Straight Dope Message Board

[griffin1977]

Pre-modern doctors (for the sake of argument say prior to 18th century, but could go much later than that if you felt like it) on the whole get have a fairly bad reputation. What with the lack of antibiotics, anesthetic and most importantly any understanding of germ theory and the importance of sterile conditions.

But doctors have been a somewhat successful profession for an awfully long time without any of those things. And there are plenty of historical description of apparently successful treatment and even surgery (warning rather unpleasant surgical description).

So what conditions could pre-modern doctors successfully treat with a reasonable chance of success? Most infections were mainly untreatable until the 20th century. Any remotely invasive surgery would most likely end if fatal infection. What about simple wound treatments? It seems whatever treatment that didn't involve washing the wound would be counterproductive.

Basic broken bones maybe? Except for the lack of an xray it seems the treatment for those (a splint, bandage or cast) would be the same in any era.

What about surgery itself? If you had an unusually strong immune system and managed to survive the dirty finger poking around in you, for which conditions was there enough correct medical knowledge about for the treatment to do any good?

[Wesley Clark]

Seeing how some of our drugs are derived from plants and herbs, A doctor could use those to treat some conditions. They wouldn't be as effective as an extract, but they'd still have some use. According to Dr. Wikipedia,

Many practices [of ancient Egyptian medicine] were ineffective or harmful. Michael D. Parkins says that 72% of 260 medical prescriptions in the Hearst Papyrus had no known curative elements

https://en.wikipedia.org/wiki/Ancien...cine#Nutrition

http://www.ucalgary.ca/uofc/Others/H...01.pdf#page=17

Which implies that 28% of the medical prescriptions did have curative elements.

Of the 260 prescriptions in the Hearst Papyrus, 28 percent contain an
ingredient which can be perceived to have had activity towards the condition being treated.

Setting broken bones, but I see you already listed that.

Sawing off gangrenous limbs.

Helping to remove guinea worm by wrapping them around a stick to get them out of the body.

There have been examples of teeth being drilled and filled in ancient times, as well as teeth being pulled.

[sbunny8]

I am not a doctor, nor do I play one on TV. But I think the strongest asset of a doctor from any century before the 20th was the ability to hold a patient's hand, make them feel like somebody cares whether about their health, and give the patient confidence that they would be healed. The human body will heal itself in the vast majority of illnesses. The doctor's job was to reassure the patient. They could also give some herbal remedies, which mostly work by the placebo effect, which again relies on confidence.

[TSBG]

There are examples of trephination being performed in the ancient world, and of patients who lived long past the surgery. I don't think it's known whether the procedure was performed for an actual medical reason like a buildup of fluid in the skull, or to "let the demons out."

[Jackmannii]

Originally Posted by Wesley Clark

Sawing off gangrenous limbs.

Coincidentally, I've been reading David Oshinsky's Bellevue, which talks about 19th century pre-Lister surgery, and the success rate for amputating limbs (without killing the patient) was about 50%, since post-op infection was very common.

Besides which, the lack of effective anesthesia made things dicier even if you survived. Supposedly surgeons at Bellevue had an "informed consent" procedure at the time which involved asking the patient "Will you have the leg off?". If the patient lost his nerve and said no, he was taken back to the ward. If the patient said yes, they proceeded to saw off the leg as fast as possible, ignoring all protests/screams while holding down the patient till the amputation was finished.

[John Mace]

Read all about it.

Small Pox vaccinations were not uncommon in the 18th century. Washington had a good number of his troops inoculated during the American Revolutionary War. (That was a Jeopardy question a few days ago.)

[TriPolar]

Cauterization goes far back in history. However the wiki indicates it may not have been greatly effective at preventing infection.

