The regularity, relative safety, and relative convenience of modern surgery is easy to take for granted in today’s world of high-tech medical. Operating on a human body has always been a risky, agonizing, and often bloody process. In the past, surgeons would rush to amputate a limb or remove a tumor before their patient bled to death on the operating table, without the aid of anesthetic or sterile procedures. Because most patients died within days of surgery from complications like infections, even if they made it through the treatment alive, there was no assurance that it would be successful. But as medicine progressed, surgeries grew less risky and more effective. Every year, thousands of people undergo operations like heart transplants and extensive brain surgeries, which were unimaginable even a generation ago. However, a strange and unsettling phenomenon swept the medical profession in the early 20th century, along with the revolution in surgery and most scientific advancements.
The current trend of surgically removing perfectly good organs as a precautionary measure originated with one of the earliest medical fads: constipation. For his groundbreaking work in immunology, Russian biologist Ilya Metchnikoff was awarded the Nobel Prize in Physiology or Medicine in 1908. In 1914, he proposed a hypothesis of chronic disease that he called “auto-intoxication.” As far as Metchnikoff was concerned, the colon—the 4.5-foot section of the large intestine that connects the small intestine to the rectum—was nothing more than a putrid cesspool where waste products from the body built up and festered. According to Metchnikoff, the amount of poisons that leaked into the body via the intestinal wall increased as the time waste sat and rotted in the gut. He blamed these poisons for a wide range of long-term health problems, including diabetes, rheumatoid arthritis, ulcers, bladder cancer, high blood pressure, and mental illnesses including depression and schizophrenia. Another theory put forth by Metchnikoff was that the absorption of essential nutrients was hindered when old waste solidified and stuck to the gut wall. In a nutshell, he suspected that chronic constipation was somehow associated with nearly every ailment imaginable.
Metchnikoff was an early proponent of this notion in contemporary scientific language, but the concept that intestinal waste builds up over time and causes chronic illness has deep historical roots; it appears in the Sushruta Samhita, a Sanskrit medical work from circa 1000 B.C.E. Not only did this old book detail a laundry list of ailments that many claim are brought on by persistent constipation, but it also recommended a number of purgatives and cleansing enemas to alleviate the problem. With the advent of the Four Humours theory of medicine in ancient Greece, the use of enemas and purgatives as sickness treatments became even more widespread.
A Theory of the Four Humors and Clysters
Blood, phlegm, black bile, and yellow bile were considered the four “humours” that determined how the human body functioned according to the Four Humours doctrine. It was believed that all ailments stemmed from an imbalance of these humours, and that reestablishing this equilibrium could cure them. For instance, bloodletting could alleviate an excess of blood. It was once believed that an accumulation of black bile, caused by constipation, would result in sadness or despair. Oral purgatives and enemas, or clysters (from the Greek for “to wash out”), were the most often prescribed therapies for this.
During the rule of the French “Sun King” Louis XIV, clysters were at the height of their popularity, but they continued to be a popular remedy for almost two millennia. Like modern-day practices like exercise, proper nutrition, and vitamin supplements, keeping one’s colon clean was essential to a healthy existence in 17th-century France. Professional doctors called “limonadiers des postérieurs” or “backside lemonade applicators” would administer enemas as often as four times daily, either in patients’ homes or in specialized establishments called restaurants. These institutions transformed into the current idea of restaurants from their initial purpose of renewal.
People could pick from an overwhelming array of enema alternatives, each with its own price tag, ranging from nozzles crafted from rare materials like tortoiseshell and mother of pearl to purifying concoctions containing orange blossom, angelica, rosemary, bergamot, and damask rose, all of which were said to possess their own unique medicinal qualities. Even more dangerous were the ones that included coffee and smoke, which may lead to addiction as well as an instant high. Curiously, in the River Thames in the 18th century, specialized kits were set up to resuscitate victims of drowning using tobacco enemas.
Prisoners in 17th-century France were not exempt from using enemas for regular cleansing because of how essential they were to society. There was an infinite amount of enemas that could be administered to the King in order to keep him healthy. During his six-month illness in 1643, Louis XIII—the father of the Sun King—received a minimum of 47 bloodlettings, 215 oral purgatives, and 312 enemas. As he continued his infamous appetite, the equally gluttonous Louis XIV endured 38 bloodlettings, hundreds of enemas, and thousands of oral purgatives. Notable commentators of the time, such Jonathan Swift of England and Molière of France, poked fun at the enemas craze in their respective works, including “Le Malade Imaginaire” (1673) and “The Hypochondriac.” It is ironic that Molière was put in danger by the exact physicians he had sarcastically derided when he had a brain hemorrhage while performing the principal part.
Persistent Fixation on Regular Bowel Movements
Constipation remained a medical fixation, even though the enemas craze never returned to its 17th-century absurdity. For almost three centuries, the most popular medications were laxatives and purgatives. Problems with auto-intoxication and bowel regularity remained even after the medical paradigm shifted from the Four Humours to more contemporary models like Germ Theory.
