Pulling Teeth and Cutting Colons: the Weird Early 20th Century Obsession With Surgically Removing Perfectly Healthy Body Parts
In today’s world of high-tech medicine, it is easy to take for granted the ease, regularity, and relative safety with which modern surgery is performed. For most of human history surgery was a bloody, painful, and dangerous affair. Without the benefit of antiseptic techniques or anaesthesia, surgeons had to work fast, racing against the clock to amputate a limb or excise a tumour before their patient bled out on the operating table. And even if a patient survived the procedure this was no guarantee of success, with the vast majority succumbing within days to infection or other postoperative complications. But with advances in medical science surgery became progressively safer and more effective, and today procedures that would have seemed unthinkable just a few decades before – like heart transplants and major brain surgeries – are performed by the thousands every year. But as with most scientific advances, this revolution in surgery came with its fair share of quackery and abuses, and in the early 20th Century the medical profession was swept by a bizarre and disturbing fad as surgeons, drunk on their newfound operating abilities, began relieving patients of all manner of perfectly healthy organs – from teeth to tonsils to their entire colons – in a fanatical quest to rid humanity of disease once and for all.
This fad for preventatively excising healthy organs had its origins in one of humanity’s oldest medical obsessions: constipation. In 1914, Russian biologist Ilya Metchnikoff, winner of the 1908 Nobel Prize in Physiology or Medicine for his pioneering work in immunology, developed a theory of chronic disease which he dubbed “auto-intoxication.” According to Metchnikoff, the colon – the 4.5-foot length of large intestine connecting the small intestine to the rectum – was little more than a festering cesspool where bodily wastes accumulated, stagnated, and putrefied. Based on the observation that injecting faeces into rats and mice inevitably resulted in death, Metchnikoff concluded that the same process was taking place in the colon, and that the longer waste stagnated and putrefied in the gut, the more toxins leached through the intestinal wall into the body. Metchnikoff attributed a whole host of chronic ailments to these toxins, including ulcers, bladder cancer, hypertension, rheumatoid arthritis, and even psychiatric disorders such as schizophrenia and depression. He further theorized that old waste adhered to the intestinal wall and hardened, preventing the absorption of vital nutrients. In short, almost every disease under the sun could in some way be linked to chronic constipation.
While Metchnikoff was among the first to frame this theory in modern scientific terms, the idea that waste piling up in the intestines is the root of chronic disease is actually a very old one, first appearing in the Sushruta Samhita, an ancient Sanskrit medical text written around 1000 B.C.E. In addition to listing the various afflictions allegedly caused by chronic constipation, the text also prescribes a variety of purgatives and cleansing enemas for treating the underlying condition. The use of purgatives and enemas to treat disease gained further popularity in ancient Greece with the development of the Four Humours theory of medicine, which held that the human body was governed by four fundamental fluids or “humours”: blood, phlegm, black bile, and yellow bile. An imbalance of these humours was thought to be at the root of all diseases, which could be cured by restoring said balance. For example, an excess of blood could be relieved by bloodletting – and for more on this, please check out our previous video What’s Up With the Increasingly Popular Practice of Modern Medical Leeches? Constipation was thought to cause a buildup of Black Bile, leading to melancholy or depression, and once again the prescribed treatments were mainly oral purgatives and enemas, also known as clysters after an ancient Greek word meaning “to wash out.”
