Paging Dr. Frischer: Ancient Practices

I love practicing medicine in 2017. There are so many more options at our disposal then there were even 10 or 20 years ago. It is interesting, however, just how many old or even ancient practices are still in use. Are they medical myths, barbaric treatments, or is there a modern rationale to support them?

Maggots can consume dead and infected tissue, which allows wounds to heal. Maggots have been used for healing since antiquity. In more recent centuries, military surgeons have observed and documented that soldiers who remained on the battlefield healed more quickly when flies laid eggs in their wounds. In 2004, the FDA allowed maggots to be marketed for medical use on slowly healing wounds like diabetic foot ulcers and bedsores, chronic leg ulcers, post-surgical wounds and acute burns. This therapy has actually experienced newfound popularity due to growing antibiotic resistance.

Not long ago I wrote of a dear friend who swears by leech therapy for her arthritic knee. Leeches are worms with teeth to cut into flesh, and suckers to feed on blood. Since ancient times, leeches were used for bloodletting. The FDA has approved the use of medical leeches for venous congestion, a condition where blood pools in a particular area of the body, and the veins aren’t capable of returning it to the heart. This might happen after a surgery to reattach a finger or ear, or after major reconstructive surgery. Leeches are also currently being used to numb pain, reduce swelling, and keep blood flowing.

Are you aware that bloodletting is still performed? It is not done with leeches, and certainly isn’t used for the wide range of diseases that it once was. It is, however, used for hemochromatosis, a condition where the blood contains excess iron. Too much iron can be toxic to the liver, heart, pancreas and joints. Bloodletting is performed by inserting a needle into a vein and drawing out a pint or more of blood, once or twice per week, over several months.

Would you consider allowing yourself to be stung by a bee in order to use the venom to heal? Apitherapy refers to a number of bee therapies, including bee venom, honey, pollen, and royal jelly. It’s thousands of years old, depicted in ancient rock art and practiced in ancient Egypt, Greece (Hippocrates wrote of it), and China. It’s now being used by some to treat arthritis, immune system dysfunction, multiple sclerosis, hay fever, ALS, shingles, gout, tendonitis, bursitis, infectious diseases, wound healing, burns, fractures, and even cancer. Do note that apitherapy gets mixed reviews in the scientific literature, and clearly more and better-controlled studies are called for. Further, there are potential risks to these therapies that may outweigh any benefits.

The great novel and movie One Flew Over the Cuckoo’s Nest horribly featured ECT (electroconvulsive therapy). Developed in the 1930’s, ECT passes electrical currents through the brain. It is actually still used for those with treatment-resistant depression, but is now administered under general anesthesia. ECT affects brain chemicals and nerve cells, and can alter mood, sleep, memory and appetite.

Trepanation is the oldest known surgical procedure, dating back to the Stone Age. A hole was made in the skull, with the belief that this would rid the patient of the evil spirits felt to cause illness, or to treat headaches, epilepsy, head injuries and infections. Today, neurosurgeons perform a form of trepanation for very different reasons. A small hole is drilled into the skull in order to treat epidural and subdural hematomas, or for surgical access for other procedures, such as intracranial pressure monitoring.

Lastly, let’s move to the subject of stool. The concept of transplanting stool dates back to 4th century China. Doctors gave a healthy person’s dried or fermented stool to a patient who was suffering from diarrhea, vomiting, fever or constipation. Today this is known as fecal microbiota transplantation (FMT). FMT directly transfers stool from healthy donors to the stomach or small intestine of the patient. The goal is to introduce a new mix of bacteria to restore a healthy microbial balance in the gut for those with recurring Clostridium difficile (C. diff) infections.

Some treatments have indeed withstood the test of time. Still, don’t expect to find maggots, leeches, bees, or stool in my black bag…yet.