5 Medical Practices of the Past: Barbaric or Brilliant?

Detail from "The Extraction of the Stone of Madness," a painting by Hieronymus Bosch depicting trepanation (c.1488–1516). Public domain.

The evolution of medicine is a journey filled with remarkable discoveries and, at times, harrowing practices. What was once considered standard treatment in ancient and medieval times might seem barbaric by today's standards, but these practices often laid the groundwork for modern medical advancements. Below is a list of five such practices, examining whether they were genuinely barbaric or, in some twisted sense, brilliant.

1. Bloodletting

Bloodletting was once a cornerstone of medical practice. It was based on the belief that balancing the body's four humours — blood, phlegm, black bile, and yellow bile — was essential for health. Physicians used this method to treat everything from fevers to mental illnesses, draining patients' blood to restore this supposed balance. While the rationale behind bloodletting was fundamentally flawed, the practice has surprisingly persisted in a more refined form.

Therapeutic phlebotomy is used to treat specific conditions such as hereditary hemochromatosis and polycythemia vera. In these cases, controlled blood removal helps to manage iron levels or red blood cell counts, preventing potentially severe complications. Although the historical practice of bloodletting often did more harm than good, its modern application demonstrates how even misguided practices can evolve into valuable medical treatments.

2. Trepanation

Trepanation, the practice of drilling or scraping a hole into the skull, dates back to prehistoric times. This procedure was believed to treat a variety of ailments, including head injuries, epilepsy, and even mental disorders, by releasing evil spirits or relieving pressure.

In modern medicine, the principles behind trepanation have informed neurosurgical techniques. Today's surgeons use precise tools to relieve pressure on the brain or access specific brain areas, significantly reducing the risks associated with the ancient practice. While trepanation may seem brutal, it paved the way for crucial advancements in brain surgery.

3. Leeches

Leeches were a staple of medieval medicine. These slimy creatures were believed to balance the body's humours by drawing blood from the body (the popular bloodletting practice), and their use was widespread across Europe and the Middle East. The "yuck factor" associated with leeches might make this practice seem particularly brutal, but modern medicine has again found a place for these creatures.

Today, leeches are used in microsurgery to reduce venous congestion — a condition where blood pools in a particular area, often after reconstructive surgery. Thanks to their anticoagulant-rich saliva, leeches help by removing excess blood and promoting blood flow. Though leeches may seem medieval, their effectiveness in specific medical scenarios has ensured their continued presence in modern healthcare.

4. Obsidian Blades in Surgery

In the Stone Age, obsidian — volcanic glass — was used to create some of the sharpest cutting tools known to humanity. Obsidian blades were utilized in early surgical procedures, including trepanation, due to their excellent edge, up to 100 times sharper than modern surgical steel. At the same time, these blades were fragile and not without risk; they could break and shatter, leaving small pieces in the wound.

Even today, a few surgeons use obsidian scalpels in highly delicate surgeries, particularly in areas where minimizing scarring is crucial. Despite being an ancient tool, the precision of obsidian blades highlights how some "barbaric" practices were ahead of their time in understanding the nuances of surgery.

5. Lobotomy

The lobotomy, introduced in the 1930s, involved severing connections in the brain's frontal lobe in an attempt to treat severe mental illnesses like schizophrenia and depression. The procedure was performed with minimal precision, often leaving patients in a vegetative state or with dramatically reduced cognitive function. By the mid-20th century, lobotomies had become notorious for their devastating effects and were largely abandoned with the advent of antipsychotic medications.

However, the concept of altering brain function to treat mental disorders has not disappeared. Modern psychosurgeries, such as cingulotomy, are performed with far greater precision, targeting specific brain tissues to alleviate symptoms of severe obsessive-compulsive disorder. While the lobotomy is rightfully viewed as a dark chapter in medical history, it inadvertently led to more sophisticated, targeted treatments in neurosurgery.

While many of these ancient practices might appear barbaric by today's standards, they often laid the groundwork for the medical advancements we benefit from now. The journey from bloodletting to therapeutic phlebotomy, from trepanation to modern brain surgery, illustrates that even the most primitive practices can contribute to the evolution of medicine, transforming from barbaric to brilliant.

References: These 'Barbaric' Medical Treatments Are Still Used Today | Bloodletting: A Brief Historical Perspective and Modern Medical Applications