Clysters remained a popular cure-all for nearly two millennia, reaching the peak of popularity during the reign of the French “Sun King” Louis XIV. To the fashionable 17th Century French nobleman, keeping a clean colon was as vital to a healthy lifestyle as regular exercise, good diet, and vitamin supplements are to us today. Enemas – up to four a day – were administered by specialized doctors known as limonadiers des postérieurs [“Lee-moh-nahd-ee-ay Deh Pohst-ee-ree-uhr”] – literally “backside lemonade applicators” – either at home or in special facilities known as restaurants, from the French meaning “to restore” or “to rejuvenate.” Only later did this term come to refer to establishments which serve food. Depending on the size of his pocketbook, the discerning nobleman could choose from a bewildering variety of enema options, from nozzles made of tortoiseshell, mother of pearl, and even gold, to cleansing mixtures containing ingredients such as orange blossom, angelica, thyme, rosemary, bergamot, and damask rose – each of which was claimed to have its own specific therapeutic properties. Certain popular concoctions even contained coffee and tobacco, producing an immediate rejuvenating rush and, in certain cases, long term addiction. At first tobacco was infused and administered in liquid form, but the development of the rectal smoking pipe allowed tobacco smoke to be blown directly into the rectum. Tobacco enemas were later developed into a method for resuscitating drowning victims, and in 18th Century special kits were installed along the river Thames for this purpose – and for more on this, please check out our previous video When Doctors Literally Blew Smoke Up Your Arse.
So indispensable were enemas to 17th Century French society that not even criminals in prisons were denied their daily cleansing. And when it came to maintaining the health of the King, there was no such thing as too many enemas. When the Sun King’s father, Louis XIII, fell gravely ill in 1643, over the course of six months his doctors administered no less than 47 bloodlettings, 215 oral purgatives, and 312 enemas – 2 per day except on holidays. Louis XIV was equally indulgent, subjecting himself to 38 bloodlettings, hundreds of enemas, and thousands or oral purgatives in order to sustain his legendary gluttony. This mania for enemas attracted the mockery of contemporary commentators such as English writer Jonathan Swift and French playwright Molière, who parodied the practice in his 1673 production Le Malade Imaginaire [Luh Mah-lad Ee-majh-ee-nay-r”] or The Hypochondriac. Ironically, Molière suffered a brain haemorrhage while playing the lead role onstage, and found himself at the mercy of the very doctors he had so thoroughly skewered. Unsurprisingly their swift intervention with bleedings, purgatives, and enemas proved ineffective, and the great playwright died later that day.
While the mania for enemas never again reached the absurd heights of the 17th Century, the medical obsession with constipation never really went away, with laxatives and purgatives remaining the best-selling pharmaceuticals for over 300 years. And while the Four Humours eventually gave way to more modern medical paradigms like Germ Theory, ironically this did little to quell anxieties about bowel regularity and auto-intoxication. Following the publication of Charles Darwin’s seminal 1859 work On the Origin of Species by Means of Natural Selection, anatomists began to realize that the human body was not in fact a perfect creation made in God’s image but a messy and imperfect machine containing all manner of vestigial features left over from its evolutionary past, from the tailbone and appendix to the uvula and tonsils. In these seemingly leftover and useless organs doctors began to see the roots of all human disease, and no single organ attracted more scrutiny and scorn than that old enemy: the colon. Thanks to theorists like Ilya Metchnikoff and health guru John Harvey Kellogg – yes, the inventor of Corn Flakes – the colon came to be seen as a venomous snake coiled up in the abdomen of every person, slowly poisoning them and robbing them of a long, healthy life. But while surgeons may long have dreamed of excising the troublesome organ altogether, it was not until the development of antiseptic techniques and anaesthesia in the late 19th Century that such a procedure became a viable reality. And when it did, surgeons jumped upon it with fanatical zeal, and none more so than Dr. William Arbuthnot Lane.
