by Lydia Kang
But sometimes, the theory seemed a little too soft in the face of the obvious. In 1875, Dr. Charles-Édouard Brown-Séquard used cautery to “wake people up” from deep comas (which technically wouldn’t work—he probably just woke sleeping patients). Counterirritation via cautery was also used to treat melancholy and suspected werewolfism “when all other remedies fail.” Practitioners claimed it even cured headaches, sunstroke, and paralysis.
Surely, though, cautery imparted a hefty placebo effect, or at least distraction from the actual problem. In 1610, Jacques Ferrand recommended cauterizing the forehead with a searing-hot iron for lovesickness. For swelling, a twelfth-century physician recommended no less than twenty burns all over the body, including the temples, chest, ankles, under the lip, collarbones, hips… . You get the idea.
It shouldn’t be surprising that counterirritation wasn’t exactly a hit with patients. Dr. Carman had one final note about cautery that pretty much says it all: “It is sometimes difficult to convince a timid person that it is not a terrible procedure.”
Agreed. But fire wasn’t even the worst of it. Some antiquated methods of counterirritation and counterstimulation were blisteringly awful. And we mean blistering.
Blistering: A Beetle Tale
Now let’s say you chose option 3 from those headache cure options. Perhaps you found putting a red-hot iron on someone’s back to get her out of bed a little tame? Then you’ll be pleased to meet Lytta vesicatoria, a type of blister beetle, also known as Spanish fly.
Spanish fly’s reputation as an aphrodisiac is well known, but its usage as a blistering agent goes back centuries. The beetle is quite a pretty thing—half an inch in length, with an iridescent green back. Better to look and not touch, though: Its body contains a compound called cantharidin, which causes blistering when applied to the skin. The males of the species have more cantharidin than the females. They usually offer a romantic package of cantharidin-laced secretions to wrap around the female’s eggs to keep them safe from predators.
Spanish fly, at your service.
A London dispensary from the early 1800s offered a recipe containing a pound of beetle powder, a pound of wax, and a pound of lard. Toothsome. This paste was applied to the skin for as long as it took to form a blister. Where? It depended. Generally, the aim was to blister near the problem in order to draw it to the surface. So the abdomen was blistered for stomach ailments, or the lower legs for gout. If the patient became delirious, he would be blistered on the head instead. Unfortunately for some, the blisters caused gangrene, where the underlying flesh simply died and blackened.
Why blister? An 1845 medical textbook describes a leading theory from a Dr. Charles Williams: Many illnesses, like the measles, didn’t improve until after the skin erupted. Instead of a symptom, the rash was thought to be the actual pathway to healing. Hence, countless healers thought that irritating the skin could cure, and these theories went back as far as ancient Greek physicians.
And the bigger the blister, the better. Blistering agents—known as vesicants—were as plentiful as Jelly Belly flavors. Tartar emetic, an antimony compound typically used to cause vomiting (see Antimony, page 15), was also applied as an ointment to produce pus-filled blisters that resembled smallpox. Strong acids were effective but messy and hard to control. Same with jets of boiling water; boiling oil worked, too. Both made nice, painful blisters via partial-thickness burns.
Like most quack cures, blistering was used as a last-resort treatment for just about everything: hysteria, laryngitis, hypochondria, inflammation, fevers, diphtheria, encephalitis, even opiate addiction as late as 1929. Then what? Well, sometimes the blisters were sliced open to allow continuous draining of fluids, or blistering ointments were used to create a crop of blisters to maintain a “constant drain of … humours,” according to an eighteenth-century English materia medica. Sometimes, the fluids were collected, and in a rarely used process called phlyctenotherapy, the blister liquid was bizarrely injected back into the patient.
Blisters not your thing? Smart choice. I guess you finally decided option 4 was really the way to go. World peace, FTW.
Peas, Anyone?
Sometimes, blistering or cautery wasn’t enough to draw out the problem. The more bad humors that could pour out of a wound, the better, right? So on occasion, the blister was unroofed or a cautery iron was used to create a small divot in the skin. A dried pea was then shoved inside. The pea would cause more irritation, hopefully producing copious pus. (The authors would now like to apologize for your inability to eat peas in the forthcoming weeks.)
