Sometimes, we physicians take ourselves too seriously, so we thought it would be fun to take a little romp through some of the less than auspicious history of our esteemed profession.

 

The folly of doctors in art

Greek vase depicting the physician Iatros performing bloodletting
Iatros bleeding his patient

Let’s start with art. This classic Greek vase depicts the physician, Iatros, performing blood-letting on a patient. In those days, it was believed that blood and other bodily fluid were “humors” that had to be in balance to maintain good health. Although unproven and unpleasant, this practice was common until the end of the 18th century, almost 2,000 years!

Since people who underwent this procedure were usually sick, many become sicker as a result of bloodletting and, who knows how many went to an early grave because of this “treatment”. Of note, we now use the term iatrogenic to describe illnesses caused by a medical treatment.

Depictions of doctors as quacks were common in the 19th century. FOC Darley’s “The Quack Doctor” appeared in the Boston Magazine “Every Saturday” on January  14, 1871. His sumptuous clothes and haughty stance as he poses in front of posters hawking his wares says it all. Somehow, this brings to our minds the purveyors of today’s nutritional supplement industry.

Another wonderful quack lithograph has the delightful title, “Dr. Kill’em or Cur’em.” The wording below the elegant doctor says,

Dr. Killem or Curem lithograph
Dr. Killem or Cure’em

Doctor Kill’em or Cure’em which ever it may be.
If you cure’em or kill’em it don’t matter to thee.
To be shaken when taken, or “two pills at bed-time.”
When you’re caught you’ll be shaken, my dear valentine.

There is a difference of opinion as to the origin of the term quack. Some say it originated from the word “quicksilver”, a common name for mercury that was used unsuccessfully to treat syphilis in the 19th century. Another theory is that the word comes from the old English term quacksalver” (the combination of quack” (to shout) and “salve” (therapy)). In other words, a quacksalver is someone who loudly promotes his salves.

 

Moving on to literature

Post of The Doctor in Spite of HimselfMoliére, the delightful French playwright of the 17th century, made a successful career out of exposing quacks and charlatans in some of his classic plays. For example, in his 1666 comedy, “The Doctor in Spite of Himself,” the main character, Sganarelle, an alcoholic woodcutter, terrorizes his family, spending all of their money on food and alcohol. His wife decides to get even. She convinces servants of a rich family that Sganarelle is the best doctor in the world. After being beaten, Sganarelle agrees to accept the well-paying position as the family’s doctor. There are many twists and turns including Sganarelle almost being executed, but eventually, all ends well and the alcoholic woodcutter becomes a rich and respected doctor.

In the “Imaginary Invalid,” Argan, a severe hypochondriac, plots to have his daughter marry a doctor so he can get free care. But, of course, she doesn’t want to because she loves someone else. After much hilarity, Argan eventually gives in and allows his daughter to marry her love. His brother eventually solves the problem by convincing Argan that he should become a doctor so he can treat himself.

 

The cereal entrepreneur

Dr. John Harvey Kellogg, Cereal Doctor
Dr. Kellogg’s formula: eat your morning cereal followed by a daily enema!

What is America’s quintessential contribution to breakfast? Why cereal, of course. Until the introduction of corn flakes, the closest thing to today’s cold cereal meal was porridge or cornmeal mush—often served with molasses and maybe even a beer. The person who introduced breakfast cereal was John Harvey Kellogg, MD. He was actually quite bizarre.

In addition to elaborate diets, he advocated cleansing enemas, vibration therapy, and light therapy, to name a few. To cure what? Everything from headaches, to eczema, arthritis, and chest pain. Bizarre or not, he was wildly popular and his corn flakes cereal, manufactured in his plant at Battle Creek, Michigan, is still with us today. Kellogg’s story is fictionalized in the very fun read, “The Road to Wellville,” by T. C. Boyle.

BTW, a number of entrepreneurs from Battle Creek, including Sylvester Graham (“Graham Crackers”) and CW Post (“Post Cereals”), soon climbed on the bandwagon with their manufacture of breakfast cereals and health foods. Have you ever suspected that the cereal aisle in your favorite supermarket is so laden with medical history, albeit not very glorious?

 

Snake oil, vibrators & enemas

Quack medicine: snake oil
It isn’t just a metaphor; here is proof

Another quintessential American invention is snake oil. Yes, we aren’t kidding. Patent medicine salesmen hawked this product in every little town in America, and then quickly high-tailed it out of town, before being strung out by the angry townspeople on the first available tall tree.

Wonder if they taught this in his Med School?

Speaking of legacy: Did you know that the ubiquitous vibrator has a terribly male-chauvinistic origin? Female depression and emotional excesses were thought to originate from the uterus, and were classified as hysteria (from the Greek word hystera, for uterus); so what a better way to cheer up a sad uterus then an invigorating vibratory stimulation? Dr. Swift embraced it, to the delight of many a female patient (as well as Dr. Swift we presume).

Dr. Jason Salber sent us this one. This is utterly unbelievable, but true nonetheless. Physicians gave patients tobacco smoke enemas for various medical purposes, primarily for resuscitation of drowning victims. A rectal tube inserted into the anus was connected to a fumigator and bellows that forced the smoke up the rectum. The warmth of the smoke was thought to promote respiration. Unfortunately, no drowning victim was thusly resuscitated, but the treatment did leave a legacy: the expression of “blowing smoke up your ass.” Don’t believe me? Click on this link Nash Spring2012 1up (dragged).

 

Mondo bizzaro

Although, on reflection, we shouldn’t rush to judgment. I am sure that one hundred years from now, some smart aleck, not unlike the present writers, will poke fun at the way we practice medicine today. We will close by leaving you with the sage words of Dr. William Osler (1902), the father of modern American medicine:

“The philosophies of one age have become the absurdities of the next, and the foolishness of yesterday has become the wisdom of tomorrow.”

Pat Salber, MD, MBA and Dov Michaeli, MD, PhD
Patricia Salber, MD, MBA (L) is the Founder and Editor-in-Chief of The Doctor Weighs In. She is also a physician executive who has worked in all aspects of healthcare including practicing emergency physician, health plan executive, consultant to employers, CMS, and other organizations. She is a Board Certified Internist and Emergency Physician who loves to write about just about anything that has to do with healthcare. Dov Michaeli, MD, PhD (R) loves to write about the brain and human behavior as well as translate complicated basic science concepts into entertainment for the rest of us. He was a professor at the University of California San Francisco before leaving to enter the world of biotech. He served as the Chief Medical Officer of biotech companies, including Aphton Corporation. He is now retired and enjoys working out, following the stock market, travelling the world, and, of course, writing for TDWI.

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