The medical record is surprisingly rich with bumbles and quirks, bold moves and devil-may-care experimentation. But important and interesting discoveries have come from these often outrageous acts: by sheer accident, through daring self-sacrifice, from people eccentric enough to look at medical issues through an equally unconventional perspective.
Here’s a look at 10 successes from the annals of the avant-garde that actually worked, along with a brief analysis of their continuing impact on areas as diverse as heart disease, pain management, gastroenterology and seat belts.
This Is Spinal Tap: The Bizarre Origins of Epidurals
German surgeon August Bier remains best known for two things: First, the quote “A professor is a gentleman with a different point of view.” Second, the way he embodied that different point of view while pioneering spinal anesthesia as a surgical procedure.
Inspired by the work of New York neurologist James Corning, who experimented with injections of cocaine as a local anesthetic, Bier took that research to an entirely new level in 1898. He surmised that injecting a cocaine solution into the cerebrospinal fluid would block pain during surgery without the dangers of general anesthesia.
With the help of his assistant, August Hildebrandt, Bier inserted a needle between vertebrae in his own neck. Unfortunately, a loose-fitting syringe caused the cocaine solution, and a good bit of Bier’s cerebrospinal fluid, to leak out. This would eventually leave Bier flat on his back for nine days with a severe headache and dizziness.
But rather than abort the mission, the two switched places. Bier successfully injected the cocaine mix into Hildebrandt’s spine — so successfully, in fact, that Bier was able to stub out a cigar on his assistant, jam a needle through his thigh muscle down to the femur and smash him in the shin and testicles. All without pain — at the time.
Not surprisingly, a bitter Hildebrandt soon parted company with Bier, but their legacy lives on in the epidurals administered millions of times each year to block the pain from childbirth, back problems and other types of surgery.
Cast the Dye: A Fluke Gives Us Coronary Angiography
By the late 1950s, doctors were regularly using high-contrast dyes to give them a view of the larger structures of the heart and aorta, but the much-smaller arteries feeding blood to the heart itself remained off limits.
That’s because the dye, inserted directly into these arteries, would cause a deadly heart attack. And in 1958, F. Mason Sones, a cardiologist at the Cleveland Clinic, found that out the hard way, as did the 26-year-old man on his exam table.
Sones and his assistant had injected a large cloud of dye into the area where the young man’s arteries branched out from his aorta, in the hope that some of the contrast agent would seep into the smaller vessels and give the doctor a view inside them.
When Sones flicked on an X-ray machine to view the results, he was astonished to see a brilliantly clear image of the man’s right coronary artery — something never shown on an angiogram before.
There was a flicker of recognition and a moment’s horror before he shouted to his assistant, “Pull it out!” The tip of the needle had accidentally pierced the coronary artery and filled it with dye. Sones’ beautiful view came with an immediate cost: The man’s heart flatlined.
As his patient rapidly began to lose consciousness, Sones shouted at him to cough. The young man managed to crank out three or four sharp barks. The resulting pressure cleared the patient’s coronary artery of the dye, allowing the heart, thankfully, to beat normally again.
After what was assuredly a period of brow-wiping and breath-catching, Sones went on to refine the right amounts and types of contrast dyes to produce the kind of clear images of coronary arteries we see today — images crucial in diagnosing the blocked arteries that can lead to most heart attacks.
The Marshall Plan: An Ulcer Cocktail Wins Him a Nobel
Australian physician and internist Barry Marshall needed a willing human subject to test his then-radical hypothesis that ulcers were caused by a bacterium, not stress or spicy foods. But medical ethics prevented him from deliberately infecting a person with a potentially dangerous bug.
So in 1984, he cultured some Helicobacter pylori, stirred it into an infectious cocktail and drank it. A few uneventful days passed. Then, success — if you consider success to be vomiting, grotesquely fetid breath and utter exhaustion, all from a wicked case of gastritis, a known precursor to ulcers.
From there, a cure was as simple as giving himself a round of antibiotics. Today, stomach cancer, which is almost exclusively caused by untreated ulcers, has been virtually eradicated from those whose ulcers and H. pylori infections are treated.
The impact of Marshall’s self-experimentation was recognized with a 2005 Nobel Prize, which he shared with pathologist and co-conspirator Robin Warren. For more on Marshall’s plan, see Discover’s interview with him on page 40.
