to send some patients’ blood pressure soaring, but at least it can be said that medical instruments these days are no longer the stuff of nightmares. Not so long ago though, even the most soothing bedside manner was not enough to put a patient at ease once they glimpsed the horrific-looking implements that would be put to use on them.

Trypanophobia, fear of needles, was certainly more justified back in the 1660s than it is today. In the 1660s experimenters J.D. Major of Kiel and J.S. Elsholtz of Berlin were the first to attempt injections in humans. They used a forerunner of the syringe put together by the renowned English architect Sir Christopher Wren, who probably should have stuck to buildings. Fashioned using animal bladders as the syringe and goose quills for the needle, Wren used the primitive device to deliver opium intravenously to a dog, likely to see if orally administered medicines could be delivered in this way. Major and Elsholtz boldly went where they should not have gone and used the device on humans with often deadly results. Their failed experiments were enough to turn the medical establishment away from injections for nearly two centuries.

Child-sized

When they were taken up again in the latter half of the 19th century, they were still not for the faint of heart. Early models were made entirely of metal. Only later did a version with glass make it possible for the user to better estimate dosages.

Today’s anti-vaxxers might have even more support than they do now were vaccines still administered as they were back in the day -- with a mechanical scarificator. Even a good-sized needle pales in comparison to these hulking metal objects. Manufactured between 1874 and 1900 and thoughtfully curved to fit the arm of a child, they usually housed four rows of double blades, or sometimes, gilded steel teeth, reminiscent of the “steel leeches” from the time when bloodletting was a common practice. The instruments were prepared for a small pox vaccination by dipping the working end in lymph material from the pustule of a person who had received the vaccine five to eight days before and was showing skin blisters as proof. A similar delivery method, greatly refined, is still used today for small pox vaccinations.

A lousy system

Vaccines bring to mind another distasteful tool-of-the-trade, this one invented in the 1920s: louse cages. About the size and shape of a match box minus the protective sleeve, these were filled with live lice and strapped by the half-dozen to the legs of human “feeders.” When the lice had had their fill of blood, they were infected with typhus, dissected, and used to create a vaccine for the terrible disease which until then could not be stopped.

No catalogue of horrific medical instruments would be complete without a respectable collection of bloodletting devices. Spring lancets, fleams and blood bowls can still send a chill through the hearts of both patients and practitioners, especially the latter, who can fully appreciate how harmful the gory practice was. In an era when there is never enough blood to go around no matter how generously donors may give, the idea of hacking into a patient’s leg with a twelve-bladed scarificator and dumping the resulting blood down the drain is almost as disturbing as the effect on the victim.

Cut it out

Other instruments were used somewhat higher up on a patient’s body. Hemorrhoid forceps ruled the day before quilted toilet paper and Preparation H, banding and cauterization with lasers. Generations of physicians who proceeded you simply mustered all the gumption they could, grasped the hemorrhoid tightly with the instrument and crushed it to restrict blood supply. Eventually, the damaged hemorrhoid tissue would wither and fall off.

A similar concept was at work with the once common physician’s tool, the eraser or “crusher.” A loop at the end of a long hook made it possible to lasso all manner of growths, tumours, polyps and cysts and strangle and crush the offending matter, by turning a screw to apply pressure and restrict blood supply like a tourniquet. Speaking of tourniquets, a helpful mechanism to be sure in some cases, we can be thankful that Lister-type tourniquets, invented by Joseph Lister, father of antiseptic surgery, are a thing of the past. Designed to compress the abdominal aorta during surgery, the Lister often damaged internal organs during operations and was doubtless the cause of some deaths.

The doctor’s safety was occasionally taken into consideration in the manufacture of medical tools whose barbaric purposes were obvious to the patient from the start. The tonsil guillotine was a long, wicked-looking device with a loop and a moveable blade on the end. Gruesome as it sounds, doctors of the 19th century were glad to have it, as it saved them from having their fingers bitten by terrified patients. After piercing the tonsil with a fork and severing it with the guillotine’s blade, their work was done. More fortunate patients received a mild anesthetic in the form of a cocaine solution.

A hole in the head

Not so lucky were the patients who underwent trepanning, the well-intended though misguided operation designed to relieve pressure on the brain by drilling a hole in the skull. The osteotome was a kind of hand-cranked chainsaw with a spike on the end meant to be jabbed into the patient’s skull to stabilize the rotating blade chains. The practice has never entirely died out. As recently as 1965, Dr. Bart Hughes, a librarian, not a physician, drilled a hole in his own head with a dentist drill. He was not alone in believing that trepanation increased "brain blood volume" and enhanced cerebral metabolism, and claimed that it had benefits similar to that of natural vasodilators such as ginkgo biloba.

Finally, there are certain medical instruments that should be banished from our collective memory. The fetal destructor comes to mind, a tool which delivered a killing blow to a baby when the mother’s health was failing and a caesarean was deemed too risky. The fetal perforator and extractor would be used to puncture the baby’s skull and empty its contents, rendering the head collapsible and easier to extract.

One of the most challenging instruments to reconcile in the history of medicine is one from our recent past. The leucotome, invented by Canadian neurosurgeon Dr Kenneth G. McKenzie in the 1940s, has a narrow shaft which is inserted into the brain through a hole in the skull. Depressing a plunger on the back of the instrument extends a wire loop into the brain, cutting brain tissue and so performing a lobotomy.

Another version of the leucotome was introduced by American Walter Freeman for use in the transorbital lobotomy. It was only too easy to insert the pointed shaft, modelled after an icepick, into the tear duct of a misbehaving teenager or wayward patient at a mental hospital, and give a quick tap with a mallet. The results were abominable, causing death in 5 percent of cases and a range of often hideous personality alterations in the rest. Freeman performed more than 3500 such lobotomies until 1967 when his license was revoked. The practice was eventually banned but not before over 40,000 lobotomies had been performed worldwide.

The present-day patient fears associated with a physician’s white coat would seem to pale in comparison to what’s gone before. Not so fast. The once ubiquitous garment has been banned in Britain, due to the propensity of the long sleeves to spread infection.

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