‘Barbaric’ medical practices still used today

In an age of rapidly evolving technology, it seems that the field of medicine is continually striving to develop and use the most novel innovations to optimize patient care—from robotic surgery and artificial organs to wireless brain sensors and smart inhalers. Yet there are certain age-old medical practices that continue to demonstrate modern-day relevance. Although many of these approaches may seem barbaric by virtue of current medical standards, researchers have validated their efficacy in clinical use. 

With that in mind, let’s take a look at five old-world medical practices and therapies that doctors continue to use with success today.

Trepanation

Since the New Stone Age, people across the globe have practiced trepanation: a surgical procedure that involves boring one or more holes into a person’s skull (ie, burr holes). Experts believe that ancient civilizations performed trepanation to exorcise malevolent spirits or demonic influences from an individual, as well as to treat certain health conditions such as convulsions, headaches, infections, and mental disorders.

Today, neurosurgeons still use trepanation, although for very different reasons. The technique is primarily used for the treatment of epidural and subdural hematomas. Some researchers have found that trepanation may in fact be a safer and more effective alternative procedure for the treatment of acute and chronic subdural hematomas compared with modern-day craniotomy, which is associated with a high mortality rate. Trepanation is also used for surgical access to help relieve intracranial pressure.

Lobotomy

Lobotomy is another surgical treatment that involves drilling a hole in a person’s skull. Unlike trepanation, however, the aim of lobotomy is to sever nerve fibers in the brain that connect the frontal lobe—the area of the brain responsible for thinking—with other brain regions.

The practice gained popularity in the 1930s through the 1950s, during which time it was inappropriately performed among the institutionalized for the treatment of some mental health disorders, including schizophrenia and bipolar disorder, as well as for mental retardation, chronic headaches, and anxiety. The procedure, which had a mortality rate of approximately 5% in the 1940s, also served to help address the issue of overcrowding in mental hospitals.

Although the operation gained prestige in the 1940s—primarily because JAMA published an editorial supporting the procedure and because its originator, Egas Moniz, received the Nobel Prize for Physiology or Medicine in 1949—it has now been largely overshadowed by its well-documented adverse side effects on personality and intellect. Doctors and nurses have described the personality changes exhibited by patients to range from those of docility and infantility to apathy and lethargy—all of which may inhibit the patient’s ability to function independently.

Thus, with the advent of newer and safer anti-psychotic drugs, traditional lobotomy has fallen out of practice. In the current psychosurgery setting, however, cingulotomy—an updated version of lobotomy that involves the targeted destruction or alteration of brain tissue in the anterior cingulate region—is used to treat obsessive-compulsive disorder. In severallong-term follow-up studies, researchers have found the surgical treatment to be effective, with few cognitive adverse effects. Side effects, generally mild, may develop postoperatively and include headache, nausea, and vomiting. More serious but uncommon side effects that may develop include postoperative apathy and memory deficits.  

Electroconvulsive therapy

Another brain treatment of ill repute, electroconvulsive therapy (ECT)—also known as electroshock therapy or “shock treatment”—was developed in the 1930s and practiced around the same time and in the same patient population as lobotomy. ECT involves the transmission of electrical currents through the brain, either via implanting electrodes in the brain or placing electrodes on the scalp. These currents are used to intentionally induce a brief seizure, which seems to alter the brain chemistry in a manner such that the symptoms of certain mental health conditions may be reversed.

Although the procedure has developed a notorious reputation from its inhumane use of high doses of electricity without anesthesia in the past, contemporary ECT has been proven to be safe and efficacious for the treatment of several mental disorders. When correctly administered under general anesthesia and in conjunction with a muscle relaxant, ECT can result in significant improvements in treatment-resistant depression, bipolar disorder, schizophrenia, and catatonia.

A typical course of ECT is administered approximately thrice weekly until symptoms improve—generally within 6-12 treatments—according to the National Institute of Mental Health. Although ECT is much safer today, it can have some side effects, notably upset stomach, muscle ache, headache, and memory loss, especially around the time of treatment. However, most memory problems usually improve over the days/weeks following the end of the ECT course.

Cesarean section

A common procedure today, Cesarean section (C-section) is an ancient practice with roots in India that dates as far back as 320 BCE. The name itself, however, is reported to stem from ancient Roman society. One popular legend holds that the procedure is so called for the circumstances surrounding the surgical birth of Julius Caesar; other experts claim that “cesarean” simply comes from the Latin “caedare,” which means “to cut.”

In the absence of pain control and current sanitary measures, C-section was almost exclusively performed as a last resort to save a fetus when the mother was near death. Furthermore, as a result of postoperative complications, including hemorrhage and infection, C-section births were associated with very high neonatal and maternal mortality rates. However, with the introduction of anesthetics, antiseptics, and antibiotics in the 19th and 20th centuries, along with refined surgical techniques to minimize bleeding and complications, these mortality rates significantly decreased.

In modern medicine, the objectives of C-section have evolved to consider the safety of both mother and child, and also take into account the mother’s preferences. In 2017, nearly one-third of all children born in the United States were delivered via C-section, according to the CDC.

Fecal microbiota transplantation

Experts believe that the first fecal microbiota transplantation (FMT) occurred in the 4th century when a Chinese doctor treated an individual with severe diarrhea or food poisoning via oral administration of a “yellow soup” that contained the dried or fermented stool of a healthy donor. What a wonderful cure for food poisoning!

Today, FMT is still practiced and involves the transfer of stool from healthy donors to critically ill individuals. Luckily, its administration method has improved, and is no longer administered organically.

Primarily used to combat Clostridium difficile-related infections, which affect hundreds of thousands of Americans each year, FMTs are now delivered through nasogastric or nasojejunal tubes, or through ingestion of frozen stool capsules, enemas, rectal tubes, or colonoscopies. The process works by introducing a healthy mix of bacteria that helps to restore better microbial balance in the gut.

In a systematic review of evidence conducted by the US Department of Veterans Affairs, investigators concluded that FMT for C. difficile infection was highly effective, with no administration method superior to the others. The findings from this review support those from several observational studies and randomized clinical trials in which researchers reported resolution rates of up to 90% following FMT for recurrent C. difficile infection.

Looking ahead

Only 70 years ago, lobotomy was praised for its innovation in the field of medicine—a practice that we now consider “barbaric” in the current era. Refined and rebranded as “cingulotomy,” however, and we no longer associate it with the same adverse knee-jerk reaction. If history has taught us anything, it’s the power of perception and its ability to completely alter the attitudes of a society.

In another 70 years from now, what current medical practices will we consider to be barbaric? Will chemotherapy, one of the best treatment options presently available for cancer, still be viewed in a positive light? Or will we look back in disgust and wonder how physicians ever could have injected their patients’ sick bodies with poison as a legitimate treatment? Only time will tell.