A Short History of Quackery and Byways in Medicine Author(s): Janet J. Lieberman and Stanley J.

Lieberman Reviewed work(s): Source: The American Biology Teacher, Vol. 37, No. 1 (Jan., 1975), pp. 39-43 Published by: University of California Press on behalf of the National Association of Biology Teachers Stable URL: http://www.jstor.org/stable/4445041 . Accessed: 05/12/2011 20:57
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Short

History

of

Quackery

And

Byways

In

Medicine
possible to buy medicine (Bettmann 1956). In addition, a prescription sent to a dozen different pharmacies would yield as many differents remedies, differing in appearance odor, taste, and, we suppose, effectiveness. The bubonic plague, smallpox, and syphilis took their toll, but the quack survived.

JANET J. LIEBERMAN STANLEY J. LIEBERMAN

Blood-Letting

IT IS DIFFICULT TO DISTINGUISH between a quack and a legitimate medical practitioner, if their prescribed remedies work. Most people feel that a quack is one who engages in some aspect of the healing art without proper qualifications; but he who has qualifications may also be a quack. The difference appears to be based on the criteria of place and time-and of intent. The "witch doctor" of long-ago Africa may really have believed he had the power to cure. If he made serious attempts to tend the injured and ill, he was considered a healer. But if his intentions were fraudulent-if he knew the magic incantations and potions worked only on the patient's psyches, and if he used these mainly for personal gain, power or money- he was a quack. Although the exact origin of the term "quack" is lost in antiquity, it may have come from the Dutch word Kwaksalver, which refers to a salve for sebaceous cysts (Jameson 1961) or a seller of such salves (Maple 1968). Quackery had its origins in our prehistoric past. By the time of the Roman Empire, quacks existed in great numbers. They sold cosmetics, eye salves, and love philters. The quacks' remedies often came from their Greek antecedents.
Apothecaries of the Middle Ages

When the Greco-Roman civilization fell, there followed twelve or more centuries in which anything that had been previously learned about the maintenance of health in the human body was completely forgotten. During these times anyone who practiced the healing arts did so as well or as badly as his rivals. Quacks had a field day in the Middle Ages when one epidemic after another swept through Europe. The apothecary dispensed remedies along with free medical advice. During the plague, when many physicians fled, the apothecary became nearly the sole authority on health. The apothecaries charged exorbitant fees for their elixirs, potions, and philters. As a result, the average patient generaaly found it im-

From earliest times doctors theorized that life consists of juices. The body was only the container in which the juices flowed. Four of these juices, or humours, originated from the four elements of Empedocles-earth, air, fire, and water. The organs were merely preparers of the juices. In case of disharmony in the body, excess juices had to be dispelled. Aside from the ordinary portals of release of these juices, occurring in good health and illness, the physicians invented another portal in the form of blood-letting. Blood-letting was even practiced in the Stone Age. Sharp flints, shells, fishbones, and wood splinters were used to pierce a vein and permit excess blood to be released (Glasscheib 1963). Gardner (1965) notes that Celsus, first-century Roman medical encyclopedist, details blood-letting of that era. Glasscheib (1963) goes on to say that of all the ancient civilizations, China alone withstood the epidemic of blood-letting. The Chinese developed acupuncture instead. Philosophies on blood-letting varied through the ages. Some phlebotomists (blood-letters), would make a small opening in the vein in that area of the body opposite the diseased side. Others preferred bleeding the same side. The operation had to correspond to the proper phases of the moon. Thus, elaborate blood-letting calendars were designed (Maple 1968). Maple notes that in the Middle Ages monks were obliged by ecclesiastical law to undergo regular blood-letting to regulate the decay of the juices. Eventually, laymen, too, had to submit to prophylactic phlebotomy.
The authors (wife and husband) live at 928 Monte Vista Dr., West Chester, Pa. 19380. Janet J. Lieberman is currently a doctoral candidate at Temple University, Philadelphia. For biographical information, see ABT 35(6):315. Stanley Ef J. Lieberman is the senior member of Lieberman & Kelley, Attorneys at Law. He is also a lecturer in business law at Immaculata (Pa.) College and is on the board of trustees of West Chester State College.
39

