When you think of modern medicine, what do you picture out in your head? Pristine doctors in white coats speaking to you calmly, administering safe medicines in the comforts of a nice modern office? That’s not entirely wrong, as advances in the field have led to a majority of diseases treatable in this manner. However, medicine still has its darker side.

We’re not saying people are secretly chlorinating your water source or recycling dead bodies, but several medical procedures we seem unable to get past are largely crude and horrifyingly barbaric by today’s standards. If it works, stick with it, right?

10Scraping The Womb

The fields of obstetrics and gynecology are probably among the bloodiest in medicine. Most women, due to problems with their uterus, have to undergo at some point in their lives what is known as “curettage,” or the scraping of the womb. This procedure involves the introduction of a sharp “curette” that scrapes the inner lining of the uterus. These tissues are then sent for analysis to make sure that nothing is wrong with them—namely, that there isn’t an early cancer growing particularly in the presence of problems with menstruation.

Other times, it may be done after a miscarriage to ensure that no remnants of the deceased baby are left. Although effective, it is nonetheless cringe-worthy and makes us wonder why nothing less invasive has been invented up to this day.

9Drilling A Hole Through A Skull

Probably the oldest procedure in medicine that is still practice today—the act of drilling a hole through one’s skull, referred to as “Burr Holing”—can be traced back to the time of Hippocrates and the early Greek civilization. The principle of the procedure remains largely the same, but the purpose and the methods differ.

Generally, while the early Greeks used to do it with the belief that headaches were caused by massive amounts of “water” in their heads that would cause an imbalance of the body’s functions, today’s patients who undergo this ghastly procedure usually have massive amounts of blood pooling beneath portions of their skull, often the result of severe trauma and accidents. There also exist other variations of skull carpentry, some of which involve removing a large portion of the skull and keeping it for use later. However, unlike in the older days of primitive surgery, all of this is done under heavy anesthesia.

8Burning Off Flesh

Back in medical school, a rotation in the Department of Surgery often meant being exposed to blood, guts, and burning flesh. As barbaric as this sounds, the science of “cauterization” or “cautery” has drastically improved how surgeries are done.

Cautery simply refers to the act of searing a portion of flesh. This is done via a small electrical current that is driven through a handheld electrode that can be controlled with either a foot pedal or a button. Fundamentally, it refers to destroying microscopic layers of protein and ensuring that blood vessels are sealed shut in the process—an invaluable tool in procedures where one cannot risk having the patient lose too much blood. So the next time you see a surgeon, thank him for having the stomach to endure that oh-so-characteristic smell. Perhaps that’s what those masks are really for.

7Sticking A Tube Through Your Brain

Many of us would like to think of the brain as the single most important untouchable organ in the body. So how would you feel if doctors told you they had to stick a tube into the deeper portions of your brain?

No, nothing sophisticated to it. Just a tube. Passing through your skull, burrowing into the cavities of your brain.

Yes, people still do this, particularly for cases where there is a pressure buildup inside the skull (hydrocephalus). However, as expected, it’s done under utmost controlled conditions. It is lifesaving, but despite that, the thought of having a tube rammed into your head is enough to scare the life out of most people.

6Shoving A Tube Down Your Windpipe

What happens when we don’t breathe? We get a machine to do it for us. However, despite the promise of noninvasive means of facilitating breathing, the most effective method still remains the crudest and the most invasive. This involves placing a special plastic tube (or “endotracheal tube“) down someone’s windpipe.

How do they place it in, doctor? Good question. In a nutshell, they get a metal blade that holds the patient’s mouth open while the doctor forces it down the windpipe. Simple. Effective. Yet utterly frightening.

It is, however, considered to be one of the more “heroic” measures that must be done in the event of cardiac arrest and for critically ill patients. So the next time you watch the next episode of ER or Code Black, look for the tube. Chances are, it’s bound to get shoved down someone’s throat. Fast.

5Rotting Radiation

Cancers still remain among the most difficult diseases to treat in today’s medical landscape. Our understanding of cancer remains highly rudimentary, and our current methods of treatment reflect that. Generally, cancers are treated with a course of either chemotherapy (poison injected into your veins), surgery, or radiotherapy, or a combination of the three.

