INTRODUCTION

A COUPLE OF YEARS ago I was sitting in a library, plowing through a rather dull nineteenth-century article about heart disease, when I spotted something more interesting on the previous page of the journal I was perusing. Underneath the promising headline “Sudden Protrusion of the whole of the Intestines into the Scrotum,” I found the following:

John Marsh, aged 50, a labourer, was brought into the hospital, having just been run over by a cart laden with bricks. His scrotum, on inspection, was found to be of most enormous size, extending two thirds downwards between the thighs, and measuring in circumference 17 inches. Its colour of a jet black; and its texture, from over distention, so exquisitely thin as to threaten immediate rupture from the slightest manipulation.

Questions whirled through my mind. Why was his scrotum so enormous? What on earth could a doctor do about such an injury in 1829? How long did the unfortunate John Marsh survive? Horrified and fascinated in equal measure, I could not stop reading. The answers proved to be just as intriguing. When the cartwheels had passed over Mr. Marsh’s belly, they had done so with such force that his intestines were squeezed through the inguinal canal, a narrow passage between the abdominal cavity and the scrotum. With his guts now competing with his nuts for scrotum space, as it were, the physicians had a simple task: Get them back where they belonged.

On being placed in bed the viscera were returned to their natural situation without much difficulty, merely by elevating the hips, depressing the shoulders, and applying moderate and careful pressure with flannels moistened in hot poppy fomentation.

Hot-water bottles, laxatives, opium and leeches (applied to the scrotum) completed the treatment. My assumption about Mr. Marsh’s survival prospects turned out to be unduly pessimistic.

On the twelfth day from the occurrence of the injury the patient was reported as quite convalescent, and able to sit up for some hours in bed, the precaution of applying a truss having previously been taken. At the end of the third week he was discharged cured.

Not quite cured, it turned out. A postscript adds:

He is compelled to wear his double truss both night and day, otherwise the viscera descend immediately into the scrotum in very large quantities.

I soon discovered that you can hardly flick through the pages of an old medical journal without stumbling across a story that is compellingly disgusting, hilarious or downright bizarre. In between long, dry dissertations on London sanitation or the treatment of yellow fever are scattered little anecdotal gems: tales of patients who glowed in the dark, performed surgery on their own bodies or vomited living slugs. Some are poignant or touching, a few are grim, but they all have more to offer than just a good yarn. However embarrassing the ailment or odd the treatment, every one of these cases says something about the beliefs and knowledge of an earlier age. While superstition and folk traditions can be seen influencing medics until surprisingly late, it is also clear that the practitioners of long ago were sometimes capable of immense sophistication. I began to collect these incredible tales from little-known corners of the medical literature: stories of weird treatments, jaw-dropping surgery and miraculous recovery from almost certain death.

The case histories in this book span three hundred years, from the early seventeenth century to the turn of the twentieth. Medicine changed dramatically during that period, undergoing a partial transformation from an art into a science. Early modern clinicians were still heavily influenced by the theories of ancient medicine, especially the writings of the Greek physician Galen—even if the realization that his opinions were not, after all, infallible had stimulated a new age of inquiry and innovation. Nevertheless, many of their treatments were based on the Galenic idea that health depends on the correct balance among four bodily fluids, or humors: blood, phlegm, yellow bile and black bile. If a surfeit of one humor was suspected, equilibrium could be restored by evacuating the excess, using bleeding or purgative medicines to do so. There was no anesthesia, so operations were short, painful and brutal—and while physicians and apothecaries had a vast range of drugs at their disposal, few were of much use.

Three centuries later, the microscope had shown that most infectious diseases were caused by organisms too small to be seen by the naked eye. Doctors had learned to control infection and perform surgery on an unconscious patient and could prescribe drugs that were effective against a range of serious conditions including heart failure and epilepsy. But old remedies still lingered: Bleeding was being recommended by some old-fashioned physicians as late as 1894, and laxatives were prescribed with wild abandon by Victorian doctors, who seldom failed to inquire about the state of their patients’ bowels.

Many of the treatments offered in these stories may seem ludicrous, even barbaric, from a modern perspective, but it is worth remembering that the medics of the past were no less intelligent or assiduous than their modern counterparts. One thing that these case histories demonstrate is the admirably tenacious, even bloody-minded, determination of doctors to help their patients, in an age when their art left much to be desired. Where there were no effective remedies, they looked for new ones, and it was inevitable that many dead ends would be explored before they found the way ahead. The methods they used were consistent with their understanding of how the human body worked, and it is not their fault that medical knowledge has advanced considerably since then.

In 1851, James Young Simpson, the pioneer of chloroform anesthesia, wrote an article about the strange remedies employed by ancient Roman doctors. He cautioned that it was unwise to be too hard on the “extravagance and oddity” of their methods, adding presciently:

Perhaps, some century or two hence, our successors . . . will look back upon our present massive and clumsy doses of vegetable powders, bulky salts, nauseous decoctions, etc., with as much wonderment and surprise as we now look back upon the preceding therapeutic means of our ancestors.

The same could be said of twenty-first-century medicine, which is far from a perfected science. That said, some old treatments were misguided to the point of perversity, even by the standards of their time, and I have not resisted the urge to dole out a little gentle mockery where I thought it justified.

Most of these cases are extracted from the medical journals that started to proliferate at the end of the eighteenth century as a means for doctors to share their knowledge and experience; other source material includes surgical textbooks and newspaper reports. While a few (in the Tall Tales chapter) may be hoaxes, the vast majority are genuine case reports, written by medics who give an honest account of what they did and saw. Some are presented in their entirety; others have been edited to remove superfluous or uninteresting details; but I have not added or embellished anything.

Finally, a disclaimer: I am not a doctor, and nothing within these pages should be construed as medical advice. Readers who choose to treat their ailments by administering port-wine enemas, ingesting snake excrement or smoking cigarettes steeped in mercury do so at their own risk.