Leeching

and Cupping

Leech therapy, another method of blood-letting, is mentioned in Pliny's Historia Naturalis (circa 100 A.D.) Galen (a Greek physician and philosopher of the 2nd century) was concerned with what should be done if a leech was inadvertently swallowed (Lasagna 1962). Physicians and barber surgeons had long employed the leech in popular medicine. However, in the late 18th and early 19th century, particularly -in France, leeching became the rage. French ponds were quickly emptied of these valuable worms and they had to be imported from other countries. Between 1827 and 1836, Paris hospitals alone used five to six million leeches annually (Glasscheib 1963). Applied by the hundreds to a patient's abdomen, the leeches could suck up to one ounce of blood apiece before dropping off engorged. Because the leech injected an anticoagulant into the wound, blood continued to flow even after the leech fell off. The practice of cupping was an allied art. Into a cup was placed some cotton or paper which was then ignited. The cup and burning contents were placed immediately over the patient's skin. A vacuum was created as the fire extinguished itself, drawing the underlying tissue into the cup. Blood too was pulled into the area. If the skin was left unpunctured a hematoma (tumor filled with blood) developed; this was dry cupping. Wet cupping required the skin to be pierced before the cup was applied, resulting in bloodletting. Hippocrates mentions cupping, and it apparently gained and waned in popularity up to the present. Lasagna (1962) says that the medical profession had by the 20th century given up the practice, yet he also mentions that in 1929 author George Orwell was cupped for pneumonia in a French hospital. It appears that "old wives" still use this remedy in many parts of the world. Purging, The poisons had to be dispelled from the body, even if it cost the patient his life. In addition to blood-letting, there was also the practice of purging. If the poisons could not be expelled through the veins, they fmust be forced out through the intestines. Use of emetics and purgatives became common medical practice, both in the curing of ills and for prophylactic purposes. Even this was not enough, however, and the use of the enema, or clyster, became the panacea. According to Lasagna (1962) and Glasscheib (1963), the enema was applied by the Egyptians. Pliny suggested that the Ibis, a bird sacred to the Egyptians, used its curved beak, aided by its very long neck, to give itself a rectal infusion of Nile water. In the 15th century the clyster syringe once again became popular. There followed three-hundred years during which the clyster was enjoyed as one of the most popular remedies for all cases of physical discomfort. Louis XI had enemata administered to his pet dogs. Louis XIII collected clyster syringes that were works of art; some of silver, others of tortoise shell,
40 THE AMERICAN BIOLOGY TEACHER,JANUARY 1975

f+:S~'i
Fig. 1. A lady of quality is bled. After the procedure the surgeon bandages the cut by her elbow. Engraving by Abraham Basse, in Glasscheib (1963). (Reprinted with permission from Rowohlt Verlag Gmbh, Reinbek bei Hamburg, Germany, and MacDonald & Co., London.)

mother-of-pearl, and porcelain. According to Glasscheib (1963), Louis XIII was subjected to 47 phlebotomies, 215 purgings, and 312 clysters all in a six-minth period. (One would assume that the royal throne was largely unoccupied during that time.) It became the mode at the French court of Louis XIV to take anemata even three or four times a day. Clyster mixtures ranged from holy water, used to exorcise devils from possessed nuns, to wine, extracts of orange blossoms or roses, and tobacco smoke, which was said to have a purifying effect and to ease stomach cramps and fainting fits. Although it may appear that the blood-letting, purgings, and clysters were part of the legitimate practice of medicine at the time, some people realized how senseless and potentially damaging these measures were. Contemporary writers and poets mocked them. Moli'ere ridiculed them in his plays, but this also served to popularize their use. One had to be copiously bled and one's intestines thoroughly evacuated in all cases of joy and sorrow.

Fig. 2. A sick woman about to receive a clyster. Engraving by Abraham Basse, in Glasschieb (1963). (Reprinted with permission from Rowohlt Verlag Gmbh, Reinbek bei Hamburg, Germany, and MacDonald & Co., London.)