Radiotherapy is deadly radiation that is concentrated into the diseased site. Despite whatever fancy names companies think of, it is a beam that causes the tissues to either self-destruct or rot. It is a death ray, albeit a very precise and concentrated one. It’s not exactly pretty, nor is it without risks—other organs may also be affected should the procedure not be done properly. But don’t be afraid. We’re not going to see any scarred megalomaniacs strapping these onto sharks in his death lair anytime soon.

4Cavity Exploration

We’ve come a long way in terms of X-rays and other imaging. Today, we have CT scans, MRIs, and a bunch of other noninvasive ways to determine what’s wrong with our bodies. But what happens when nothing shows up on the readouts? And the patient’s still complaining that he’s about to explode? In most cases, most doctors have a good idea of what’s going on. But a confirmatory procedure, such as a getting a tissue sample or directly observing it, may be necessary.

So what happens? You guessed it. There are times when doctors conduct what is known as an exploratory surgery to tell what’s causing symptoms or diseases. They open you up and start probing to see what’s wrong. This may also be attempted in cases of emergencies where both a diagnosis and treatment are necessary, such as gun-shot wounds and other accidents.

3Gouging The Knee

Apart from the famous Skyrim memes, the medical field has a penchant for doing many violent things to one’s knees, the most frightening of which is gouging a huge needle through the knee.

There exist numerous variations of this, the most brutal one of which is called “intraosseous cannulation.” This procedure involves sticking a large bore needle through the knee to deliver medications straight to the blood system, which can be achieved with the needle traversing the rich blood vessel network within the front portion of the knee. However, this is regarded as a drastic measure and used as an alternative to the usual vein lines in giving medications.

2Snapping Joints Back Into Place

On TV, have you ever seen someone fall and snap their leg into an awkward position? And then the character just snaps it back into place? We actually do that in the medical field.

Bones are held together at joints by a complicated system of ligaments (or stretchable tissue) and muscles forming a generally strong support system. However, when accidents happen, some of these joints are forced out of alignment and may fracture. In the absence of a fracture, where the bones are simply not aligned, there really is no other option than to snap it back into place, often immediately before the muscles start to tighten.

1Amputation

Nothing too drastic has changed in the long history of managing severely infected and destroyed limbs. Apart from trying to salvage one’s toes, fingers, arms, and legs through restoring blood flow, once the limb reaches the end game of having it rot, amputation is still the way to go.

Although we’ve mapped out most of the structures of the arms and legs we’d like to minimize injuring, the act of actually removing a limb to cure someone is still quite astonishing despite advances in science. So everyone—please do take care of those cuts and bruises, and if you’re diabetic, foot care and blood flow screening should be at the top of your to do list today.

Dr. Keith Andrew Chan is an internist and Internet meme extraordinaire. He often refers to himself as “The One” and frequents local milk tea parlors when not working at the hospital. He is a regular contributor to cebumd.com and writes for various national health publications. Follow him on Twitter for more medical humor.

When we consider some of the various barbaric practices that were commonplace in the lives of our ancestors, we tend to look at them with a judgmental eye—thinking of them as uncivilized, and downright savage. Most of us would even admit to wondering if our violent predecessors, like those who relished the bloody gladiator games or those who condoned cruel medieval torture chambers, were actually less evolved than those alive today.

But has humankind really progressed that much, or are we just as bloodthirsty and ruthless as ever? If you’re under the impression that we are somehow more enlightened, you might be surprised by some of the ancient, barbaric practices that still exist throughout the world.

A woman in Papua New Guinea was stripped, tortured with a fiery iron rod, covered in gas, and burned alive on a mound of car tires in front of hundreds of onlookers—all for being a supposed witch. If it wasn’t for the gas and car tires you’d probably assume this happened in the sixteenth or seventeenth century and not in February 2013. Like something out of the Salem Witch Trials, the perpetrators let mere hearsay convince them the twenty-year-old woman was a witch, and took their revenge in horrific fashion.

Papua New Guinea isn’t the only place that’s still afraid of witches. Multiple societies in Africa still have regular witch hunts—and it’s not just isolated groups of people. For instance, Gambia’s own president, Yahya Jammey (who admittedly is a little crazy), launched a witch-hunting campaign in 2009 that terrorized the villagers, caused dozens to flee the country,  and killed at least six.