Cautery was historically believed to prevent infection, but current research shows that cautery actually increases the risk for infection by causing more tissue damage and providing a more hospitable environment for bacterial growth

[JWT Kottekoe]

Lewis Thomas talks about this in one of his books of essays, perhaps The Lives of a Cell. His father was a physician around 1900. His primary occupation was making house calls and, as an earlier poster remarked, his job was primarily to provide authoritative moral support to the patient and family. A good doctor was an excellent diagnostician, who could help his patients understand the nature of their illness and the prognosis. He could counsel them on simple remedies, like bed rest and therapeutic heat and cold. There were a variety of medications he might prescribe, but few, if any, provided more than a placebo effect. Thomas mentioned the smallpox vaccine as an extreme outlier, out of place with the other ineffective items in the physician's arsenal.

Thomas's books are wonderful. I read several about 40 years ago and the memory of their content has faded, but I clearly remember how much I liked them.

[Willcross]

Originally Posted by Jackmannii

Coincidentally, I've been reading David Oshinsky's Bellevue, which talks about 19th century pre-Lister surgery, and the success rate for amputating limbs (without killing the patient) was about 50%, since post-op infection was very common.

Besides which, the lack of effective anesthesia made things dicier even if you survived. Supposedly surgeons at Bellevue had an "informed consent" procedure at the time which involved asking the patient "Will you have the leg off?". If the patient lost his nerve and said no, he was taken back to the ward. If the patient said yes, they proceeded to saw off the leg as fast as possible, ignoring all protests/screams while holding down the patient till the amputation was finished.

I wonder if a guillotine style device was ever used to removed the infected limb at the nearest joint? Seems like it would be much easier.

[AK84]

Originally Posted by JWT Kottekoe

Lewis Thomas talks about this in one of his books of essays, perhaps The Lives of a Cell. His father was a physician around 1900. His primary occupation was making house calls and, as an earlier poster remarked, his job was primarily to provide authoritative moral support to the patient and family. A good doctor was an excellent diagnostician, who could help his patients understand the nature of their illness and the prognosis. He could counsel them on simple remedies, like bed rest and therapeutic heat and cold. There were a variety of medications he might prescribe, but few, if any, provided more than a placebo effect. Thomas mentioned the smallpox vaccine as an extreme outlier, out of place with the other ineffective items in the physician's arsenal.

Thomas's books are wonderful. I read several about 40 years ago and the memory of their content has faded, but I clearly remember how much I liked them.

Presumably either the Doc was from 1900BC or your memory really has faded. A Doctor in 1900AD had quite a lot of effective medication and diagnostic techniques. Quinine for pain. Carbolic acids for infection. Aspirin. Radiation therepy for cancer. Plus X Rays

[TokyoBayer]

There are quite a few traditional Chinese medicine doctors here in Taiwan, of course.

There are things which they do better because they have better relationships with the patients.

Conditions which are caused by stress and which Western medicine may not be particularly effective can sometimes be treated with their herbs.

I think it's the placebo effect although my Taiwanese wife thinks otherwise.

[sirwired]

Originally Posted by AK84

Presumably either the Doc was from 1900BC or your memory really has faded. A Doctor in 1900AD had quite a lot of effective medication and diagnostic techniques. Quinine for pain. Carbolic acids for infection. Aspirin. Radiation therepy for cancer. Plus X Rays

Quinine is an anti-malarial, not a pain medication. (Though they did have Salicylic Acid and Opiates, but you'd need a doctor for neither of them, just a pharmacist.) Aspirin did exist at the time, but was still quite new (as in, Bayer didn't even think about mass-producing it until 1897.)

Carbolic acid is a disinfectant, like for cleaning surgical instruments, it's not something you take as a drug to treat infections. (It does have some use as a drug; it's the active ingredient (in small, dilute, doses) in throat spray.)

X-Rays and Radiation therapy were not widespread, again, they had just started to be used for medical applications at research hospitals. If we make the bold leap that his father wasn't practicing at a university hospital with access to a physics lab, those techniques would not have been available at all, if he even knew they existed.

[Hari Seldon]

Originally Posted by JWT Kottekoe

Lewis Thomas talks about this in one of his books of essays, perhaps The Lives of a Cell. His father was a physician around 1900. His primary occupation was making house calls and, as an earlier poster remarked, his job was primarily to provide authoritative moral support to the patient and family. A good doctor was an excellent diagnostician, who could help his patients understand the nature of their illness and the prognosis. He could counsel them on simple remedies, like bed rest and therapeutic heat and cold. There were a variety of medications he might prescribe, but few, if any, provided more than a placebo effect. Thomas mentioned the smallpox vaccine as an extreme outlier, out of place with the other ineffective items in the physician's arsenal.

