The history of medicine is, to a degree that is sometimes uncomfortable to acknowledge, also a history of confident, well-intentioned harm. Physicians were not careless. They had theories, they had texts, they had licensing bodies in some periods and guilds in others. What they did not have, for most of the span discussed below, was any reliable way to know whether a treatment worked. Controlled trials are a nineteenth-century invention, and germ theory is later still. Before those tools arrived, doctors reasoned from inherited authority — Galen, Avicenna, the Hippocratic corpus — and from pattern-matching against individual cases. The result, over several centuries, was a medical practice that frequently hastened the deaths of the people it was trying to save.
What follows is not a list designed to mock. These practitioners were, by the lights of their training, doing their jobs. Several of the treatments below were administered by physicians who outlived their critics. The catalog is organized by the type of harm done and draws on physicians’ manuals, apothecary ledgers, mortality records, and the occasional surviving patient complaint. Dates are given where the specific practice can be localized; where it persisted across centuries, a range is provided.
1. Bloodletting, the universal remedy (c. 200 AD – c. 1900)
No treatment was more widely applied, or applied to a wider range of complaints, than bloodletting. Drawn from the humoral theory inherited from Galen, the practice held that most illness was caused by an excess of one of the four humors — most commonly blood — and that the excess could be drained, either by lancet, by leech, or by scarificator. Patients were bled for pneumonia, fevers, melancholy, gout, headaches, and insomnia. Bleeding was prescribed prophylactically in spring. It was administered to pregnant women, to newborns, and to the dying.
The most famous bloodletting death is probably that of George Washington in December 1799, when three physicians removed roughly 2.3 liters of blood — nearly 40% of his total blood volume — over the course of ten hours in the attempt to cure what was almost certainly acute bacterial epiglottitis. He died that evening. Washington’s case is late, but it is emblematic of the entire tradition: the treatment was aggressive, the reasoning was coherent within the theory, and the patient was doomed the moment the physicians arrived with their instruments.
2. Mercury for syphilis (c. 1495 – c. 1910)
When syphilis appeared in Europe in the 1490s, physicians reached for mercury, which had long been used topically for skin conditions. It was administered as an ointment rubbed into the skin, as pills, as inhaled vapor, and in steam-baths in sealed cabinets. Patients salivated copiously — sometimes producing more than a quart of saliva per day — lost their teeth, suffered tremors and memory loss, and frequently died of the treatment rather than the disease.
A saying attached itself to the practice: “a night with Venus, a lifetime with Mercury.” The treatment was the standard of care for roughly four hundred years, which is to say that mercury was displaced only by the arrival of Salvarsan in 1910, which was itself an arsenic compound and not without its own hazards.
3. Trepanation for headaches and “madness”
Drilling a hole in the skull — trepanation — is one of the oldest surgical procedures in the historical record; Neolithic skulls show evidence of it, and many of those patients healed and lived. The medieval practice was less favorable. Performed with a hand-drill called a trepan, on conscious patients, in non-sterile conditions, to treat headaches, epilepsy, and what the texts described variously as possession, melancholy, or the presence of a “stone of madness,” the procedure had a high mortality rate. Hieronymus Bosch painted the operation around 1494, and his painting is a critique.
4. Mummy powder (c. 1100 – c. 1700)
For roughly six centuries, one of the most common ingredients in European pharmacies was ground-up mummy. The practice began with a mistranslation: the Persian word mumia referred to a bituminous substance that oozed from certain rocks and was genuinely used medicinally. Arab and then European physicians, encountering it only as an imported good, concluded that the effective ingredient was the preservative material used on Egyptian mummies. They began importing mummies — first genuine ones, then, as the supply ran low, freshly-prepared imitations — and grinding them into powder to be dissolved in wine or tinctures. It was prescribed for bruising, internal bleeding, epilepsy, and the plague. Francis I of France reportedly carried a small bag of it on his person at all times.
5. Tobacco smoke enemas (c. 1745 – c. 1811)
The Royal Humane Society of London, founded in 1774 to recover drowning victims from the Thames, recommended for several decades that apparent-drowning cases be revived by blowing tobacco smoke into the rectum through a set of bellows specifically designed for the purpose. Kits for the procedure were installed at intervals along the river. The theory was that tobacco, a stimulant, would restart respiration if introduced into the body; the route was chosen because the mouth was felt to be unreliable in an unconscious patient.
“Transmit the smoke of tobacco into the intestines, by means of a pipe, or the instrument contrived for the purpose.”
— Instructions for the Recovery of Persons Apparently Drowned, Royal Humane Society, 1774.
The practice was abandoned after Benjamin Brodie demonstrated, in experiments on animals around 1811, that nicotine was a cardiac depressant and that the treatment was more likely to stop the heart than restart it. The origin of the phrase “blowing smoke up someone’s” may or may not be related; the etymology is disputed.
6. Powdered pearls, gold leaf, and other confections
The European apothecary tradition made extensive use of consumable precious materials, on the theory — sometimes explicit, sometimes merely implied — that expensive substances had proportionate medicinal power. Patients swallowed ground pearls, flakes of gold leaf, crushed coral, and silver filings. These preparations were expensive and their efficacy, measured against the alternative of doing nothing, was zero. Their principal hazard was the displacement of potentially useful treatment. A seventeenth-century London apothecary’s ledger in the Wellcome Collection records gold-leaf preparations sold at roughly the price of a small farm animal per dose.
7. Animal and human dung poultices
At the opposite end of the price scale, medieval and early modern medicine made heavy use of dung-based poultices, applied externally or, in some preparations, ingested. Pigeon dung was prescribed for the plague. Dog dung (album Graecum, white dog feces) was used for sore throats in powdered form. Human excrement was incorporated into preparations for wounds. The infection rates among patients treated with these remedies are not recorded in any systematic way but are unlikely to have been favorable.
8. Swallowed lead and antimony cups (c. 1550 – c. 1700)
For intestinal complaints, one fashionable treatment was to drink wine that had been left overnight in a cup cast of antimony. The antimony leached into the wine, produced dramatic vomiting and diarrhea when drunk, and was judged to have “purged” the patient. The cups were often passed down as family heirlooms. Antimony poisoning, accumulated across years of use, produced kidney failure, cardiac damage, and death. The treatment was endorsed by Paracelsus in the sixteenth century and only gradually abandoned as the mortality became evident.
9. The king’s touch
For scrofula — a tubercular infection of the lymph nodes, then called the king’s evil — the standard English and French treatment for several centuries was to be touched by the reigning monarch. Charles II of England is recorded as having touched roughly 92,000 sufferers during his reign. The treatment was harmless, which by the standards of the rest of this list makes it something of an outlier; it also probably produced a measurable number of apparent cures, since scrofula often remits spontaneously. The practice ended in England with Queen Anne in 1714 and in France with the Revolution.
A closing note on self-deception
The physicians who administered these treatments were not, with few exceptions, cynical. They recorded their cases, consulted their texts, and defended their reasoning in print when challenged. What they lacked was the mechanism that would eventually prove them wrong — the randomized trial, the control group, the willingness to say we do not know. Medicine’s history is, more than it is flattering to admit, a history of things that seemed to be helping because no one had yet designed the test that would reveal otherwise. The practitioners in this catalog are not monsters. They are a warning about the limits of well-intentioned pattern-matching, and it is not a warning that has dated.