Mercury, Bromine and Leeches — How Treatment Looked Before Antibiotics

A variety of methods were used to treat infections in the pre-antimicrobial era
A variety of methods were used to treat infections in the pre-antimicrobial era

The development of antibiotics and other antimicrobial therapies is arguably the greatest achievement of modern medicine. However, overuse and misuse of antimicrobial therapy predictably leads to resistance in microorganisms. Antibiotic-resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus species (VRE) and carbapenem-resistant Enterobacteriaceae (CRE) have emerged. Certain CRE species are resistant to multiple antibiotics, and have been deemed “superbugs” in the news.

Alternative therapies have been used to treat infections since antiquity, but none are as reliably safe and effective as modern antimicrobial therapy.

Unfortunately, due to increasing resistance and lack of development of new agents, the possibility of a return to the pre-antimicrobial era may become a reality.

So how were infections treated before antimicrobials were developed in the early 20th century?

Blood, leeches and knives

Bloodletting was used as a medical therapy for over 3,000 years. It originated in Egypt in 1000 B.C. and was used until the middle of the 20th century.

Medical texts from antiquity all the way up until 1940s recommend bloodletting for a wide variety of conditions, but particularly for infections. As late as 1942, William Osler's 14th edition of Principles and Practice of Medicine, historically the preeminent textbook of internal medicine, included bloodletting as a treatment for pneumonia.

Bloodletting is based on an ancient medical theory that the four bodily fluids, or “humors” (blood, phlegm, black bile and yellow bile), must remain in balance to preserve health. Infections were thought to be caused by an excess of blood, so blood was removed from the afflicted patient. One method was to make an incision in a vein or artery, but it was not the only one. Cupping was another common method, in which heated glass cups were placed on the skin, creating a vacuum, breaking small blood vessels and resulting in large areas of bleeding under the skin. Most infamously, leeches were also used as a variant of bloodletting.

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