I don’t think I need a cite for this one. Some old medical practices were brutal. And pretty “moronic”, as Cecil Adams even said once.
My question that I have wondered for some time is simply this: Didn’t this ancient doctors notice their patients weren’t getting any better? In fact, I suspect they may have even gotten worse.
Take the common cold. Bleeding was the ancient cure. But bleeding removes fluids from the body. Modern doctors tell you to get more fluids, don’t lose them. Plus bleeding likely weakened the body. Made you anemic, and even removed some vital white blood cells too (I would imagine).
Didn’t the doctors of old notice this? Even before the age of modern records and statistics, this must have been clear. No one ever got better when you bleed them, or burned them, or dosed them with poisonous mercury laxatives. They got sicker, plain and simple.
Many cases of illness just clear up on their own. Bleeding someone who has the common cold isn’t likely to tip the balance and prevent them recovering naturally (albeit perhaps a little more slowly than they might have without the bleeding) - therefore, bleeding cured them, or so it would be easy to assume.
And for the patients who didn’t recover… well, they never came back to complain.
A lot of times they did get better. You go to the doc to get bled for your cold, most of the time, that cold is going to get better by itself anyway. The bleeding isn’t great for you, but as long as it doesn’t kill you, you’re going to be fine. Bleeding works! So does Vitamin C, right?
Also, a good many of the cures were probably accidentally/incidentally mildly beneficial; you’ve got a cold and the doc tells you the drink a hot decoction of fennel (or whatever) three times a day; what’s actually happening is that you’re drinking water that has been boiled (so reducing your exposure to things that might make you sicker), and you’re guaranteeing some fluid intake, even if the fennel does nothing.
Then [because we are lumping everything before say 1901 as a single homogenous lump of medical otherness], as now doctoring was likely to involve a mix of treatments to cure ailments by removing their cause, managing symptoms, fixing trauma, dealing with complete misdaignosis and self-medication, managing the medical manifestations of underlying social and psycholgical problems and palliative care.
I would suspect many medical traditions had enough of a pharmacopeia to do a lot effectively with many of these complaints using whatever framework they had for disease causation. If you believe in dolphin shakras you fix the shakras, if you believe in tiny invisible bugs then you deal with tiny bug treatment.
Also lets not assume that ‘doctor’ is a role that readily transfers to other times or cultures.
Why restrict it to “ancient” doctors? Up until about 100 years ago a great deal of seriously ill patients of “modern” doctors didn’t get better. The difference was perhaps that by then medical science had a pretty good idea of what was wrong and what the prognosis was. They could tell you with some certainty that you were going to die and why. They did at least have slightly better ideas about what was actually harmful. Nursing care was improving.
And we are beset with modern “doctors” who are treating people in the modern world with bottles of ultra pure water, infusions of “natural remedies”, manipulation of joints, and the wisdom of the ancients. Seems they don’t notice their patients either have little wrong with them, or die anyway. One suspects the reasoning on the part of both the charlatans and their patients is also very ancient.
I have a feeling that the ancient world was actually a little more sensible. Patients probably noticed a certain lack of success on the part of their doctors as well. Desperate times call for desperate measures, so it you are seriously ill you might be prepared to take on the advice of your local blood letter. Placebo and all that as well. But I have noticed that many ancient doctors tended to focus in treating less well defined issues. “Women’s problems” being a big one. AKA reproductive health. No shortage of folk remedies for either ensuring pregnancy, or of course, terminating one.
Exactly right. The key is being able to notice what worked better than doing nothing, giving a placebo, or just being of social support to the ill person, all of which sometimes resulted in recovery. Until the scientific method was actually applied the bias was often to “expert opinion” based on personal experience that leaned heavily to doing something, even if that doing something commonly made the patient worse off than if they had been left alone.
That bias is not completely gone today of course (and not only among the woo-meisters), but it is striking to note how recently in the grand scale any attempt to apply it systematically to medicine is.
And there was always another explanation available. I remember one young adult book I read where a character gets bit by a rattlesnake, and doesn’t have any booze available. He suffers mightily, but in the end makes it through. Which is, of course, the typical effect of a rattler bite without booze: Most human victims will survive. Rattlesnake bites are only a serious threat for a healthy adult if you follow them up with depressants. But in the book, do they conclude that you don’t need booze for a snakebite? Of course not: They conclude that he’s just a tough-as-nails hero.
Yes, they noticed. If they hadn’t the science of medicine would never have improved as doctors would have believed they already had all the answers. And by the way I’d much rather put myself in the hands of Hippocrates than some of the modern quacks and kooks with their ‘alternative medicine’ bullshit.