Other examples: in India, around one hundred and fifty to two hundred women are killed per year for witchcraft, and in Saudi Arabia witchcraft is legally punishable by death.

In modernized countries we cringe at our ancestors’ past use of slavery, yet talk ourselves into feeling less guilty by believing those days are long past. Unfortunately they’re not. The International Labor Organization estimates that there are currently between ten to thirty million slaves worldwide—more than at any other single point in history. Yep, you read that right: there have never been more slaves than there are right now. Even during the eighteenth century—the zenith of the African slave trade—there were only six million slaves transported out of Africa.

Where are all these slaves coming from? Well, pretty much everywhere. All across the globe, men, women, and children are abducted or tricked into capture and forced into debt slavery, the sex trade, and various other forms of exploitation. In the US alone there are an estimated 100,000 children trapped in the sex trade; human trafficking worldwide has grown to a US$32 billion business, and is soon expected to surpass the drug trade.

Although no country is exempt from this crime, the bulk of slaves exist in Asia, where there are around 12.3 million people in forced labor. These victims often go unnoticed as slaves because they work in plain sight in restaurants, agriculture, hotels, and similar industries. Meanwhile, the captors benefit from free labor and keep their slaves ensnared through threats of harm or death, coercion, and drug addiction.

Of course, child-selling goes hand-in-hand with slavery, but there’s just something unfathomable about parents selling their own flesh and blood into a life of forced servitude fraught with unimaginable suffering. It seems that there really is nothing like the power of the almighty dollar. . . .

What’s truly shocking is that the internet is full of websites offering to take people’s children in exchange for money. They try to dupe parents into thinking it’s okay by claiming that it’s better for the environment (touting some BS about population control) and posting pictures of smiling children who look like they’re in summer camp and not coming off an eighteen-hour shift at the sweatshop.

One particular site—and we’re really, really hoping it’s some kind of sick joke and not the real thing—offered child-sellers a “brand new Miata” in exchange for their kid; although if you read the fine print it turns out the Miata is used (if it wasn’t so tragic, it’d actually be kind of comical). [editor’s note: that particular site is clearly a hoax—but this website brings home the weight of the problem].

Excluding the random psychopaths or the occasional group of stranded people who are forced to eat each other to survive, are there still legitimate groups of cannibals who still regard eating humans as part of their culture? Apparently so.

Some say they do, and some say they don’t, but if you ask the Korowai people they admit that—yes—they still eat their fellow tribesman. Located in Indonesian New Guinea, this tribe has a long tradition (dating from prehistoric times) of eating humans, and the fact that they’ve been relatively isolated from the modern world for so long has allowed this custom to remain. Today, their most common human entrée is a khakhua (a witch doctor), whom they supposedly torture, kill, and eat—brains first. They believe that khakhuas eat people from the inside, so it is only just that they eat khakhuas in return.

When Smithsonian Journalist Paul Raffaele went to stay with the Korowai tribe, his guides openly shared their own experiences with cannibalism and even cleared up the rumor according to which human flesh tastes like pig; apparently it tastes more like a cassowary bird (just in case you wanted to know).

Besides the Korowai, there are rumors that other cannibals exist in remote places throughout the South Pacific, and in 2011 the media claimed that a German sailor, Stefan Ramin, was eaten by cannibals. Of course there was no irrefutable proof that he had been consumed, but the only things left of him were his charred and dismembered bones, teeth, and clothing remnants, which authorities found by an old campfire. His guide was long gone.

The first thing that comes to most people’s minds when you mention human sacrifice is some group of ancient villagers throwing an innocent victim into a volcano—and while the whole death-by-volcano bit was probably invented by storytellers, human sacrifice did and does in fact exist.

For instance, discreet groups of Hindus still practice the now-illegal tradition of Sati. Sati is a funeral custom whereby a widow will throw herself (either willingly, or due to social pressure) on the pyre of her dead husband, and burn to death. The women do it to show devotion and piety for their husbands, but in addition to being suicide or murder, detractors argue that the practice perpetuates female subordination.

