Medical History...

After watching Masters and Commanders I began to have some questions about how medicial science were like in the times of 1800s and the past…

Here are the questions -

  1. When did medicial science began to be, IYHO, reliable?

  2. What are some of the major concepts that doctors in the 1800s and early 1900s (or even earlier) have to grasp which enabled them to save more lives?

  3. How did doctors in those time diagonose what’s wrong with their patents, without all the fancy equipment nowadays?

  4. How did doctors work in those times?

Many thanks in advance!

I would say that the establishment of microbiology as a pragmatic medical tool (around 1960) was when medical science became IMHO reliable.

As for the rest of the questions, there are several books about the history of medicine that are absolutely fascinating. A quick search on Amazon will bring up many results. I didn’t see the one I’m thinking most of, and I can’t remember the name.
There is a new book out called Stiffed, about the life of cadavers that looks interesting.

“The life of cadavers?” :eek:

I have that book! It’s really good- very factual , but amusing at the same time. Not for the squeamish , though!

I have Stiffs, too! It’s an outstanding book.

One good way to get some insight on the history of medicine is to go to a good medical library that has a lot of old textbooks. I’ve done this for papers and the like, and you get a good idea of how disease was diagnosed without all the fancy-schmancy stuff they have now.

Robin

Lewis Thomas wrote several books on medicine and in one of them he wrote about his father, a physician at the beginning of the 20th c. One thing that struck me was that doctors actually cured very few things. Mostly they tried to give very accurate diagnoses and prognoses. They were able to tell the patients what to expect and what to do about it and give palliative care when necessary. One thing that had changed by then was anasepsis and that was a vast improvement. That, clean water and sewage were responsible for a vast increase in life expectancy around then. Also anasthesia came along, so doctors could take out an appendix (unless it ruptured). X-rays helped since certain things could be diagnosed more readily. Then came the sulfa drugs in the 30s, antibiotics in the 40s and modern medicine was off and running.

I seem to recall that in one of Thomas’s books (and I’ll second how great they are), he say something to the effect of “Doctors haven’t studied medical history much, probably because most of it is so horrible.”

In Patrick O’Brian’s books, he makes it pretty clear that Stephen, although considered a brilliant physician at the time, would be a quack today – dirty, and given to bleeding people at the drop of a hat.

Can someone explain to me why anyone thought that bleeding someone might be a good thing? We’re leeches commonly used to treat people who were sick?

Let’s see, this guy looks weak, is hot to the touch, can’t keep anything in his stomach, let’s bleed him and see if that helps!

Why not just give him a haircut? It would have been just as effective and wouldn’t have been so hard on everyone concerned?

In other words, how did bleeding catch on as a treatment for anything?

Bleeding as a medical treatment goes back to the old Greek theory of the the four humours. In the time period we are discussing, the “germ theory” and microbiology were in the future.

In a nutshell – Humans had four different fluid substances circulating through the body: blood, phlegm, black bile and yellow bile. Good health meant that all four were in balance; ergo ill health meant that one had become too prominent.

One of the most common symptoms of an infectious condition is fever. Today, we recognize this as a side-effect of the immune system defending the body against the invading organisms. Then, it was recognized as an over-prominence of blood throwing the humours out of balance. Removing blood was an attempt to re-balance the system.

It may sound ludicrous today, but there really is no reason for an early 21st-century Westerner to look on the practioners of the time as stupid or benighted.

Well, for a long time, the vast majority of effective major medical therapies were in infections and a few surgerical interventions. Child birth was more common, but most were conducted without a physician present, and indeed, physicians contributed to poor outcomes.

Semmelweis noted the correlation between the participation of doctors/studentsand poor outcome in the 1840s, and propounded a crackpot system of cleanliness including such outlandish measures as washing your hands after dissecting cadavers and squeezing ous out of boils. The incidence of puerperal (childbed) fever dropped dramatically, so naturally Semmelweis died in poverty and disgrace.

If you were raised in the South, as I was, you were probably taught that Crawford Long invented ether anaesthesia in 1842, but up north, ether was mostly used recreationally for the next few years (“ether frolics” were popular among physicians and students), Boston area doctors (among which I now number myself, so I can mock them) apparently took the Antoinettesque view that “it’s entirely too good for them”, until William TG Morton began doing demonstrations at the Massachusetts General Hospital about 1846. He certainly inspired a steady trickle of medical articles in the Boston medical journals, and is credited as the inventor by the Yankees.

Anaesthesia is not just a comfort measure. The pain of surgery alone can readily cause shock and death. Today, anaesthesiologists often describe their job as "desperately trying to keep the patient alive while the surgeon at the other end of the table does his damnedest to kill them. As someone who’s done surgery, but no ansetheiology since med school, I must confess I agree.

Pasteur’s work with vaccines, aseptic technique (sterilization, airborne contamination, and more) didn’t come until the 1860s. At around that time, Lister was pioneering chemical antiseptics and aseptic techniques in surgery. Some of his other milestones, like the use of catgut instead of silk (publ. 1884, IIRC) are probably as important but little heralded.

Koch, in the 1870s, was the first to prove links between specific types of bacteria and specific diseases. Dmitri Iwanowski did the first good work on viruses in the 1890s, but had no idea what they were. Actually his work was on a tobacco virus. Close enough.