Thomas's books are wonderful. I read several about 40 years ago and the memory of their content has faded, but I clearly remember how much I liked them.

I was about to say something exactly like this. There were a limited number of things a doctor could actually help with. There was aspirin and, given anesthetics, a surgeon could remove a sick appendix, but by and large the most they could do was hold your hand and make a prognosis.

And I agree that Lewis Thomas's book were wonderful.

[griffin1977]

Originally Posted by Wesley Clark

Which implies that 28% of the medical prescriptions did have curative elements.

Though only if they were given to things they could actually treat. Which I am doubtful of. Without some kind of underlying understand of the efficacy of particular plants for particular conditions (which I don't see any evidence of in most cases) then your chances of actually treating an illness with something that is going to help it is pretty slim.

[griffin1977]

Originally Posted by sirwired

He could counsel them on simple remedies, like bed rest and therapeutic heat and cold.

Originally Posted by sirwired

Carbolic acid is a disinfectant, like for cleaning surgical instruments, it's not something you take as a drug to treat infections. (It does have some use as a drug; it's the active ingredient (in small, dilute, doses) in throat spray.)

Yeah this is a really important point. Prior to the invention of penicillin for most infections the best treatment anyone could possibly hope for, even if they were the King of England with best scientific and medical minds on the planet at their beck and call, was "keep the patient warm and well fed, hope they recover". This is why the rise of antibiotic resistance is a very bad thing and everyone should be more worried about it.

[griffin1977]

Originally Posted by TriPolar

Cauterization goes far back in history. However the wiki indicates it may not have been greatly effective at preventing infection.

I was thinking about this. I could well believe Cauterization was less effective than washing and bandaging the wound with a sterile bandage. But that wasn't the alternative in pre-modern times, whatever that alternative was it mean leaving the wound much dirtier than they found it, so I can see Cauterization being the best option.

[Weisshund]

Originally Posted by Willcross

I wonder if a guillotine style device was ever used to removed the infected limb at the nearest joint? Seems like it would be much easier.

[McCoy]
My god man, are all people in your time butchers?
[/McCoy]


A guillotine CHOPS.
No matter how fast, it still chops.
Chopped bone simply crushes and shatters, now you have to cut again up higher past the shattered parts.
Bone joints are not exactly flat with big gaps in them.

Also, how would the surgeon then close the amputation? he didnt get to save any skin and tissue to do it with?
I dont think you can just go about life with your amputation looking like the end of a chicken drumstick, unless you life ends shortly afterwards?

[Qadgop the Mercotan]

If I, as a modern Family Medicine physician, were transported back a few hundred years in time, I would bring a few useful skills back with me.

Mainly antisepsis in treating wounds. Just washing my hands and washing wounds with soap and water would save lots of lives. Particularly for compound fractures where bone fragments are exposed to open air. And certainly for childbirth.

Incising and draining abscesses would also resolve a lot of infections that would otherwise go on to cause many to sicken further, and often to die.

Using hollow needles to drain fluid accumulations outside the lung or in the abdomen could help in some cases.

If I could get coca leaves, I could make topical anesthetics, enabling me to do more careful and anatomically correct laceration and other injury repairs, which leads to better healing and less disability.

Just promoting better hygiene and boiling water before drinking it in my community would markedly reduce illness and death rates.

I'd also be helpful by not bleeding or purging patients. Or giving them poisons like mercury and other toxic compounds in vain pursuits to cure illnesses.

Promoting the use of condoms for contraception and disease prevention would also help the public health, if it didn't get me lynched.

Those are the most obvious advantages I'd have in comparison to the practices of other health professionals of the time.