Occasionally, the pea was replaced or supplemented by a seton, a thread that was needled through the skin, preferably in the back of the neck. The thread—made more irritating with a coating of resin-based salve—would then be “flossed” daily through the new wound. Basically, it was like putting rosin on a violin bow and playing a wound. The accompanying sound must have been pretty awful. Just think of all that squishy pus, not to mention the human wailing.
Blistering and Cautery Today
Cautery continues today, though it is decidedly less awful a procedure. Partly because we’ve got anesthesia to thank, and partly because we’ve abandoned humoral theory and no longer panic in our helplessness when faced with disease. Surgeons wield modern electrocautery instruments with precision. Ye olde hot irons have long since been left to cool in museums around the world.
People still employ a type of distraction and counterirritation by rubbing on salves with menthol, capsaicin, camphor, or methyl salicylate (with the telltale wintergreen scent) for body pain or congestion. These salves tend to cause slight tingling and burning sensations of varying degrees, but do not get absorbed in sufficient amounts to precisely target that phlegmy airway or aching shoulder.
As for blistering, there is a good reason why it has no place in modern toolboxes. Blistering cannot truly “draw out” a disease from the body. And it’s obvious why the gentler distractions of medicated muscle salves are on the shelves, instead of Spanish fly ointments. Modern patches and rubs actually do feel nice, so long as you’re not covering ginormous patches of skin with the medicines (yes, you can actually be poisoned to death by those minty-smelling rubs). They are relatively safe, and happily there won’t be a bubbling, drippy, oozy blister in sight.
15
Enemas & Clysters
Of Autointoxication, Pfear of Ptomaine, Public Enemas, a Rectal Blasting Cushion, and Guardians of the Anus
On this earth, right now, there exists an eight-hundred-pound enema bulb. Yes. It’s a brass statue situated in the spa town of Zheleznovodsk in Russia, famous for its colonics. The enema bulb is about four feet in length and held aloft by three cherubic angels, who aim it lovingly toward the sky. It’s as if they’re temptingly inviting some celestial buttocks down to earth for a nice anal washout. What a gilded tribute and testament to our obsession with the enema!
Since the beginning of recorded time, humans have been fixated on their bowels. Medical practitioners have always battled the beast called constipation, and their sword in this fight has often been the enema. Sure, constipation is a nagging problem that no one wants, but enemas were thought to cure all sorts of problems besides sluggish stools.
The word enema originates from a Greek word meaning “to throw” or “send in.” Later, the Latin meaning became synonymous with enemas: inject. The seventeenth-century term for enema was clyster, perhaps a somewhat prettier word, which sprouted from the Greek word for “wash.”
Throughout history, enemas have contained a range of agents, including water, herbal concoctions, milk, molasses, turpentine, honey, beer, soaps, wine, and oils. What did they treat? Just as colorful a range of ailments—tuberculosis, dropsy, hernias, appendicitis, depression, poor nutrition, headaches (Mozart’s father once famously said—“the arse cures the head”), obesity, sluggishness, breathing problems, fever-borne illnesses, sexual dysfunction, drowning, and coughing up blood. Somewhere in that rear cave of the a
ilment-addled human was a dark place that promised health, if it was simply power-washed with a deft hand.
Spanish vase, c. 1600s. The inscription states, “I am Don Joaquin Hernandez’s jar. Through intense devotion to my constitution I find myself on this occasion shamefully syringed at the hands of a serf.”
The delivery system started out as more rudimentary, with hollowed gourds, tube-shaped bones, or animal bladders. Thoughtfully, some people were employed as “blowers” to give the medicated liquids a little oral push to their dark destinations. In more recent centuries, there were beautifully constructed clyster syringes of metal and ivory up to a foot long, or tubes with decorated pumping chambers, or chairs you sat on that shot the liquid … upstream. Most people might recognize the designs of rubber sacks with flexible tubing and rubberized enema bulbs that still exist today.
The range of products and medicated liquids was vast. The most famous and infamous have used them (Hitler used chamomile tea, not to drink, but as enemas for “cleansing” and possibly weight loss). So why the obsession with enemas?
Galen administers a clyster. The dog seems rather entertained!