In 2011, a BBC undercover reporter also discovered that child sacrifice had reemerged and developed into a big business in Uganda’s capital, Kampala. Apparently, the wealthy were paying witch doctors huge sums of money to sacrifice children, a ritual some believed would bring them wealth and good health. The practice was so widespread that signs were put up warning parents and children about abduction by witch doctors, and in 2013, Miss Uganda joined the effort to stop child sacrifice, which she said is “tearing the community apart.”

Prior to the twentieth century, public executions were events considered fun for the whole family. But nowadays . . . not so much. In the Western world they have mostly disappeared, and many nations are banning capital punishment altogether. Butin some places public executions never went away, and certain countries are relying on it more and more as a way to deter people from crime.

Lately, the country making the most headlines with this practice is Iran. After experiencing an increase in violent crime, Iranian officials decided to move their hangings (they have hundreds per year) out from behind prison walls and into a central park in Tehran, for all to see. And—just like the public executions from centuries ago—people file in by the hundreds and jostle for the best view. Convicts are executed for crimes like murder, rape, homosexuality, assault, and drug-related offenses. According to Amnesty International, only China executes more criminals than Iran; although exact statistics are hard to gather, since much of it still happens in secret.

If there’s one thing worse than a public execution, it’s execution preceded by public torture. Yes: in some places it’s not enough to just kill you for your crimes—they need to make you suffer first.

One of the most horrific ways to go is through stoning, which involves burying people up to their waists or chests and bludgeoning them to death with rocks. And you’d better hit the criminal with just the right sized stone (not too small and not too big—they don’t want you to kill ’em in one shot) or you could be convicted of a crime too (seriously). Currently, stoning is legal in Saudi Arabia, Pakistan, Yemen, United Arab Emirates, Sudan, Iran, and parts of Nigeria and is typically used as a punishment for adulterers.

Stoning just scratches the surface of all the lethal and non-lethal punishments in the torturer’s bag. In Saudi Arabia, for instance, eye-gouging and beheadings are still legal forms of punishment; in Nigeria amputation for theft is perfectly acceptable; flogging and caning are common occurrences in Singapore, and let’s not even get into the horrifying forms of torture that are committed worldwide in the name of war.

Infanticide—the intentional killing of infants—is an age-old practice that is carried out for many reasons, including religious sacrifice, the inability to care for the child, cannibalism, sex selection, and population control. Most have heard about China’s infanticide issue, which is primarily a result of their one-child per family policy, but you may not know that a legal form of infanticide is happening in the Netherlands.

Around ten years ago the Netherlands made euthanasia legal, and now that right extends to parents who want to euthanize their sick and disabled babies. Granted, euthanasia is more humane than leaving your unwanted child on a hillside to die of exposure or animal attack (as the ancient Romans did), yet it still seems a bit regressive. Euthanizing infants to prevent suffering when death is inevitable is one thing, but some advocates want to expand the law again to include unwanted babies. Currently around eight percent of all babies who die in the Netherlands do so at the hands of their doctors.

Ladies, feel free to cross your legs now, as it hurts to even think about this shocking practice. Indeed, it’s a difficult subject to talk about—but there’s no way it could be left out of a list of modern barbarism. Avoiding any graphic details, it involves the surgical (we use that term loosely) removal of all or part of a female’s external genitalia. It’s mostly done in parts of Africa and the Middle East and has cultural and religious background dating as far back as 484 B.C. Practitioners believe it’s a religious obligation that will control a woman’s libido.

The World Health Organization and leaders throughout the world have tried to put a stop to the tradition, saying it has no health benefits and causes all types of lifelong complications. They also note that there are no religious scripts which explicitly prescribe the practice.

Dress these guys in loin cloths and sandals and you’d swear you’d just gone back in time to the Roman arena. In reality, they’re a bunch of modern day Spaniards enjoying a day of bull torture and killing. Blood fiestas usually occur around major holidays, and involve whole towns coming out to inflict brutal, bloody pain on various animals—particularly cattle. All manner of medieval torture is exacted, and villagers think nothing of dropping a goat off a bell tower, or covering a bull with burning wax and chasing it through the streets while slowly killing it with knives and spears. The official killer of the bull even gets the “honor” of parading its ears, tail, and testicles on a ceremonial spear, after which he has permission to eat the animal’s testicles.

Spain has around ten to twenty thousand blood fiestas per year, and they’re not the only ones; Portugal, Mexico, and Brazil all carry on the tradition.