Frankly, I wouldn't have a lot to offer from a pharmaceutical point of view. Pain control via coca or the tears of the poppy or hemp would be the most likely useful products. Aspirin is a bit of a bitch to extract. As are antibiotics.

[Melbourne]

Originally Posted by Qadgop the Mercotan

If I, as a modern Family Medicine physician, were transported back a few hundred years in time, I would bring a few useful skills back with me.

...
Frankly, I wouldn't have a lot to offer from a pharmaceutical point of view. Pain control via coca or the tears of the poppy or hemp would be the most likely useful products. Aspirin is a bit of a bitch to extract. As are antibiotics.

Ipecac syrup for the treatment of respiratory congestion. With your superior knowledge, perhaps production of gentian violet and mercurochrome. Treatment of all vitamin deficiency diseases.

And have I missed a mention of bone-setting?. Obstetrics, depending on what is meant by "pre-modern", obstetric forceps were developed in the 16th century.

[Chronos]

It's kind of funny, given your actual clientele, to think of you as "family practice".

But isn't draining abscesses one of the few things which old-time doctors actually could and did do? Though admittedly, they probably didn't use a sterile needle to do it.

Aspirin is a bit of a bitch to extract. As are antibiotics.

There's a time-travel series I've been reading where the modern folks thrust into the past use chloramphenicol for almost everything, because despite its very serious (though rare) side effects, it's the only antibiotic they can actually make, and the risks are a heck of a lot better than bubonic plague. Yes, they know that penicillin can be made from mold, but which mold? If you culture a mold and extract it, you're going to get something, but is it going to be safe and effective penicillin, or something completely different which may not be safe nor effective?

[Qadgop the Mercotan]

Originally Posted by Chronos

It's kind of funny, given your actual clientele, to think of you as "family practice".

We've had father/son pairs in prison at the same time before. And I've a handful of pregnant female patients. They're on buprenorphine for the duration of their pregnancy, and that takes special licensing which only I have in our system.

In addition I get called on juvenile patients at times, from our juvenile system.

But I must admit I don't do a lot of well child checks or birth control appointments anymore. I miss the kids, they were fun. The parents were often a PITA though.

Yeah, draining abscesses goes way back. But doing it with emphasis on antisepsis is what would improve my overall patient outcomes.

And I don't see myself making chloramphenicol or mercurochrome or gentian violet or penicillin based on what knowledge I carry in my head. Though if supplied with gentian root I suppose I could experiment a little.

Basically the biggest benefits I'd bring to bear would involve better hygiene and water and sewer arrangements, and not harming people with ineffective treatments.

[griffin1977]

Originally Posted by Qadgop the Mercotan

If I, as a modern Family Medicine physician, were transported back a few hundred years in time, I would bring a few useful skills back with me.

Mainly antisepsis in treating wounds. Just washing my hands and washing wounds with soap and water would save lots of lives. Particularly for compound fractures where bone fragments are exposed to open air. And certainly for childbirth.

Incising and draining abscesses would also resolve a lot of infections that would otherwise go on to cause many to sicken further, and often to die.

Using hollow needles to drain fluid accumulations outside the lung or in the abdomen could help in some cases.

If I could get coca leaves, I could make topical anesthetics, enabling me to do more careful and anatomically correct laceration and other injury repairs, which leads to better healing and less disability.

Just promoting better hygiene and boiling water before drinking it in my community would markedly reduce illness and death rates.

I'd also be helpful by not bleeding or purging patients. Or giving them poisons like mercury and other toxic compounds in vain pursuits to cure illnesses.

Promoting the use of condoms for contraception and disease prevention would also help the public health, if it didn't get me lynched.

Those are the most obvious advantages I'd have in comparison to the practices of other health professionals of the time.

Frankly, I wouldn't have a lot to offer from a pharmaceutical point of view. Pain control via coca or the tears of the poppy or hemp would be the most likely useful products. Aspirin is a bit of a bitch to extract. As are antibiotics.

That's a pretty good summary. But to be clear I wasn't talking about a time travelling modern doctor. But an actual pre-modern doctor with the technology and knowledge available to them at the time.

