In Episode 15 of Under The Knife, I explore the horrible reality behind dental practices from the past, including how dentures used to be made from the teeth of executed criminals, exhumed bodies, and sometimes even slaves.
On 12 November 1935, a Portuguese neurologist named Antonio Egas Moniz [below right] became the first individual to perform what would later be known as a lobotomy. Moniz’s work built upon that of the 19th-century Swiss psychiatrist, Gottlieb Burkhardt, who performed a series of operations in 1888 in which he removed sections of the cerebral cortex from six patients under his care at the Préfargier Asylum. Moniz’s early experiments involved drilling holes into patients’ skulls and pouring alcohol into the frontal cortex in order to sever nerves; and coring out regions of the brain with hollow needles.
Moniz’s lobotomy quickly became a popular treatment for various mental conditions, putting an end to the therapeutic nihilism that dominated the psychiatric profession in the Victorian era. Suddenly, doctors believed they could “cure” patients whom they had previously deemed beyond help. Within a decade, the lobotomy became so esteemed that Moniz was awarded a Nobel Prize for his role in developing it.
During this time, Moniz’s procedure was adopted (and adapted) by the American neuropsychiatrist Walter Freeman, who performed the first lobotomy in the United States in 1936. Freeman won acclaim for his technique, and people all over the country began lining up to get their lobotomies, including Rosemary Kennedy [below]—sister to the man who would later become President of the United States. Rosemary was described by members of her family as a rebellious child who was prone to violent mood swings while she was growing up. In November 1941, Rosemary’s father took her to see Freeman, who diagnosed the 23-year-old girl with “agitated depression” and suggested she undergo a lobotomy to correct her erratic behavior. [Interestingly, 80 percent of the lobotomies performed in the US in those early years were carried out on women].
Freeman performed the operation right then and there on Rosemary, without her mother’s knowledge. Shortly afterwards, it became clear that something had gone terribly wrong. Rosemary could no longer speak, and her mental capacity was equivalent to that of a toddler. Her father institutionalized her, telling people that his daughter was mentally retarded rather than admitting that her condition was due to a failed brain operation. It was only after his death decades later that the truth behind her condition was revealed. Rosemary never did recover her ability to speak coherently, and remained in care till her death in 2005 at the age of 86. She was the first of her siblings to die of natural causes.
The incident did little to damage Freeman’s reputation, who soon began looking for a more efficient way to perform the operation without drilling directly into the skull. As a result, he created the transorbital lobotomy in which a pick-like instrument was forced through the back of the eye sockets to pierce the thin bone that separates the eye sockets from the frontal lobes. This procedure—which later became known as the “ice-pick” lobotomy—could be performed in under ten minutes without anesthetic.
Freeman took to the roads with his ice-pick and hammer, touring hospitals and mental institutions around the country. He performed ice-pick lobotomies for all kinds of conditions, including headaches. Eventually, he began performing the operation in his van—which later became known as “the lobotomobile.” At one point, he undertook 25 lobotomies in a single day. He even performed them on children as young as 4 years old. Years later, one of them spoke of the frightful incident: “I’ve always felt different—wondered if something’s missing from my soul. I have no memory of the operation, and never had the courage to ask my family about it.”
Over the course of four decades, Freeman performed nearly 3,500 lobotomies despite the fact that he had no surgical training. Many of his patients often had to relearn how to eat and use the bathroom. Some never recovered. And, of course, there were fatalities. In 1951, one of his patients died when Freeman suddenly stopped to pose for a photo during the procedure. The surgical instrument slipped and went too far into the patient’s brain. Many others fell victim to a similar fate at the good doctor’s hands.
The lobotomy eventually came under attack from the medical community. By the 1970s, several countries had banned the procedure altogether. Freeman eventually retired the lobotomobile and opened a private practice in California. Contrary to popular belief, he never lost his license to practice medicine.
Today, surgical lobotomies are no longer performed. The rise of drugs like thorazine make it easier to lobotomize patients chemically. In recent years, there have been calls for the Nobel Foundation to rescind Moniz’s prize that he received for developing the lobotomy, which has often been labeled one of the most barbaric mistakes of modern medicine.
Special thanks to Paul Koudounaris for bringing this fascinating subject to light for me when I was in Los Angeles this past April.
If you’re interested in the history of surgery, you can now pre-order my book, The Butchering Art. All pre-orders count towards first-week sales once the book is released, and therefore give me a greater chance of securing a place on bestseller lists in October. I would be hugely grateful for your support. If you’re in the US, click HERE. If you’re in the UK, click HERE. Info on further foreign editions to come.