Animal

Magnetism

The 16th-century physician Phillipus Aureolus Theophrastus Bombastus von Hohenheim, who called himself Paracelsus (greater than Celsus), was considered a quack by his peers. His revolutionary teaching and his burning of the standard textbooks of the time, particularly Galen's works, estranged him from the rest of the medical profession. His contribution to scientific and medical knowledge was considerable. He was the first to put forward the theory of the presence of magnetic forces in the human anatomy. Paracelsus advocated sowing some seed in the ground and then stroking a patient with a magnet impregnated with Mummy. According to Lasagna (1962), Mummy was perhaps sea foam hardened on rocks, bits of human flesh from the bodies of travelers, or fluid exuded from exhumed bodies. Bettmann (1956) says Mummy was powder of Egyptian mummies. Jameson (1961) indicates that Paracelsus preferred Mummy made from criminals that had just been hanged. After the patient had been stroked with the Mummy-impregnated magnet, the magnet was thrust into the earth where the seeds had been sown. As the seeds germinated and grew, the patient's symptoms would disappear and he would be cured. Franz Anton Mesmer, a late 18th-century physician, was introduced to the magnet by his friend, astronomer Maxmilian Hell. After a few successful attempts in curing patients' stomach cramps with a pass or two of his magnet, Mesmer decided that he had a cure for all ills. Since this cure was painless, even inducing a pleasant excitation of the nerves, it immediately became a welcome respite from the painful blood-letting, constant purgings, and clysters. In a very short time, Mesmer was the most successful and sought after doctor in Vienna. His magnet therapy alleviated, at least temporarily, the symptoms of the genuinely ill and cured the hypochondriacs. It was not long before he magnetized his fish pond. A dozen or so patients at a time could dangle their feet into the marble fountain and holding hands would allow the magnetism to pass through them to effect a cure. He magnetized drinking water and the beds and clothing of the ill; he even magnetized mirrors so that they would reflect magnetic power. The magnetized trees in his garden, in addition to the fish pond, ac companied by magnetic music from magnetized musical instruments, produced significant results. Mesmer's attempts at curing the blind-since-birth piano virtuoso, Maria Theresia Paradies, brought a great outcry from the Viennese medical community, especially when he took the young girl into his home for closer observation (Glasscheib 1963). Eventually Mesmer had to flee to Paris, where he found everyone suffering from the "vapours." Hysteria and hypochondria were also at great heights. In Paris, Mesmer established a clinic *with fantastically appointed treatment rooms. Here patients gathered in large numbers around magnetic sources, while Mesmer, wearing a lilac colored gown and magnetic

wand in hand, drifted from one patient to the next. With the odor of incense all about and to plaintive background music, the patients, holding hands, fell one by one to the floor in ecstatic convulsions. Mesmer's treatment of psychosomatically ill patients resulted in immense success. His seances offered something for everyone. To the sick he offered a cure; to the bored, a new experience; to the sexually repressed, sensual gratification. Mesmerism swept France like a hurricane. He might have continued in this state of adoration were it not for three occurrences which impaired his career. Louis XVI appointed a commission to investigate Mesmer's animal magnetism. Some of the commission's illustrious members were Benjamin Franklin, Antoine Lavoisier, and Dr. Joseph Guillotin. This commission concluded, "L'imagination fait tout, le magnetism nul" (Jameson 1961). The Royal Society of Medicine, in a similar investigation, reached the same conclusion. The third and most serious impairment to his career as a mental healer was the French Revolution. His popularity waned, and when heads began to roll, Mesmer fled to Switzerland where he retired to the life of an obscure country doctor.

Fig. 3. Samuel Christian Friedrich Hahnemann (1755-1843). Artist unknown, in Glasschieb (1963). (Reprinted with permission from Rowohlt Verlag Gmbh, Reinbek bei Hamburg, Germany, and MacDonald & Co., London.)
QUACKERY AND BYWAYS IN MEDICINE 41