Until the 1930s, you could get a correspondence school medical degree in a year or less from Harvard Medical School,a nd in a matter of days or weeks from less reputable schools like Columbia (which is now among the finest American medical schools) To find out more, Gooogle the “Flexner report”.

Fleming discovered the first truly effective antibiotic (penicillin) in the 1920s, but use was not at all widespread until the 1940s. Prior to the use of antibiotics, most antibacterial therapies seemed to be toxic compounds of arsenic, strychnine, mercury and the like, administered on the principle that the germs, being smaller, would probably die first. The basic idea was just to break the balance between man and germ, so the human immune system could get the upper hand. Even in modern medicine, the largest part of the cure (whether combating infections or healing) is actually done by the patient’s body. Even with our fanciest drugs and techniques, treating a patient who is immunocompromised or has impaired healing is a drawn-out struggle with an iffy outcome.

You also asked about diagnosis.

Fancy equipment is great, but even today medical students are told that 50-90% of the time, “the patient will tell you what they have” - i.e. a properly conducted medical history and account of the illness is usually enough to make a diagnosis. Tests are usually just used to confirm a diagnosis, not make it. They can also provide valuable information in tricky diagnoses, to assist in treatment, or to monitor the progress of a condition. (“90%” is hyperbole, though)

In most cases where we can’t make the diagnosis from the history and patient account, we usually make it from a basic physical exam that uses the same basic tools that were available 100 years ago. My oto-layrngoscope may be brighter, lighter, and with somewhat better optics than the light used 100 years ago, but the principle is the same. My stethoscope is probably better than placing my ear on a silk scarf on the patients chest (the original method of auscultation, which goes back two centuries or more) but even that is arguable.

In fact, every generation of new physicians in the past 50 years (or possibly century) has been berated by its elders for having terrible examinations skills. Most students quickly learn which of their classmates to turn to for a good confirmation palpation. Moreover, the time pressures and other facts of modern practice often cause an abbreviated exam (though, to be honest, I had exactly one half decent physical exam before I learned to do them myself, and that was the mandatory hospital physical before I began med school, so I’d say abbreviated exams were always a problem)

In the case of auscultation (a particular interest of mine in med school), countless studies have shown that residents really don’t ‘hear’ prominent cardiac findings very well at all. (Attendings are usually to smart to participate in such tests) I can assure you those studies are accurate. I probably spent 10x as much time listening to a variety of patients and tapes, reading, and otherwise sharpening my ears, as almost any of my fellows or the residents who did most of our teaching (many of whom actually mocked my interest). Yet in spite of that, any number of cardiologists can put me to shame.

The basic skills of modern diagnosis are a) using your ears to listent to the patient; b) using your mind to make a complete differential; and c) knowing all the physical tests -there are a lot of lesser known ones- and executing them properly. While tests are extremely useful , I doubt 10% of all cases truly rely on them - partly because we often need to begin treating presumptively (and usually correctly) before the test results come back.

Also, you shouldn’t underestimate the armory of tests available 100 years ago. Many of them have been supplanted by better ones, but they did serve a useful purpose. X-ray imaging was around 100 years ago (and actually quite trendy). Microscopy was very well established in science, and available to doctors. Common blood tests like the CBC (complete blood count), hematocrit, ESR (Erythrocyte Sedimentation Rate) were easily done manually, without todays fancy and expensive automated testers. My grandfather, a diabetic, had been monitoring his own sugar level at home (or, for a brief period, a village in rural India) using a urine test call the Fehling reaction, decades before I was born.

You get the idea. If I had to go back and practice medicine 100 years, the thing I’d miss most are a few dozen of today’s drugs. The thing I’d fear most would be the misconceptions of my colleagues (and the spears and torches they’d use to drive me out of town)

The Wound Man is a diagram that often accompanied medical texts in the middle ages.

The picture that I linked to dates to 1530, but I think that they date even earlier. I read an old English medical book from the 12 or 13 century and IIRC it had a Wound Man diagram. Of course the book I read was a reprint so it may have been added after the fact.

Didn’t the Asian cultures have much better luck diagnosing and treating ailments than their Euro counterparts? Or is that a myth?

I noticed no one has mentioned A Sea of Words (available on Amazon), which is a reference book written to help people reading O’Brian’s Aubrey/Maturin books.

The first half has two essays, one of which is all about how Dr. Maturin would have practiced medicine. It was written by an expert and is a very interesting read.

The latter half is a detailed glossary (the definitions are often several paragraphs–little essays) of words used in the books, and includes many medical terms.

From what I know of medical history, I find it equally fascinating and also nightmare-inducing. So I gather I shouldn’t see this movie before it comes out on DVD? I think I was permanently traumatized by the Civil War hospital scenes in…ah, crap. That Costner movie. I just went blank on the title.

The Wound Man is a diagram that often accompanied medical texts in the middle ages.

The picture that I linked to dates to 1530, but I think that they date even earlier. I read an old English medical book from the 12 or 13 century and IIRC it had a Wound Man diagram. Of course the book I read was a reprint so it may have been added after the fact.

Devils, Drugs and Doctors (by Howard W. Haggard, MD) is a fascinating medical history.