The Strangest Side Effect of Sleeping Medicine: Waking Up Comatose Patients
Since at least 1999, news outlets have reported on a bizarre effect of zolpidem (brand name Ambien). No, not the many reports of sleepwalking; in fact, quite the opposite.
These stories talked of comatose people gaining a temporary return to consciousness after being given the sleeping medication. The level of consciousness has varied, from minor improvements to the ability to fully converse with family.
Intrigued, medical researchers began to look closely at zolpidem. One of the largest and most recent studies, released in February 2014, tried the therapy in 84 vegetative and minimally conscious people. Researchers found the drug worked at least to some degree in about 5 percent of patients, and the effects typically lasted one to two hours. Not at all a cure, but perhaps a wake-up call for researchers to pursue further study.
Dive Down, Stand Up: How Scuba Diving Let a Man Walk Again
Mark Chenoweth has spina bifida, a birth defect that leaves the spinal cord exposed or otherwise unprotected by vertebrae. He lived a relatively normal life until 1996, when at age 34 he lost the ability to walk and began using a wheelchair.
Two years later, with an upcoming vacation, he decided he wanted to try scuba diving. So he asked his doctor to sign off on a medical clearance. The doc’s answer was unequivocal: Don’t do it. Chenoweth sought clearance from five others — the answer was always the same.
Undeterred, Chenoweth went to a Mediterranean resort and fudged a medical clearance, then took a brief training course. On his first open-water dive, he descended 55 feet. He enjoyed it so much, he dove twice more.
After the third dive, he noticed something different about his legs. Then he did something astonishing. On the dive boat, in front of everyone, he stood up for the first time in years.
The ability to walk returned for longer and longer periods the deeper he dived. These days, after hundreds of dives, he has to use a wheelchair only about twice a year.
A few years ago, his wife reports, a research center in Hull, England, wanted to study scuba’s effect on Chenoweth and others with spina bifida, but funding wasn’t available. So his near-cure remains a genuine medical mystery — for now.
Come Hungry, Leave Angry: Cafeterias Can Make Us Nasty
You already know trans fatty acids, or trans fats, are exceedingly unhealthy in frequent doses. But you might not know they’re also linked to increased aggression and irritability.
In a large study of almost 1,000 people, researchers at the University of California, San Diego, found that people who ate more trans fats were significantly angrier — at everything — across all the measures the researchers used.
Trans fats seem to interfere with the body’s ability to regulate DHA, another fatty acid that helps stabilize moods and acts as a natural antidepressant.
Now guess which organizations tend to serve menu items high in trans fats. Did you guess prisons and schools? Don’t get all bent out of shape if you didn’t — it’s probably just the french fries talking.
Hand Over Fistula: Gastroenterology’s Origins May Be Hard to Stomach
Three unlikely elements came together in 1822 to create what we now know as the medical specialty of gastroenterology: an unlucky frontiersman, a misaimed musket and a less-than-scrupulous doctor.
Alexis St. Martin, a 20-year-old trapper and fur trader, took an accidental close-range musket blast, tearing a ragged hole in his ribs and stomach. St. Martin promptly presented himself and his grim wound to William Beaumont, a U.S. Army surgeon on Mackinac Island, in what is now the state of Michigan.
At first, Beaumont didn’t see much hope for St. Martin. For 17 days, everything the patient ate came right back out of the wound. But by day 18, the injury had healed enough to keep food inside, although a hole — the medical term is fistula — remained, giving Beaumont the rarest of permanent windows directly into St. Martin’s stomach.
Beaumont seized the opportunity to study the little-understood digestive process and took advantage of St. Martin’s illiteracy by having him sign a contract that essentially turned the trapper into a servant and medical guinea pig.
Beaumont experimented with St. Martin’s digestive tract by attaching chicken, beef, oysters and many other food items to a string and shoving them through the fistula for various periods of time. After he pulled them out, Beaumont recorded the rate of digestion and collected a sample of gastric juices.
This went on for 11 years before St. Martin was finally able to return to his home in Quebec, where he lived until his death in 1880 at age 78. Although few would remember St. Martin’s name today, Beaumont is still known as the father of gastric physiology.
Help From a Horror Drug: New Hope For Leprosy
From 1957 until 1962, the now-infamous drug thalidomide led to a generation of horrifying birth defects after mothers-to-be took it to relieve morning sickness. About 10,000 babies were born with missing or malformed limbs, deformed eyes and hearts, and other tragically critical issues. Only half of those children survived.