If you visit the Gordon Museum at Guy’s Hospital in London, you’ll see a small bladder stone—no bigger than 3 centimetres across. Besides the fact that it has been sliced open to reveal concentric circles within, it is entirely unremarkable in appearance. Yet, this tiny stone was the source of enormous pain for 53-year-old Stephen Pollard, who agreed to undergo surgery to remove it in 1828.
People frequently suffered from bladder stones in earlier periods due to poor diet, which often consisted of lots of meat and alcohol, and very few vegetables. The oldest bladder stone on record was discovered in Egyptian grave from 4,800 B.C. The problem was so common that itinerant healers traveled from village to village offering a vast array of services and potions that promised to cure those suffering from the condition. Depending on the size of these stones, they could block the flow of urine into the bladder from the kidneys; or, they could prevent the flow of urine out of the bladder through the urethra. Either situation was potentially lethal. In the first instance, the kidney is slowly destroyed by pressure from the urine; in the second instance, the bladder swells and eventually bursts, leading to infection and finally death.
Like today, bladder stones were unimaginably painful for those who suffered from them in the past. The stones themselves were often enormous. Some measured as large as a tennis ball. The afflicted often acted in desperation, going to great lengths to rid themselves of the agony. In the early 18th century, one man reportedly drove a nail through his penis and then used a blacksmith’s hammer to break the stone apart until the pieces were small enough to pass through his urethra. It’s not a surprise, then, that many sufferers chose to submit to the surgeon’s knife despite a very real risk of dying during or immediately after the procedure from shock or infection. Although the operation itself lasted only a matter of minutes, lithotomic procedures were incredibly painful and dangerous—not to mention humiliating.
The patient—naked from the waist down—was bound in such a way as to ensure an unobstructed view of his genitals and anus [see illustration below]. Afterwards, the surgeon passed a curved, metal tube up the patient’s penis and into the bladder. He then slid a finger into the man’s rectum, feeling for the stone. Once he had located it, his assistant removed the metal tube and replaced it with a wooden staff. This staff acted as a guide so that the surgeon did not fatally rupture the patient’s rectum or intestines as he began cutting deeper into the bladder. Once the staff was in place, the surgeon cut diagonally through the fibrous muscle of the scrotum until he reached the wooden staff. Next, he used a probe to widen the hole, ripping open the prostate gland in the process. At this point, the wooden staff was removed and the surgeon used forceps to extract the stone from the bladder. 
Unfortunately for Stephen Pollard, what should have lasted 5 minutes ended up lasting 55 minutes under the gaze of 200 spectators at Guy’s Hospital in London. The surgeon Bransby Cooper fumbled and panicked, cursing the patient loudly for having “a very deep perineum,” while the patient, in turn, cried: “Oh! let it go; —pray, let it keep in!’” The surgeon reportedly used every tool at his disposal before he finally reached into the gaping wound with his bare fingers. During this time, several of the spectators walked out of the operating theater, unable to bear witness to the patient’s agony any longer. Eventually, Cooper located the stone with a pair of forceps. He held it up for his audience, who clapped unenthusiastically at the sight of the stone.
Sadly, Pollard survived the surgery only to die the next day. His autopsy revealed that it was indeed the skill of his surgeon, and not his alleged “abnormal anatomy,” which was the cause of his death.
But the story didn’t end there. Word quickly got out about the botched operation. When Thomas Wakley [left]—the editor of The Lancet—heard of this medical disaster, he accused Cooper of incompetence and implied that the surgeon had only been appointed to Guy’s Hospital because he was nephew to one of the senior surgeons on staff. Wakley used the trial to attack what he believed to be corruption within the hospitals due to rampant nepotism. Outraged by the allegation, Cooper sued Wakley for libel and sought £2000 in damages. The jury reluctantly sided with the surgeon, but only awarded him £100. Wakley had raised more than that in a defence fund campaign and gave the remaining money over to Pollard’s widow after the trial. 
Bransby Cooper’s reputation, like his patient, never did recover.
If you’re interested in the history of pre-anesthetic and pre-antiseptic surgery, you can pre-order my book The Butchering Art in the US (click here) and in the UK (click here). Information of foreign editions to come!
1. Druin Burch, Digging up the Dead: Uncovering the Life and Times of an Extraordinary Surgeon (2007), p. 26. I am greatly indebted to his work for bringing this story to my attention.
2. Thomas Wakley, A Report of the Trial of Cooper v. Wakley (1829), pp. 4-5.
I’m thrilled to reveal the UK cover for my upcoming book THE BUTCHERING ART, which will be published by Allen Lane, an imprint of Penguin, on October 17th. The book tells the story of the surgeon Joseph Lister and his quest to transform the brutal world of Victorian surgery through antisepsis.