[elfkin477]

Originally Posted by TriPolar

Cauterization goes far back in history. However the wiki indicates it may not have been greatly effective at preventing infection.

I thought the main reason wounds were cauterized was to keep you from bleeding to death?

[Qadgop the Mercotan]

Originally Posted by griffin1977

to be clear I wasn't talking about a time travelling modern doctor. But an actual pre-modern doctor with the technology and knowledge available to them at the time.

Whoops. Sorry for the inadvertent hijack.

[Weisshund]

Originally Posted by Qadgop the Mercotan

And I don't see myself making chloramphenicol or mercurochrome or gentian violet or penicillin based on what knowledge I carry in my head. Though if supplied with gentian root I suppose I could experiment a little.

Well penicillin you'd kind of be in luck for, it wasnt exactly totally unknown, you just might wanna isolate it and bottle in in pink liquid form instead of rotten bread form.

Aspirin your good, even though it may have a barky woody taste

[Weisshund]

Originally Posted by griffin1977

That's a pretty good summary. But to be clear I wasn't talking about a time travelling modern doctor. But an actual pre-modern doctor with the technology and knowledge available to them at the time.

Well, if said Doctor could somehow collect the various known things from other areas
he might be in pretty good shape for his time, long as no one burns him for being a witch, heretic, unbeliever or what not to what ever deity is in charge.
Said doctor is going to need some world traveling ability though.

[TriPolar]

Originally Posted by elfkin477

I thought the main reason wounds were cauterized was to keep you from bleeding to death?

Yes, you'll see in the wiki I linked to that it was effective for that. Infection isn't a major concern if you bleed to death first.

[Chronos]

Quoth Weisshund:

Aspirin your good, even though it may have a barky woody taste

The compound in willow bark is salicylic acid. Aspirin is acetylsalicylic acid, a closely-related compound derived from it. Both have similar benefits, but the side effects from salicylic acid are much worse, especially on the digestive system. And it's not easy to process salicylic acid into acetylsalicylic acid.

Likewise, it's easy to get bread mold, but that does you very little good. One particular strain of one particular species of bread mold produces a very safe and effective antibiotic. Other strains or species of mold produce other substances, some of them more or less similar to that antibiotic. Some of those substances aren't safe to humans, some aren't very effective versus bacteria, and some are neither. And I don't think it's even known how common the "good" strain is in the wild: It's very common now due to us going to great lengths to cultivate it, because it's so useful to us, but we don't know exactly how lucky Fleming was to have that particular strain growing in his petri dish.

Don't read too much into the fact that premodern doctors used moldy bread in poultices, by the way. They did, but then, they used just about everything imaginable in poultices, including various sorts of dung. It's conceivable that some few patients in history might have gotten lucky and ended up with the good strain of penicillium in their moldy-bread poultice, but overall, people would have been much better off with poultices of just boiled cotton cloth with no mold (or honey or dung or whatever) at all.

[hajario]

Originally Posted by Qadgop the Mercotan

Whoops. Sorry for the inadvertent hijack.

Don't be. That was very interesting.

[griffin1977]

Originally Posted by Weisshund

Well, if said Doctor could somehow collect the various known things from other areas
he might be in pretty good shape for his time, long as no one burns him for being a witch, heretic, unbeliever or what not to what ever deity is in charge.
Said doctor is going to need some world traveling ability though.

Would that help too much? I know there were times that one region was ahead of others (I would rather be treated by a Arab doctor than his European counter-part during the dark ages). But other than a few things where knowledge was more advanced (or possibly a general tendency to treat holistically rather than go poking around with dirty fingers) would it have made it much difference? The big things that made a difference (germ theory, antiseptics, anesthetics and antibiotics) were not AFAIK invented anywhere prior to the Europe in the modern age.

[Nava]

Originally Posted by Chronos

The compound in willow bark is salicylic acid. Aspirin is acetylsalicylic acid, a closely-related compound derived from it. Both have similar benefits, but the side effects from salicylic acid are much worse, especially on the digestive system. And it's not easy to process salicylic acid into acetylsalicylic acid.