Autointoxication: No, It’s Not Drinking a Gallon of Beer
Much of the lure of enemas was due to the concept of autointoxication, the theory that feces are full of toxins and noxious agents. We now know that our own bowels don’t naturally intoxicate us, but it took a few millennia to figure that out.
The ancient Egyptians had called it wh˘dw, a putrefactive element found in feces that caused disease, and therefore purged the body via emetics and enemas for three days a month, according to Herodotus’s writings in the fifth century bce. Hippocrates, around the same time, was reported to have said that disease arose from the vapors produced by undigested food in the colon.
In the second century, Galen thought that the body’s humors would putrefy given the right conditions, and expelling them in the feces helped. Then there was the theory that these putrefaction particles might be in the air, ready to cause disease. In addition to originating inside the bowels, these “miasmas” were thought to be disease-carrying airs that came from fetid swamps or rotting vegetation. Also simply called bad air or night air, miasmas were blamed as a cause of many epidemics, including cholera and the Black Death. This concept was widely accepted for centuries. In Jane Eyre, the typhus that killed half of the orphans grew from “fog and fog-bred pestilence.” Ma Ingalls in Little House on the Prairie cautioned Pa against eating watermelon because “it grew in the night air” and might give him the “fever ’n’ ague” (ague being malaria, itself from the Italian for “bad air”) that was striking down settlers. Pa ate the watermelon anyway and survived.
It’s easy to understand why constipation was a theoretical source of putrefaction—human waste, to most people, is utterly revolting, and knowing that disgusting pile of crap came from inside you, well, it must mean that excrement itself is a perilous thing. Perhaps if feces spent longer amounts of time in the colon and bowel movements happened infrequently, then these dirty toxins would escape into the body. The putrefactive elements would then be absorbed into the circulation, causing fever and pus, insanity, and hemorrhage, then world wars, then alien invasions… . You get the idea.
In the 1700s, Johann Kämpf loudly proclaimed that all illness came from impacted feces (dry, hard stool that is “stuck” in the colon). Hence, if you expelled them faster with enemas, you were less likely to get sick.
Or so the theory goes.
In the 1800s, the feverish fear regarding “ptomaines” worsened these beliefs about the evil lurking within our bowels. Ptomaines are the chemicals—putrescine and cadaverine (tasty names!)— that make rotting things smell bad and were thought to be the particles that caused severe sickness. Basically, the assumption was that germs consumed organic matter in your intestine, and ptomaines were the by-product. From the Greek word ptoˉma for “fallen body” or “corpse,” ptomaines were blamed for any and every food-borne illness. Not only were they inaccurately considered to cause food poisoning, ptomaines were also thought to arise in a constipated feces. (Autointoxication strikes again!) This added to the fear that inner feces alone made people sick, instead of being the end product of a healthy physiologic process. Rectal cleanliness could fix it all, for if filth was the root cause of disease (true, in many cases), then internal colonic cleanliness could prevent it. One little problem, though—the ptomaine theory was wrong. Bacteria and their toxins, not ptomaines, actually cause food poisoning, so the theory fell out of use. Washing hands? A great way to prevent infections. Washing colons? Not so much.
In addition to autointoxication was the pervasive humoral theory. For multiple centuries, “clyster, bleed, purge” was the treatment for everything, particularly if the black bile/melancholic humor was out of sorts. Methods of cure that made bile flow out the anus ruled. The clyster was looked upon as a rectal savior for all things awry in the human body. The love of enemas became so extreme that Molière’s The Imaginary Invalid poked fun at it in 1673. When the doctor is asked repeatedly how to cure dropsy, then diseased lungs, then chronic illnesses, his response is always “Give a clyster, then bleed the patient, afterward purge him. Rebleed him, repurge him, and reclyster him.”
The scene is a funny and sharp-tongued editorial on current medicine and its one-size-fits-all cures that lasted for far too long.
Champions of the Rectal Door
In ancient Egypt, concern about health and digestion was so paramount that the enema was an indispensable part of life. Documents from 1600 to 1550 bce described enemas and how the pharaohs had their own specialized healthcare servant—the honorably named “Guardian of the Anus.” We might laugh at this idea, but unlike today, the health of the lower digestive tract in ancient Egypt was appreciated with far less comedic flair.
