Which Medical Treatments Today Will We Someday Regard as Barbaric?

shutterstock_113504578Medical history is instructive, if for no other reason than that it might help to moderate somewhat the medical profession’s natural inclination to arrogance, hubris and self-importance. But the medical curriculum is now too crowded to teach it to medical students and practicing doctors are too busy with their work and keeping up-to-date to devote any time to it. It is only when they retire that doctors take an interest in it, as a kind of golf of the mind, and by then it is too late: any harm caused by their former hubris has already been done.

Until I read an article in a recent edition of the Lancet, I knew of only one eminent doctor who had been shot by his patient or a patient’s relative: the Nobel Prize-winning Portuguese neurologist Egas Moniz, who was paralyzed by a bullet in the back. It was he who first developed the frontal lobotomy, though he was also a pioneer of cerebral arteriography. As he was active politically during Salazar’s dictatorship, I am not sure whether his patient shot him for medical or political reasons, or for some combination of the two.

The article in the Lancet doubled the number of eminent doctors I knew of who had been shot. Professor Luigi Maria Bossi, an eminent gynecologist in Milan, was shot dead in his office in 1919 by a jealous husband, who fired first at Bossi and then at his wife, Bossi’s patient, and then turned his gun on himself.

Bossi was responsible, inadvertently, for the death of Constance Holland, Oscar Wilde’s wife. He operated on her in 1898 for a fibroid in her uterus and the complication killed her five days later.

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The operation was probably unnecessary, because Bossi wrongly attributed the urinary symptoms from which Constance had been suffering to the fibroid. In fact, she was almost certainly suffering from multiple sclerosis, a disease which had only recently been recognized and of whose existence and symptomatology Bossi, who was not a neurologist, might not have been aware.

Constance began to suffer from the symptoms even before her husband’s conviction. From 1889, six years before his imprisonment, she suffered from sudden lameness in the leg, which came and went in a way characteristic of the disease. She then suffered a variety of neurological symptoms, including neuralgia and weakness of the arm. Bossi undertook to cure her and performed an operation on her two years before he operated again and killed her.

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He may have operated because he thought that Constance suffered from hysteria, for he also believed that gynecological conditions were a cause of insanity and hysteria and was the author of two books on how to cure insanity by gynecological operations. Such beliefs, that now seem to us so absurd that it is a wonder to us that anyone could ever have held them, were not uncommon at the time, and Freud himself, under the influence of his friend, the ear, nose and throat surgeon Wilhelm Fliess, believed that a condition of the nasal septum could cause hysterical symptoms. In the 1920s a man called Cotton tried to cure schizophrenia by taking out all the patients’ teeth, on the theory that infected teeth were the cause of the condition.

What are our theories today that will seem absurd to our successors, what unnecessary or dangerous operations performed on the flimsiest of hypotheses? We can never know. Properly conducted trials repeatedly demonstrate that widespread practices are useless at best and harmful at worst. However, there is a more fundamental principal of medical ethics than First do no harm. It is that Something must be done.

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