For those of you who are familiar with the US cover (right), you’ll notice a lot of similarities. The US cover features a painting by the 19th-century artist Thomas Eakins. It depicts the surgeon Samuel Gross, who didn’t believe in the existence of germs and made a point of not using Lister’s antiseptic techniques in the operating theater. The painting is dark and bloody, and the surgeons are all wearing their everyday clothing. These men are the last “butchers” of their profession – men who were lauded for their brute strength and speed, and who didn’t wash their hands or their instruments between operations.
In contrast, the UK cover (above) features a second painting by Eakins, this one completed a decade later after Lister triumphs and germ theory is finally accepted by the medical community. This painting is lighter, brighter, and there is a sense of cleanliness and hygiene (note: the publisher has stylized the original painting to give it a slightly modern look here). I think it’s brilliant that the US and UK covers are in conversation with one another. So here’s the important part! I would be HUGELY GRATEFUL if you would consider pre-ordering the book today if you’re in the UK. Pre-orders are especially crucial at the start of a writer’s career as they increase my chance at getting onto bestseller lists when the time comes. Click HERE.
And don’t forget you can also pre-order the US edition by clicking HERE. Info on further foreign editions to come!
The book delves into the grisly world of Victorian surgery and transports the reader to a period when a broken leg could result in amputation, when giving birth in a squalid hospital was extraordinarily dangerous, and when a minor injury could lead to a miserable death. Surgeons—lauded for their brute strength and quick knives—rarely washed their hands or their instruments, and carried with them a cadaverous smell of rotting flesh, which those in the profession cheerfully referred to as “good old hospital stink.” At a time when surgery couldn’t have been more dangerous, an unlikely figure stepped forward: Joseph Lister, a young, melancholic Quaker surgeon. By making the audacious claim that germs were the source of all infection—and could be treated with antiseptics—he changed the history of surgery forever.
Many of you have been devoted readers of my blog since its inception in 2010, and I can’t thank you enough for your continued interest in my work. Writing a book has been the next logical step for a very long time. The idea of telling this particular story arose during a very difficult period in my life when my writing career was at risk. It is therefore with great pride (and some trepidation) that I am turning this book loose into the world, and humbly ask you to consider pre-ordering it. All pre-orders count towards first-week sales once THE BUTCHERING ART is released, and therefore give me a greater chance of securing a place on bestseller lists in October. I would be hugely grateful for your support.
Pre-order from any one of these vendors using the links below:
*Please note that THE BUTCHERING ART will also be published by Penguin in the United Kingdom, as well as several other publishers around the world. I’ll be revealing covers for these foreign editions in the coming months, along with information on where to buy a copy.
Photo Credit: The Royal College of Surgeons of England
We don’t know much about her. We don’t even know her name. What we do know is that the woman who wore the above prosthetic in the mid-19th century was suffering from a severe case of syphilis.
Before the discovery of penicillin in 1928, syphilis was an incurable disease. Its symptoms were as terrifying as they were unrelenting. Those who suffered from it long enough could expect to develop unsightly skin ulcers, paralysis, gradual blindness, dementia and “saddle nose,” a grotesque deformity which occurs when the bridge of the nose caves into the face.
This deformity was so common amongst those suffering from the pox (as it was sometimes called) that “no nose clubs” sprung up in London. On 18 February 1874, the Star reported: “Miss Sanborn tells us that an eccentric gentleman, having taken a fancy to see a large party of noseless persons, invited every one thus afflicted, whom he met in the streets, to dine on a certain day at a tavern, where he formed them into a brotherhood.” The man, who assumed the name Mr. Crampton for these clandestine parties, entertained his “noseless’” friends every month until he died a year later, at which time the group “unhappily dissolved.”
The 19th century was particularly rife with syphilis. Because of its prevalence, both physicians and surgeons treated victims of the disease. Many treatments involved the use of mercury, hence giving rise to the saying: “One night with Venus, a lifetime with Mercury.” Mercury could be administered in the form of calomel (mercury chloride), an ointment, a steam bath or pill. Unfortunately, the side effects could be as painful and terrifying as the disease itself. Many patients who underwent mercury treatments suffered from extensive tooth loss, ulcerations and neurological damage. In many cases, people died from significant mercury poisoning.
For those determined to avoid the pox altogether, condoms made from animal membrane and secured with a silk ribbon were available [below], but these were outlandishly expensive. Moreover, many men shunned them for being uncomfortable and cumbersome. In 1717, the surgeon, Daniel Turner, wrote:
The Condum being the best, if not only Preservative our Libertines have found out at present; and yet by reason of its blunting the Sensation, I have heard some of them acknowledge, that they had often chose to risk a Clap, rather than engage cum Hastis sic clypeatis [with spears thus sheathed].