Hippocrates also touted the benefits of the beloved enema, for “ardent fevers” or intermittent fevers often seen with malaria. If that didn’t work, “then purge with the boiled milk of asses.” Galen, in the second century ce, described his ministrations to a sick lady coughing up blood. Aside from rubbing her body and giving her opium, “I ordered a sharp clyster.” Ouch.
In the Middle Ages, we first begin seeing artistic renderings of clyster and enema use. There’s a fifteenth-century illustration of Galen pouring fluids down a funnel into someone’s rectum while others mill about in the room. Nearby, a dog is howling, or laughing; it’s rather unclear.
Clysters had become de rigueur and à la mode in fifteenth-and sixteenth-century France—perhaps because royalty loved them so. King Louis XIV was rumored to have enjoyed two thousand treatments in his lifetime. Two thousand. At the height of the craze in France, many used clysters as often as three times per day to “maintain health.” The ordinariness of the procedure was illustrated famously by the Duchess of Burgundy. She had her servant duck beneath her skirts to administer a clyster. In front of the king. Naturally, she was modestly covered while the clyster was given. But it makes you rather glad you weren’t part of the royal court of Louis XIV or one of the servants in charge of clysters—no matter how blinged-out those syringes were.
Amidst the chaos of the seventeenth-century Protestant rebellions, Louis XIV receives a clyster while sitting on the world.
DIY Enemas
In the late 1800s, shysters started to exploit our fears of autointoxication with an array of products. Alcinous Burton Jamison sold his “eager colon cleanser” as well as his horseshoe-shaped “internal fountain bath,” all while trying to scare his customers about the “pest-house of absorbed poison” within the intestines. Eager patients were strapped down onto tilting tables like the “West Gravitiser,” in an effort to keep things moving in the right direction—down and out. Or consider “Dr. Young,” whose treatments went, well, the other direction. His “self-retaining rectal dilators” (see Sex, page 244) were short, phallus-shaped rods of increasing size, touted to cure constipation and hemorrhoids. Because nothing soothes
hemorrhoid pains like sticking a thick rubber rod up your behind.
We’ll now take a brief interlude to meet Dr. Charles A. Tyrrell (1843–1918), who perhaps wears the crown of quackery for his constipation wares. The story begins with him telling his own story, of course. He claimed that before his medical career, he’d traveled to exotic locales including New Zealand, South Africa, and the Far East; he’d dined with indigenous peoples and experienced diseases like “jungle fever” (malaria), typhoid fever, and dysentery. He was also paralyzed by a gunshot wound in India. But it wasn’t until 1880 when a second bout of paralysis struck, for unknown reasons, that enemas came to the rescue. He read a treatise by a physician extolling the cure-all nature of the enema. After years of self-treatment and a recovery from the paralysis, he had a proctological epiphany. Tyrrell opened the Hygienic Institute in New York City and announced, “There is only one cause for disease,” and it was constipation.
Enemas to the rescue! (Cue the trumpets!)
A cure for hemorrhoids? Nope.
Continuing with the autointoxication theories of yore, Tyrrell believed that illnesses such as seizures, achy joints, cholera, and dysentery were due to the rotting miasmas arising from the gut, so extreme measures were necessary to flush them out. Most enema bags at the time consisted of a rubber bag filled with liquid that used gravity to insert its contents into a reclined patient, via a tube and nozzle. But Tyrrell’s “J. B. L. Cascade” was different. J. B. L. stood for “joy, beauty, life” and promised to provide an “internal bath,” via a large rubber bottle that held five quarts of liquid. A nozzle protruded out of the center, so a health-seeker could impale his-or herself on it while in a seated position. The person’s weight would compress the reservoir and blast their innards, as often as they pleased. He recommended the Cascade up to four times a week and was happy to promote his wares using quotes from satisfied customers. One man’s wife saved the Cascade—and only the Cascade—from a house fire. Hopefully, they had no children. Another gentleman gifted his daughter a Cascade for her wedding. How loving and utterly gross. Sadly for us, it’s not available on the wedding registries at Bed Bath & Beyond.