Others studying Mesmer's techniques ultimately turned Mesmerism from the farce it then was to hypnotism, a legitimate part of medical practice today. In addition to Mesmer, such quacks as James Graham, Elisha Perkins, and Albert Abrams should be recorded for their efforts with electrotherapy. Electrotherapy was similar to magnetotherapy, but instead of mere magnetism mild electric currents were passed through the body. Homeopathy Samuel Christian Friedrich Hahnemann was born in Meissen, Germany, in 1755. After completing his medical studies he attempted to practice, but because of his timidity and scepticism towards the currently practiced theraputic matters, his practice was unsuccessful. The poverty-harried generally Hahnemann had to leave village after village when his debts became too great. In order to survive, he translated literary and medical works into German. In translating the works of the medical authority William Cullen, he learned that quinine cures malaria. He disagreed with Cullen's reasoning for the cure and concluded that quinine cures because, when given to a healthy person, it produces symptoms like those of malaria. This hypothesis became the basis for the system that would soon startle the medical world-homeopathy. It is the hypothesis, similia similibus curantur, or likes cure like (Fishbein 1925). Homeopathy was to Hahnemann a revelation. He returned to medical practice and in numerous articles in the public as well as the medical press he accused the court physicians of causing the death of the Holy Roman Emperor, Leopold II, by incorrect treatment. Because of the general indignation this aroused, his name became a household word. In about 1800 a heavy epidemic of scarlet fever broke out. Hahnemann announced he had a cure, but would withhold the remedy until he received a large sum of money as advance payment. Under heavy pressure from the medical profession he finally disclosed his remedy-1/24,000,000th of a grain of belladonna juice (Glasscheib 1963). Hahnemann inisted this cure was infallible, and if it appeared ineffectual, it was only because of improper usage. Belladona produces symptoms similar to those of scarlet fever. Thus, it would, according to the principles of homeopathy, prevent and cure scarlet fever. Hahnemann was so sure of his principle that he tried his medicines on himself and his children. He noted down each and every symptom that he observed for the following thirty or forty days. The result was a compilation of medications and- all symptoms observed for each. Hahnemann concluded that the effect of a medicament increases in proportion to its dilution. He therefore prescribed many, many dilutions which produced infinitesimally small doses. He put all this together with rules and basic principles of homeopathy in his Organun der Rationellen Heilkunde. With this manual in hand, anyone could cure any patient according to the prescribed rules: observe symptoms of illness in the patient; determine
42 THE AMERICAN BIOLOGY TEACHER,JANUARY 1975

which medication produces similar symptoms; and administer appropriate quantities of the medication to effect a cure. The most effective dilution was a 10% solution diluted in alcohol thirty times. Fishbein (1925) relates the case of a young child who took the year's supply of a family's homeopathic medicine at a single sitting and had no ill effects. Hahnemann developed a handful of disciples and soon was publishing a homeopathic journal. Although homeopathy was banned in many parts of Europe, he was permitted to practice in the Duchy of AnhaltCothen (Austria). Here he thrived by demanding substantial advance payment. He never made house calls, on the theory that those who were too ill to visit

Xlt

~(t

W.

--.

Fig. 4. Caricature of the homeopath's infinitesimai closes. "I should like a hundred-thousandths of a decigram of magnesia, please." "I'm sorry, madam, we don't sell such large quantities." By George Cruikshank, in Glasscheib (1963). (Reprinted with permission from Rowholt Verlag Gmbh, Reinbeck bei Hamburg, Germany, and MacDonald & Co., London.)

his office were too ill to be cured by the homeopathic method. When Hahnemann was about eighty his wife died, and he married a thirty-year-old Parisienne. They moved his practice to Paris where after eight very successful years he died in 1843. Homeopathy had won many converts. It flourished in Europe and especially in the United States. In 1848 the first homeopathic medical college was opened in Philadelphia. Another opened in New York City in 1858. Fishbein (1925) notes that by 1900 there were 121 regular medical colleges, 22 homeopathic colleges, and 10 eclectic colleges. Thereafter, really effective medications and treatments began to replace the homeopathic system. In the final analysis, homeopathic treatment was tantamount to giving no treatment at all. If recovery occurred, it was due to the long forgotten Hippocratic axiom that nature cures. This treatment replaced the dreaded purges, phlebotomies, and clysters. By com-

parison, therefore, homeopathy was the preferred errors, his Hahnemann's Despite treatment. in inphenomenon significant a was philosophy fluencing the trend of modern medicine in the right direction. Medicine Shows
w-