The drug was yanked from the market, and it seemed unlikely to survive its vilification or ever find a place back in the pharmacopeia. That changed in 1964 when a Jerusalem dermatologist, Jacob Sheskin, used thalidomide on a patient with leprosy. How he got his hands on the then-illegal drug, and why he decided to experiment with it, remains a mystery.
What’s not a mystery is the effect it had on one of leprosy’s main symptoms — painful lesions called erythema nodosum leprosum. After only four doses over three days, Sheskin’s patient saw his lesions almost completely heal, all the more miraculous since the primary treatment for leprosy back then was simply to shunt sufferers into lives of isolation in leper colonies.
Sheskin treated another six patients and recorded similar results as long as treatment continued, suggesting thalidomide acted as a suppressor, not a total cure. Thalidomide, under tight controls, is still used to treat leprosy, along with several other newer drugs.
The No. 2 Cure: Fecal Transplant Wards Off a Bad Bug
One problem with extended courses of antibiotics is the drugs can kill off good bacteria in your gut. But one bug that survives particularly well is of the bad sort: Clostridium difficile (above). When it becomes overrepresented in your intestinal tract, you can end up with such unpleasantries as pseudomembranous colitis, toxic megacolon, perforations of the colon and sepsis. The Centers for Disease Control and Prevention says roughly 350,000 Americans have a C. difficile infection, which also causes debilitating diarrhea and up to 50,000 deaths each year.
Enter the fecal transplant, a practice borrowed from veterinarians who inserted feces from healthy horses into the rectum of other equines with intractable diarrhea. In 1958, doctors asked a human donor with healthy levels of gut bacteria to provide a fresh specimen. Then they whipped it into a slurry and squirted it into the colon of a C. difficile-stricken patient. Nowadays, it’s done over a five-day period with a series of enemas.
Result: complete cure. Since then, only a few hundred other such transplants have been performed worldwide, a mystifyingly low number since the cure rate is well over 90 percent.
Pushing the G-Force Envelope: Seat Belts and Supersonic Sunday Drives
Among its many legacies, World War II also gave us unprecedented G-forces. With the advent of jet aircraft, humans were subject to more deliberate acceleration and deceleration than ever before. Although jets played a limited role in the war, the post-conflict period saw their rapid development as a fighting machine. This posed a particular problem for pilots who had to escape a damaged or malfunctioning airplane traveling at supersonic speeds. Punching out of a supersonic jet exposes pilots to 40 to 50 Gs, or the sudden increase of his body weight by 40 to 50 times.
At the time, G-force was considered fatal above 18 G. But no one was certain. Who would be crazy enough to willingly subject himself to that much force? A guy named John Paul Stapp, that’s who. The U.S. Air Force flight surgeon was the first to strap in for a series of self-inflicted experiments designed to test the limits of human G-force tolerance.
Beginning in 1946, he designed rocket-powered sleds that could reach speeds of 750 mph and slam to the kind of sudden stop similar to ejecting at speed. The first runs didn’t look good: A test dummy slipped out of its harness and was flung over 700 feet. So Stapp designed better restraints.
Then he went for a ride himself. First at 90 mph. Then at 150. Then 200, increasing speed for a total of 29 runs over seven years, during which time he suffered blackouts, headaches, concussions, broken and dislocated bones, and watched six fillings go flying out of his mouth. The sequence of photos (shown below) feature Stapp on a typical ride, with pictures 1 through 3 showing his appearance in the first five seconds of acceleration as his sled shot up to a speed of 421 mph. The last photo shows the start of deceleration, as Stapp’s body was subjected to 22 Gs.
His last ride, in 1954, was also his fastest. He blasted to 632 mph, withstood a windblast equivalent to an ejection at 1,000 mph at 35,000 feet of altitude, was subjected to over 46 Gs, and proved that humans could survive the extreme forces of their newest machines.
Stapp’s heroic work has saved many more lives than those of pilots. In a time of cars with no seat belts, his research showed that people could survive high-force impacts if properly restrained. Stapp himself became a vocal advocate for seat belts and auto safety and was at Lyndon Johnson’s side in 1966 when the then-president signed a law requiring carmakers to install seat belts.