Figuring how to do that was one of the biggest discoveries in the history of chemistry: protected reactions. If you try to do it the obvious way it doesn't work, the acetyl group sticks in the wrong place. You have to protect this wrong site, then add the acetyl and then deprotect. This has now become routine, allowing many synthesis which would be impossible by the apparent direct routes.

[kayaker]

The secret to old timey medical practice would be specialization. Dr kayaker, specializing in the treatment of self limiting diseases and conditions. By appointment only. No billing.

[Mikeisskeptical]

Effective dentistry has been practiced for thousands of years.

[Broomstick]

Originally Posted by Hari Seldon

I was about to say something exactly like this. There were a limited number of things a doctor could actually help with. There was aspirin and, given anesthetics, a surgeon could remove a sick appendix, but by and large the most they could do was hold your hand and make a prognosis.

Folks, you certainly CAN do surgery without anesthesia. I don't know where you get this notion that no one removed anything from a human body before anesthesia. Lots of surgeons did lots of surgery before anesthesia.

It sucked if you were the patient, of course, and there would be several people holding you down so you did thrash too much, and surgeons got used to ignoring the screaming and got the job done as quickly as possible. But surgery did occur back in the old days. It helped often enough that desperate people continued to undergo it when necessary.

Originally Posted by sirwired

Carbolic acid is a disinfectant, like for cleaning surgical instruments, it's not something you take as a drug to treat infections. (It does have some use as a drug; it's the active ingredient (in small, dilute, doses) in throat spray.)

Lister used carbolic acid in dressings and the like, so it was at least used topically. Of course, it also tended to damage healing tissues as well as killing bacteria but it still beat devastating infections and sepsis.

[zimaane]

traditional bonesetters were (and in a few parts of the world, still are) effective, especially for simple (closed) fractures and dislocations

[Chronos]

griffen1977, the advantage to travel would not be in gathering knowledge from around the world (a time-traveling doctor would already have more of that than the entire world combined), but rather gathering pharmaceuticals. There are some plants which have useful medicinal properties in their natural form, and others which can be easily processed into useful forms (as well as some that are processed only with difficulty, but those aren't relevant here). But the problem is that those useful plants grow in many different places.

[scr4]

The story of the royal fistula seems relevant. To summarize: King Louis XIV (1638-1715) suffered from an anal fistula. Charles-François Felix, a barber-surgeon, was tasked to perform an operation. He asked for 6 months to prepare, during which time he experimented on 75 prisoners and peasants (many of whom didn't survive), then successfully treated the King. "The king was sitting up in bed within a month and was back on his horse within three months."

[griffin1977]

Originally Posted by scr4

The story of the royal fistula seems relevant. To summarize: King Louis XIV (1638-1715) suffered from an anal fistula. Charles-François Felix, a barber-surgeon, was tasked to perform an operation. He asked for 6 months to prepare, during which time he experimented on 75 prisoners and peasants (many of whom didn't survive), then successfully treated the King. "The king was sitting up in bed within a month and was back on his horse within three months."

That's actually the example that prompted the OP. Actually it was a discussed on QI and how following the operation having anal fistula was very de rigueur among the french aristocracy!

There obviously some cases where even fairly invasive surgery could be completed successfully (though presumably the king's survival was probably the result of good luck and a good immune system.)

[griffin1977]

Originally Posted by Broomstick

It sucked if you were the patient, of course, and there would be several people holding you down so you did thrash too much, and surgeons got used to ignoring the screaming and got the job done as quickly as possible. But surgery did occur back in the old days. It helped often enough that desperate people continued to undergo it when necessary.

For all the horror involved, and the slim chances of survival, amputation of gangrenous limbs probably counts as "effective treatment". As your slim chances during and after amputation, were still better than your chances with untreated gangrene.

[bonzer]

Originally Posted by scr4

The story of the royal fistula seems relevant. To summarize: King Louis XIV (1638-1715) suffered from an anal fistula. Charles-François Felix, a barber-surgeon, was tasked to perform an operation. He asked for 6 months to prepare, during which time he experimented on 75 prisoners and peasants (many of whom didn't survive), then successfully treated the King. "The king was sitting up in bed within a month and was back on his horse within three months."