The celebrated chief of surgery at Guy’s Hospital in London, Lane was a surgical powerhouse, pioneering techniques for setting of fractures with metal plates and screws, repairing harelips and cleft palates, clearing intestinal obstructions, and reducing postoperative infection through the use of specially-designed sterile instruments. Such were his eccentricities and prodigious powers of deduction that he is believed to be one of the real-life inspirations for the character of Sherlock Holmes. In the early 20th Century, Lane directed his considerable talents and energies towards a new enemy: the dreaded colon. At first the good doctor recommended his patients consume large quantities of heavy cream and liquid paraffin to purge their colons of harmful, putrefying bacteria, but for Lane this was merely a stop-gap measure. He soon developed the procedure that would make him infamous: the radical colectomy, in which the entire colon is excised and the end of the small intestine attached directly to the rectum. In this manner, Lane claimed, waste would be expelled as soon as its nutrients were absorbed, giving it no time to build up in the colon and putrefy. The radical colectomy caused a sensation, with patients flocking in their hundreds to Lane’s surgery to undergo the new cutting-edge procedure. From the 1910s to the 1930s thousands of Britons and Americans had their perfectly healthy colons snipped out as a preventative measure, with Lane himself performing over a thousand such procedures over the course of his career. The mania for colectomies reached such heights that the procedure was regularly prescribed for ailments as minor as a sore throat or stomach ulcer. On one occasion a young boy scheduled for a tonsillectomy was accidentally wheeled into Lane’s surgery and emerged without his colon but with his tonsils intact. The colectomy craze was parodied in George Bernard Shaw’s 1906 play The Doctor’s Dilemma, in which the character of Dr. Cutler Walpole – clearly modelled on Lane – exhorts the medical wisdom of the day:
“Ninety-five per cent of the human race suffer from chronic blood poisoning and die of it. It’s as simple as ABC. Your unciform sac is full of decaying matter – undigested food and waste products – rank ptomaines. Now you take my advice, Ridgeon. Let me cut it out for you. You’ll be another man afterwards.”
But despite the medical miracles promised by the radical colectomy – such as delaying the onset of aging and warding off depression – the actual results of Lane’s procedure were predictably disappointing. Few colectomy patients experienced the promised benefits of the procedure, and while Lane was a far better surgeon than most, up to 30% of his patients later died of infections and other postoperative complications. Gradually medical opinion began to turn against the radical colectomy, though the procedure continued to be regularly performed as late as the 1930s. Lane would later abandon his faith in surgical intervention and instead found a movement known as New Health, which promoted more practical, holistic lifestyle choices such as fresh air; whole foods, fruits, and vegetables; exercise; and vitamin supplements as a path to good health and longevity. But Lane was hardly alone in his advocacy of surgical intervention, and even his considerable zeal was far surpassed by one of his contemporaries, Dr. Henry Andrews Cotton.
In 1907, Cotton became the superintendent of the New Jersey State Lunatic Asylum in Trenton, New Jersey, and immediately imposed a series of progressive reforms including eliminating physical restraints, hiring social workers, and organizing daily staff meetings to coordinate patient care. However, around 1915 Cotton learned of a new theory proposed by Johns Hopkins psychiatrist Dr. Adolf Meyer, which held that all mental illness was caused by latent bacterial infections. Like putrefying food in the colon, Meyer argued, these hidden infections produced toxins that slowly poisoned the mind. This idea, which Meyer called the Theory of Focal Infection, was based on two key pieces of evidence: first, the observation that those with severe bacterial infections often became delirious; and second, the discovery in 1913 that Treponema pallidum, the bacterium that causes Syphilis, was also responsible for a form of dementia known as the General Paresis of the Insane – and for more on this, please see our previous video That Time a Dude Was Given a Nobel Prize for Intentionally Infecting People with Malaria.
To Dr. Cotton, the upshot of Meyer’s theory was simple: eliminate all sites of infection, and mental illness could be cured. He thus set about removing any of his patient’s body parts which could potentially harbour harmful bacteria, starting with all their teeth. So enthusiastic was Cotton that he even removed his own children’s teeth as a precaution as well as his own when he believed himself to be going insane. When pulling teeth did not achieve the desired results, Cotton moved on to other organs, gleefully excising his patients’ testicles, ovaries, spleens, stomachs, gall bladders, cervixes, and, of course, colons. Cotton reported a phenomenal success rate of 85%, winning him widespread acclaim among his fellow psychiatrists.
