#HistFicThursdays - Medical History (specifically thyroids!)

 This week has been a mad one. Close to the start of the Christmas period, we found out that Mum would be having a thyroidectomy on Candlemas (the final day of the Christmas season). Of course, this was not enough to spoil Christmas. As readers of this blog are no doubt aware, Christmas happens in a big way in this house. But when the day finally arrived it was nonetheless met with, if not fear, definite nervousness.

I'm pleased to say that the procedure seems to have been a great success! And wouldn't it have been? Thyroid treatment has been developing for over four thousand years. You know me - somewhat obsessed with putting doctors, nurses, physicians and surgeons in my historical fiction - I made a (very brief) wander into the realms of researching the topic.

I was surprised by the results.

The earliest I could find a reference to treatments for thyroid issues (in this instance a goitre) came in 2697BC, when the legendary Yellow Emperor recorded the use of seaweed in treating the affliction. There is as much myth as fact surrounding him, but this only makes me more certain that there are truths within the smallest details. His work, Huangdi Neijing, remained a core text in early Chinese medicine, a culture which developed medical skills at an impressive rate.

By Gan Bozong (Tang period, 618-907)

accessed via Wikipedia

So seaweed and burnt sponge were what was used in early treatments. I couldn't find any proof that the thyroid had been identified, but substantial goitres are visible externally, so appearance rather than behaviour may have led to this medication being used.

In fact the name thyroid didn't arrive until the mid-seventeenth century. Thomas Wharton proposed it should be named this after drawing a likeness between the shape of the thyroid and a traditional Greek shield, thyros. These days, thyroids are more often referred to as looking like butterflies, probably because more people know what a butterfly looks like!

But Thomas Wharton was late to the show in the journey of thyroid medicine. Before him, Vedic texts made reference to the identification and treatment of these medical afflictions, and later the Greeks and Romans both explored the issues of them. Men such as Hippocrates located and identified the glands, but still did not know what they did.

The next reference I found seems to be difficult to confirm: the first thyroidectomy. It is believed that this took place in the 10th century by the brilliantly talented al-Zahrawi. Never one to shirk from anyone in need of medical attention, it is a wonder that his methods were not sufficiently learned from over the following centuries. Instead, the middle ages became a time of ridicule and danger for people suffering with thyroid conditions.

Leaping forward by way of da Vinci's illustrations, and the first fully anatomic description by van Wezel, we arrive at the19th century. It is over the next hundred years (c.1840-1940) that the study and understanding of the thyroid grew. Discovers of Graves' Disease and the presence of iodine allowed the care to improve. Treatment moved away from seaweed and you could now be prescribed sheep's or pig's thyroid which was dried and ground into a powder. No good for the vegetarians! Thyroxine - the aftercare drug for those who have had a thyroidectomy - was not manufactured until the 1920s, so treatments remained more "natural" until then.

Happily, medicine and surgery continues to grow and develop. There is now no need for a lace to tourniquet the thyroid while someone hacks out the gland, nor is the alternative to have a life lived in humiliation if you are subjected to a goitre. Instead, a safe surgery of a couple of hours, and clean aftercare means sufferers can return to a normal existence after a few weeks.

Thank goodness!

[main sources: Jenny Walton's article Monstrous craws and horrid butchery: a concise history of thyroid surgery, and History of the Thyroid by Kara J. Connelly]