If someone is sick and they go to the hospital; the staff will hook them them up to machines, run a bunch of tests and pump them full of drugs … after two weeks they feel great, walk out of the hospital, and claim all those machines, tests and drugs done did cure them …
Alternately; the staff will put on voodoo masks, shake rattles and do a fancy dance around the bed … after two weeks the patient feels great, walks out of the hospital, and claims all those masks, rattles and dancing done did cure them …
The human body is just amazing in it’s ability to cure itself, or with just basic nursing … any charlatan with a gimmick can move in and claim they’re curing disease, most of the patients are actually cured … people want to believe … this is one of modern medicines dirtiest little secrets, many many patients would get better on their own without medical intervention …
Is there a class in medical school that teaches doctors how to not bust out laughing when they tell patients they have to have a camera stuck up their asshole?
Consider that even modern people with all the benefits of modern science and medicine still flock by the thousands to the “healing services” of charlatans who claim to be able to pray their cancer away.
Many of the cancers indeed do go into remission.
For those that still die, well, that was god’s plan for them.
It’s the same reason quack medicine is still pervasive today. People rely on anecdotal evidence and confirmation bias. Even someone trained in the scientific method can be influenced by confirmation bias and placebo effect - which is why medical trials are double blind (i.e. the person administering the drug and evaluating the patient’s status doesn’t know if that patient is receiving a real drug or placebo).
Even in modern times doctors and surgeons put great faith in questionable treatments and it takes quite a while for them to come to the conclusion that there is no benefit.
A dire example of this is the use of brain surgery to cure mental illness. Freeman and the lobotomy. Surgeons who were proponents of this treatment were at the top of their profession and imagined that had found a cure for mental illness. Moniz, the orginator of the procedure, won a Nobel prize.
They were in a position to monitor the outcomes of their patients, nonetheless they continued for far too long and damaged thousands of people.
The fact is there are some conditions for which there are no treatments that can be offered that produce a benefit, but there is a huge pressure for doctors to offer some sort of treatment.
Mental illness fell into that category in the period before psychoactive drugs were discovered. Today we are in the same position with many forms of cancer, where the treatments and their side effects can be extremely debilitating and of questionable benefit.
There is a strong cultural component to the attitudes to medicine and people have expectations that exceed reality. Doctors respond to that expectation and this sometimes colours their interpretation of the evidence. Decisions rest on ‘clinical judgement’ which is subjective and patients can only trust in the reputation and status of the practitioner. All very unscientific.
The trend towards objective ‘evidence based medicine’ is a fairly recent innovation.
(When I studied that in high school, someone points out that the poem does not explicitly say which doctor provided the actual “cure” - studious one or the quack.)
In an earlier thread someone described the technique the doctors used to treat Henry V(?) when he got an arrow through his head. In particular, I was impressed that they packed the wound with honey, as an antiseptic (it works fairly well, note that honey does not spoil). So some doctors were smart and observant. I guess another point is in the days before medical schools and AMA licensing, anyone could claim to be a doctor, or healer, or witch, or whatever passed for someone dispensing medicines and potions. it was probably as much about self-promotion as about ability.
But the same effect usually applies - a disease usually gets better within a few days by itself, and the majority of problems back then were disease.
there’s the anecdote about George III who not only lost America, but apparently only a few of the may doctors diagnosed his off-color urine as being related to his manic episodes (not that they would have known the cure). So many self-important doctors were willfully blind. Same applies to the doctors who did not believe Semmelweis’ observation that washing hands with antiseptic between patients dramatically cut deaths from infection during birth.
And it mostly still does, even today. While we can partially treat some mental illnesses with drugs, we’re still very far from the level we’d like to be, and so people will still cling to straws that seem to promise more.
Just as a nitpick - you don’t bleed a cold, you bleed a fever. Bleeding was done by those who believed that disease was an imbalance of the four humors. You bleed someone who is believed to have an excess of blood (warm/moist), not someone who has an excess of phlegm (cold/moist). For that, you want to increase the body’s warmth.
Problem is that he could not explain “why”. Same with John Snow and his cholera causing pump,. For most of history, people knew about the link between dirt and disease. From the 18th century they looked at the data and realised
i) Not everyone, everything or every place which was dirty would see disease.
ii) Many things which look clean cause disease and infection anyway.
They made empirical observations and came to what was a logical conclusion. Their error was not due to being incompetent, but due to the knowledge that they could not have, Germ theory of disease.
In the case of the Cholera pump, sure Snow proved that everyone who had contracted the disease had drunk water which came from that pump. On the other hand, some people who had drunk water from the same source did not catch the disease, including a brewery*, which used the most water from the said pump. They in essences said “You know nothing John Snow” and humored him by closing the pump, only to reopen it. I find it difficult to say they were being stupid, in ligh of what they actually knew.
The reason was that since water is boiled during the mashing process, killing the bacteria.