While horrifically misguided and reckless by today’s standards, Dr. Cotton’s methods were actually remarkably progressive for their day. The psychoanalytic ideas of Sigmund Freud had not yet caught on with the mainstream psychiatric community, and the eugenics-based theories of the time held that mental illness was the result of inferior genes, and could only be eliminated from society by sterilizing the mentally ill. Meyer and Cotton’s theories, by contrast, framed mental illness as a physical affliction like any other, curable via physical intervention. Cotton’s methods proved especially attractive among the upper classes, who flocked to New Jersey to experience his miracle cure. Among his highest-profile clients was Margaret Fisher, daughter of famed Yale economist Irving Fisher, who in 1919 was diagnosed with schizophrenia and transferred to Trenton to undergo treatment. Cotton attributed her condition to – what else? – chronic constipation, and proceeded to remove her colon. Tragically, Fisher suffered a fate which befell up to 45% of Cotton’s patients, succumbing to a massive streptococcus infection. Yet despite these high mortality rates Cotton’s crusade carried on for unimpeded for decades, the medical community making only a minimal effort to investigate the validity his claims. Indeed, following a 1925 investigation into Trenton State Hospital by the New Jersey State Senate, the New York Times reported that:
“…eminent physicians and surgeons testified that the New Jersey State Hospital for the Insane was the most progressive institution in the world for the care of the insane, and that the newer method of treating the insane by the removal of focal infection placed the institution in a unique position with respect to hospitals for the mentally ill.”
However, that same year Cotton left Trenton State and established his own private clinic, which was less subject to government oversight and regulation. There he carried on performing his radical surgeries for wealthy clients until his retirement in 1930. By this time, advances in medical technology had begun to undermine the assumptions which had underpinned the radical methods of William Lane, Henry Cotton, and others. X-rays dispelled the notion that wastes stagnate and putrefy in the colon for days on end, while blood tests revealed that even the most chronic constipation produces no significant rise in toxins in the bloodstream. Indeed, doctors began to realize that humanity’s hysterical obsession with constipation, regularity, and intestinal cleanliness was grossly misinformed and overblown, with British gastroenterologist Sir Arthur Hurst stating in 1935 that:
“Constipation should be defined as any condition that causes the patient to complain that his bowels are not moving often enough. One man’s constipation is another man’s diarrhea…. [People have become] a vast army of hypochondriacs, who are never happy unless their stools conform to an ideal which they have invented for themselves.”
Furthermore, doctors discovered that far from being a useless, vestigial organ, the colon in fact plays a vital role in reabsorbing water and minerals from solid wastes and contains beneficial bacteria that promote good digestion and produce Vitamin K, essential for blood clotting. Yet despite these revelations this oldest of obsessions has really never gone away, and to this day countless fad diets, alternative medicine gurus, and high-fibre breakfast cereals continue to extol the dubious virtues of regularity and flushing the colon of harmful “toxins.”
Nor, until recently, did we fully abandon our obsession with removing perfectly healthy body parts. For nearly a century, few British or American children made it through grade school with their tonsils intact – regardless of whether said organs were diseased in the first place. A 1934 study of 1,000 New York schoolchildren found that 61% had received tonsillectomies, and that doctors had recommended surgery for all but 65 of the remaining 390 children. Tonsillectomy soon became the third most commonly-performed surgery in the English-speaking world, being performed on 80,000 British schoolchildren every year. This crusade against tonsils was initially inspired by the same focal infection theory which had driven the radical surgeries of Dr. Henry Cotton, with the tonsils being seen by leading surgeons like Dr. George Waugh as particularly pernicious sites of chronic infection. However, the practice persisted long after the abandonment of such theories and the development of antibiotics, and came to be seen – along with vaccination against measles and polio – as merely another necessary preventative measure against childhood disease. It was not until 1978 that the National Institutes of Health examined the statistical evidence and concluded that not only was tonsillectomy far less effective at preventing throat infections than previously believed, but that the risk of postoperative complications far outweighed any perceived benefits of the surgery. Mass preventative tonsillectomy of schoolchildren was soon abandoned, and today the surgery is only performed in cases of chronic and persistent tonsil infection. It just goes to show that while medical science eventually advances and learns from its mistakes, sometimes much of what we think we know about the human body is, like our colons, completely full of shit.
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