The traveling quacks were the doctors for the common people. Originating in Europe in the Middle Ages, they traveled with their wagons and carts from one village fair to another. A town barker would announce the "theatra," and as crowds gathered, a jester performed and a small orchestra or acting troupe offered entertainment. When the crowd reached the proper mood, the quack appeared, dressed in doctor's robes, and with the appropriate pitch sold his miracle remedies. In Colonial America there were no medical regulations for there were few doctors. The frontier woman had to depend on her own remedies or those of a neighbor or the Indians. The field was fertile for the quack-and he came, with his nostrums that were sure cures for all ailments of man or beast. Since there were no legitimate physicians for miles around-and, at best, very few in the cities-the medicine shows brought "health" to the country. They brought minstrels, circuses, and Punch and Judy. And they brought their magic painkillers. Perhaps the most famous of these, concocted in the late 19th century, was the "World Famous Kickapoo Indian Oil." Glasscheib (1963) says it contained herbs, camphor, turpentine, and lard; obviously it was a potent medicine. Patent medicines such as "Rattlesnake Oil" were equally popular. Most contained alcohol, glucose, and some herbs. With minor variations, similar patent medicines are available today. Quacks-Sellers of Hope

Fig. 5. The quack at the medicine show. Engraving by Anton Maulpertch, in Glasscheib (1963). (Reprinted with permission from Rowohlt Verlag Gmbh, Reinbeck bei Hamburg, Germany, and MacDonald & Co., London.)

The corporate quack is the purveyor of the cure-all analgesic. The seller of deodorant that in addition to stopping perspiration will also make you popular with as yet unfound friends. He is the modern alchemist who mixes a "mouth wash" that tastes terrible but nonetheless will prevent you from contracting a cold and at the same time help hook a boy friend. And he is the creator of countless cures for the common cold. There are no advances in medical quackery, only improvements in the skill of communicating to the gullible public the attributes of the quack's elixir. As long as people have ills, real or imaginery, there will be those who sell hope.... There will be quacks.
REFERENCES BETTMANN, 0. L. 1956. A pictoral history of medicine. Charles C. Thomas, Publisher, Springfield, Ill. FISHBEIN, M. 1925. The medical follies. Boni & Liveright, Inc., New York. GARDNER. E. J. 1965. Historv of biology, 2nd ed. Burgess Publishing Co., Minneapolis. GLASSCHIEB, H. S. 1963. The march of medicine. MacDonald & Co., Ltd., London. HAGGARD, H. W. 1929. Devils, drugs ana doctors. Harper and Row, New York. JAMESON, E. 1961. The natural history of quackery. Michael Joseph Ltd., London. LASAGNA, L. 1962. The doctors' dilemmas. BFL Communications, Inc., Freeport, N.Y. MAPLE, E. 1968. Magic, medicine and quackery. Robert Hale Ltd., London.

The varied, sometimes bizarre, prectices related here may lead one to conclude that quackery is a matter of ancient history. This, unfortunately, is not the case. Medical quackery is alive and well and practicing pseudomedicine all around us. The current records of governmental control agencies at every level are filled with cases of so-called electronic devices to cure cancer. Weight control devices, programs, diets, and medication are available on the open market. Medication in some form, countless publications, or, for the more affluent, "fifteen transistor, battery powered and guaranteed one year" devices are obtainable for those who are determined to make themselves the patient or the victim of the quack. Legitimate medicine, from its beginnings until the present, was and is too expensive for those who need it the most-the poor. It is this strata of society that most often falls victim to the quack. This group is not limited to the economic poor; it includes the poor in judgment and the poorly educated. It is these unfortunates who are today the victim of the quacks, both individual and corporate.

Air-Water

Relations

The first comprehensive examination of the interactive effects of air and water pollution control has been published by the Environmental Protection Agency. The 358-page report, Intermedia Aspects of Air and Water Pollution Control (EPA-600/5-73-003), is available for $3.15 from the National Technical Information Service, U.S. Dept. of Commerce, and the Govemment Printing Office, Washington, D.C. 20402.
QUACKERY AND BYWAYS IN MEDICINE 43