[Off Topic]Being familiar with the story, when I skimmed that link in the OP what leapt out to me personally was its claim that the instruments used are on display at Versailles. No, they're not - or at least they weren't when I saw them in the collections of the Musée d'Histoire de la Médecine on the Left Bank, about a decade ago. Googling to confirm led me to this post. Really does look as if one of these two pages is somewhat plagiarising the other. At least the second does get the current location of the instruments correct.
(Other links confirm they're still in the Paris museum, rather than Versailles.)[/Off Topic]

[Quartz]

Originally Posted by Chronos

And it's not easy to process salicylic acid into acetylsalicylic acid.

Here's how to do it.

[bob++]

Sam Pepys had a stone he size of a tennis ball removed from his bladder by Thomas Hollier of St. Thomas's and Bart's on March 26, 1658.

Claire Tomalin's biography, 'Samuel Pepys: The Unequalled Self,' gives a well-researched description of this surgery, its risks, the preparations, the surgery itself, and the follow-up care. Here is the gory heart of her account, but read her book for the all the preparations--the foods and herb, the fast-binding done in place of an anesthetic--and the follow-up care--a really amazing passage in the book:

"The surgeon got to work. First he inserted a thin silver instrument, the itinerarium, through the penis into the bladder to help position the stone. Then he made the incision, about three inches long and a finger's breadth from the line running between scrotum and anus, and into the neck of the bladder, or just below it. The patient's face was sponged as the incision was made. The stone was sought, found and grasped with pincers; the more speedily it could be got out the better. Once out, the wound was not stitched--it was thought best to let it drain and cicatrize itself--but simply washed and covered with a dressing, or even kept open at first with a small roll of soft cloth known as a tent, dipped in egg white. A plaster of egg yolk, rose vinegar and anointing oils was then applied."

[Qadgop the Mercotan]

Originally Posted by Quartz

Here's how to do it.

Acetylizing is not always easy, and it can go awry. Could end up with cholesterol instead. Hence the rhymes, sung to the tune of "Jingle Bells". We used to sing this in organic chemistry lab in the mid 70's, when the mood was Christmassy.

Take an acetate,
Condense it with a mate
Pretty soon you have
Acetoacetate.
Let 'em have a ball
You get geraniol,
Add another isoprene
And you've got farnesol.

Farnesol, farnesol, good old farnesol,
First it goes to squalene, then you get cholesterol.
Farnesol, farnesol, good old farnesol,
First it goes to squalene, then you get cholesterol.

Now squalene makes a roll,
Becomes lanosterol
The extra methyls do
Come off as CO2;
Then comes zymosterol,
And then desmosterol
If you don't take Triparanol
You get cholesterol.

Repeat chorus

[clairobscur]

Originally Posted by Chronos

Likewise, it's easy to get bread mold, but that does you very little good. One particular strain of one particular species of bread mold produces a very safe and effective antibiotic.

Not just that. The bacteria that naturally produced antibiotics produced very little of it. They had to take years to select a strain that would produce absurdly high quantity of it for it to be of any use. It was a massive endeavor. So your bread mold would be ineffective, even if you chanced on the right strain.


I remember an example showing that pre-modern doctors in fact knew something. It's related to the autopsy of the remains of a 15th century famous person body to determine the causes of death.

IIRC (not sure I'll remember everything right), they found evidences of a massive intestine worms infestation (so bad that worms were probably getting out of her mouth too), of consumption of a fern, and of the presence of a toxic compound. It is apparently known that this particular fern was used effectively in conjunction with the compound to treat intestinal worms (some alcaloïde in the fern would paralyze the worms, and the compound was used to then "flush" them out). The toxic compound was however apparently used in this case in doses massively higher than was the norm, hence the death was ruled as being probably a poisoning by her own physician. Which means that said physician :


-knew an effective treatment for this ailment

-knew that one of the elements of this treatment was toxic and at what dose (of course, I guess it's possible he was in fact clueless and thought : "well, it works with X ounces of it, probably will be even better if I try with twenty times more of it").