Everyone blamed each other for the burdensome condom. The French called it “la capote anglaise” (the English cape), while the English called it the “French letter.” Even more unpleasant was the fact that once one procured a condom, he was expected to use it repeatedly. Unsurprisingly, syphilis continued to rage despite the growing availability of condoms during the Victorian period.
Which brings me back to the owner of the prosthetic nose. Eventually, she lost her teeth and palate after prolonged exposure to mercury treatments. Her husband—who may have been the source of her suffering—finally died from the disease, leaving her a widow. But it wasn’t all doom and gloom for the poor, unfortunate Mrs X.
According to records at the Royal College of Surgeons in London, the woman found another suitor despite her deformities. After the wedding, she sought out the physician, James Merryweather, and sold the contraption to him for £3. The reason? Her new husband liked her just the way she was – no nose and all!
And that, kind readers, is a true Valentine’s Day love story…Ignore the part where she most certainly transmitted the disease to her new lover.
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Leonid Ivanovich Rogozov (pictured above and below right) knew he was in trouble when he began experiencing intense pain in lower right quadrant of his abdomen. He had been feeling unwell for several days, but suddenly, his temperature skyrocketed and he was overcome by waves of nausea. The 27-year-old surgeon knew it could only be one thing: appendicitis.
The year was 1961, and under normal circumstances, appendicitis was not life-threatening. But Rogozov was stuck in the middle of the Antartica, surrounded by nothing but thousands of square miles of snow and ice, far from civilization. He was one of thirteen researchers who had just embarked on the sixth Soviet Antarctic Expedition.
And he was the only doctor.
At first, Rogozov resigned himself to his fate. He wrote in his diary:
It seems that I have appendicitis. I am keeping quiet about it, even smiling. Why frighten my friends? Who could be of help? A polar explorer’s only encounter with medicine is likely to have been in a dentist’s chair.
He was right that there was no one who could help. Even if there had been another research station within a reasonable distance, the blizzard raging outside Rogozov’s own encampment would have prevented anyone from reaching him. An evacuation by air was out of the question in those treacherous conditions. As the situation grew worse, the young Soviet surgeon did the only thing he could think of: he prepared to operate on himself.
Rogozov was not the first to attempt a self-appendectomy. In 1921, the American surgeon Evan O’Neill Kane undertook an impromptu experiment after he too was diagnosed with a severe case of appendicitis. He wanted to know whether invasive surgery performed under local anesthetic could be painless. Kane had several patients who had medical conditions which prevented them from undergoing general anesthetic. If he could remove his own appendix using just a local anesthetic, Kane reasoned that he could operate on others without having to administer ether, which he believed was dangerous and overused in surgery.
Lying in the operating theater at the Kane Summit Hospital, the 60-year-old surgeon announced his intentions to his staff. As he was Chief of Surgery, no one dared disagree with him. Kane proceeded by administering novocaine—a local anesthetic that had only recently replaced the far more dangerous drug, cocaine—as well as adrenalin into his abdominal wall. Propping himself up on pillows and using mirrors, he began cutting into his abdomen. At one point, Kane leaned too far forward and part of his intestines popped out. The seasoned surgeon calmly shoved his guts back into their rightful place before continuing with the operation. Within thirty minutes, he had located and removed the swollen appendix. Kane later said that he could have completed the operation more rapidly had it not been for the staff flitting around him nervously, unsure of what they were supposed to do.
Emboldened by his success, Kane decided to repair his own inguinal hernia under local anesthetic eleven years later. The operation was carried out with the the press in attendance. This operation was more dangerous than the appendectomy because of the risk of puncturing the femoral artery. Unfortunately, this second surgery was tricky, and ended up taking well over an hour. Kane never fully regained his strength. He eventually came down with pneumonia, and died three months later.
Back in Antartica, Rogozov enlisted the help of his colleagues, who assisted with mirrors and retractors as the surgeon cut deep into his own abdomen. After forty-five minutes, Rogozov began experiencing weakness and vertigo, and had to take short breaks. Eventually he was able to remove the offending organ and sew up the incision (pictured below, recovering). Miraculously, Rogozov was able to return to work within two weeks.
The incident captured the imagination of the Soviet public at the time. After he returned from the expedition, Rogozov was awarded the Order of the Red Banner of Labour. The incident also brought about a change in policy. Thereafter, extensive health checks became mandatory for personnel before their departure for Antartica was sanctioned.
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