Anatomists started to understand that the human body was not a flawless creation but a complex and flawed mechanism containing vestigal traits from its evolutionary past after Charles Darwin’s seminal essay “On the Origin of Species using Natural Selection” came out in 1859. The tonsils, uvula, appendix, and tailbone were all part of these characteristics. No organ was subject to greater disdain and examination than the colon as doctors started to view these apparently little organs as the source of all human illness. The colon was formerly thought of as a poisonous serpent that coiled up in everyone’s belly, sapping their vitality and health over time. A practical solution to the problem of colon cancer prevention became available in the late 19th century, thanks to advancements in anesthetic and antiseptic procedures.
Radical Colectomy and Dr. William Arbuthnot Lane
Renowned for his groundbreaking work in a variety of surgical specialties, Dr. William Arbuthnot Lane was the illustrious chief surgeon at London’s Guy’s Hospital. Metal plate and screw fracture setting, cleft lip and palate repair, intestinal obstruction clearance, and postoperative infection reduction using specially-designed sterile instruments were all areas in which he demonstrated exceptional skill. Some even went so far as to say that Lane was one of the real-life models for Sherlock Holmes due to his zaniness and extraordinary reasoning abilities.
Lane devoted most of his time and energy to the colon at the turn of the twentieth century. In an effort to cleanse their colons of dangerous bacteria, he first suggested that his patients drink copious amounts of heavy cream and liquid paraffin. Nevertheless, Lane thought this was just a stopgap measure. Not long after, he perfected the radical colectomy, a technique that would bring him widespread notoriety. In this procedure, the whole colon was removed and the small intestine was connected directly to the rectum. In Lane’s view, this would avoid the buildup of putrefying waste in the colon by ensuring that waste was released immediately after nutrients were absorbed.
Patients went crazy after hearing about the radical colectomy and wanted to have it done at Lane’s practice. Lane removed over a thousand colons during his career, and thousands of Americans and Britons had their healthy ones removed during the 1910s and 1930s as a prophylactic measure. The treatment was often recommended for minor diseases like a sore throat or stomach ulcer until the craze for colectomy reached epidemic proportions. A case occurred where a young boy who was supposed to have a tonsillectomy ended up getting a colon removed instead, leaving him without his colon but with perfectly healthy tonsils. In George Bernard Shaw’s 1906 drama “The Doctor’s Dilemma,” a character based on Lane pushed for the removal of the unciform sac as a remedy for a variety of illnesses, parodying the colectomy fad.
Colectomies: The Depressing Truth
Tragically, the radical colectomy failed to deliver the anti-aging and anti-depression benefits that its proponents had hoped for. Unfortunately, only a small percentage of patients actually reaped the benefits of colectomy, and as many as 30 percent of Lane’s patients succumbed to infections and other complications following the procedure. Even though the radical colectomy was still being done into the 1930s, medical opinion was slowly shifting against it.
Over time, Lane began to question the efficacy of surgical interventions and established a new school of thought called “New Health.” A healthy, long life was envisioned by this movement’s advocates through the adoption of a more natural, holistic way of living that prioritized things like exercise, vitamin supplements, fresh air, whole foods, fruits, and vegetables. Nevertheless, Lane was not the only one who pushed for surgical intervention; Dr. Henry Andrews Cotton, who lived during the same time as Lane, went to terrifying lengths to eliminate all possible infection-causing factors.
The Excision of Organs by Dr. Henry Andrews Cotton
The Trenton, New Jersey State Lunatic Asylum was taken over by Dr. Henry Andrews Cotton in 1907. He wasted little time implementing progressive changes, such as the removal of physical shackles, the employment of social workers, and the establishment of daily staff meetings for the purpose of coordinating patient care. On the other hand, Cotton became aware of Dr. Adolf Meyer’s new idea, put forward by the Johns Hopkins psychiatrist, around 1915. The Theory of Focal Infection proposed that all mental illness originated from dormant bacterial infections that secreted poisons that afflicted the mind. The idea was developed from the realisation that delirium was a common complication of serious bacterial illnesses and from the finding that the same bacterium that causes syphilis, Treponema pallidum, was also responsible for a kind of dementia known as the General Paresis of the Insane.
Dr. Cotton saw no ambiguity in Meyer’s theory: if all possible points of infection could be removed, mental disease might be healed. He started by extracting his patients’ teeth because he thought they might be hiding bacteria. As a precaution, Cotton extracted the teeth of his own children, and when he thought he was going mad, he extracted his own teeth as well. Such was Cotton’s enthusiasm. Cotton proceeded to remove testicles, ovaries, spleens, stomachs, gallbladders, cervixes, and colons from his patients after dental extractions failed to yield the expected results. Cotton received praise from his fellow psychiatrists for his incredible 85% success rate.
A somber period in medical history is embodied by the extreme practices of Drs. William Arbuthnot Lane and Henry Andrews Cotton. Although their intentions were good, the harsh measures they took to treat and prevent disease ended up hurting and killing many people. The significance of evidence-based medicine and ethical medical practices is brought home by these strange and scary trends in extreme surgery and organ removal. Modern surgical procedures have allowed us to make great strides in the sector, with an emphasis on ensuring the safety and well-being of patients. It is essential, though, to keep an eye out for and be critical of medical procedures to make sure they don’t do more harm than good and are grounded in solid scientific principles.