[clairobscur]

Personally, if I was somehow sent back to an earlier era and seen by a physician (or a traditional healer) for some disease, I would probably pay attention to his advice, after asking him what exactly he was prescribing me, why and what it was supposed to do. If it wasn't something that is known bullshit (bleeding me, giving me mummy powder, regulating my humors) but rather something along the lines of a plant potion intended to, say, reduce an inflammation, I would give it a try, since I believe that they knew at least *some* things that could be *sometimes* useful.

[clairobscur]

When I think of it, Ambroise Pare, a 16th century surgeon who came up with several significant improvements in his field, and is particularly well known wrt the treatment of battle wounds (sewing up blood vessels, discarding cauterization) used turpentine on said wounds. Which means again that its antiseptic properties were known at the time (even if they obviously didn't know that it was an antiseptic).

I suspect that physicians and doctors of past ages knew more than they're generally credited for.

[griffin1977]

Originally Posted by bob++

Sam Pepys had a stone he size of a tennis ball removed from his bladder by Thomas Hollier of St. Thomas's and Bart's on March 26, 1658.

Wow! I wonder what the survival rate on that surgery was? I'm not a doctor (and never had a bladder stone) but I guess while having a bladder stone like that is very unpleastant and painful, it wouldn't be lethal.

I am guessing there is a lot of survivor bias in these descriptions, in the many cases where the patient died during the surgery or afterward from infection, it was simply blamed on fate. Where as if they survived and got better, the doctor would claim success even if their intervention had nothing to do with it.

[Weisshund]

Originally Posted by Chronos

The compound in willow bark is salicylic acid. Aspirin is acetylsalicylic acid, a closely-related compound derived from it. Both have similar benefits, but the side effects from salicylic acid are much worse, especially on the digestive system. And it's not easy to process salicylic acid into acetylsalicylic acid.

Likewise, it's easy to get bread mold, but that does you very little good. One particular strain of one particular species of bread mold produces a very safe and effective antibiotic. Other strains or species of mold produce other substances, some of them more or less similar to that antibiotic. Some of those substances aren't safe to humans, some aren't very effective versus bacteria, and some are neither. And I don't think it's even known how common the "good" strain is in the wild: It's very common now due to us going to great lengths to cultivate it, because it's so useful to us, but we don't know exactly how lucky Fleming was to have that particular strain growing in his petri dish.

Don't read too much into the fact that premodern doctors used moldy bread in poultices, by the way. They did, but then, they used just about everything imaginable in poultices, including various sorts of dung. It's conceivable that some few patients in history might have gotten lucky and ended up with the good strain of penicillium in their moldy-bread poultice, but overall, people would have been much better off with poultices of just boiled cotton cloth with no mold (or honey or dung or whatever) at all.

When i wrote that, i was envisioning our Doctor member going back in time.
I figured he would not have too much of a terrible time isolating the things he needed.

[Broomstick]

Originally Posted by griffin1977

Wow! I wonder what the survival rate on that surgery was? I'm not a doctor (and never had a bladder stone) but I guess while having a bladder stone like that is very unpleastant and painful, it wouldn't be lethal.

If the stone completely blocks the flow of urine yes, it could potentially be lethal.

[AK84]

Originally Posted by Qadgop the Mercotan

Basically the biggest benefits I'd bring to bear would involve better hygiene and water and sewer arrangements,

No running water. No functional sewage system. Takes an effort to boil water. Good luck with that.

Originally Posted by Broomstick

Folks, you certainly CAN do surgery without anesthesia. I don't know where you get this notion that no one removed anything from a human body before anesthesia. Lots of surgeons did lots of surgery before anesthesia.

It sucked if you were the patient, of course, and there would be several people holding you down so you did thrash too much, and surgeons got used to ignoring the screaming and got the job done as quickly as possible. But surgery did occur back in the old days. It helped often enough that desperate people continued to undergo it when necessary.

Opium and cannabis have been used as painkillers for centuries.