Were pre-modern doctors any good?

When reading about the history of medicine, one often comes across old theories of anatomy and the origin of diseases which sound hair-curlingly wrong by modern standards but were apparently believed for a long time, such as “humorism”. This makes me wonder if doctors practising on the basis of such ideas were any good in the sense of having a decent (better-than-random) chance of improving the conditions of their patients.

So suppose you live in a medieval or early modern city and have some medical condition; something that’s seriously threatening to your life if left untreated but which can easily be treated by modern medicine. You consult a doctor of your day; a “real” doctor, with a degree from a reputable (in its day) medical school. Was there any realistic chance of cure, or would the doctor simply give you some treatment that makes you feel as if something is done but which doesn’t actually help, and your chances of survival are the same as if you were left to your own devices?

Before antibiotics and vaccines, doctors couldn’t do much about many diseases regardless of theory. They could stitch wounds and set bones, but until the importance of surgical field cleanliness was understood, a lot of people died of sepsis from surgery.

In many cases your chance of survival were worse with the doctors than if you just tried to ride it out on your own. Bloodletting alone probably killed a non-trivial number of people.

There were a few things that worked as medications - such as either alcohol or opium for pain - and some ability to set bones and do very minor operations (with pretty much no anesthetic, of course, and no concept of germ theory so infections were not just common but expected). But prior to what we’d call modern medicine what doctors could do was very sharply limited.

President Garfield was probably killed by the doctors who poked around his abdomen with unwashed hands trying to find the assassin’s bullet. Garfield actually lived several months after being shot, and seemed to be recovering, before developing sepsis.

Doctors now will tell you it’s now always necessary to remove a foreign object, and sometimes better to leave it alone, but Garfield’s doctors tortured him trying almost every day with some new method to get the bullet out.

The history of treating battlefield injuries is grim. But you stood a much better chance of survival even during 19th century conflicts compared to fighting in a Roman legion.

“Unfortunately, the introduction of antiseptic practice came too late for Civil War soldiers, and would not be used until the Spanish-American War. During this five-month conflict in 1898 every soldier carried an occlusive antiseptic dressing in his first aid kit, and this innovation, along with the use of hydration for wound shock, halved gunshot-wound mortality from Civil War levels to about 7.4%.”

Today, Garfield’s wound would have been an outpatient treatment. It wasn’t that bad. They should have just left the bullet alone. And doctors were aware of sterile procedures, it was just that American doctors “knew better” and specifically would not use them. I swear they just wiped their hands in poop before attempting to get the bullet out, just to show they were right and the British doctors were wrong. I’m sure Garfield thanked then for their total belief in American exceptionalism.

You talk about “pre-modern” doctors. When ST:TVH came out, and Chekov got a bump on the noggin and required surgery, McCoy made a comment about the butchers of the 20th century and how he wasn’t letting them operate with their stone knives and bearskins. As a resident of that time, I was offended. Hey, we’re not that bad! But today, if I needed surgery like that, I wouldn’t let a 1980s doctor operate on me, either!

I imagine that because he was the president, and an assassination attempt had just been made, they might keep him in the hospital a day or two for security. If a problem came up at home, and they needed to transport him back to a facility, that would be a lot less secure than just keeping him at the hospital with Secret Service, the hospital’s own security, and DC police brought in just for added security.

Also, if something happened, like a natural disaster, a hospital staff knows how, and has the equipment, to transport someone not fully ambulatory.

But yeah, if he were just some guy with that wound-- treat’n’street. With some antibiotics and tramadol.

This guy was not a quack:

Apparently, 150+ years ago, a mother had a better chance of surviving childbirth if the doctor didn’t show up. Midwives knew what they were doing, doctors were lax on sterility.

I don’t think anyone is saying doctors before 1900 were quacks. Doctors who followed protocol, did as they were taught, monitored reactions, and so forth weren’t quacks.

A quack is someone who follows a theory-based (as opposed to evidence-based) protocol that contradicts the consensus, and does so in spite of evidence that it doesn’t work.

Even Samuel Hahnemann, the guy who invented homeopathy, wasn’t really a quack-- in fact, he was trying to conduct evidence-based studies of his concoctions, he just didn’t know how since no one had tried that before. Honestly, having read what he did to develop homeopathy, and what his motivations were, I think that if he were transported to the present, he would embrace modern medicine.

Doctor vs Healer is probably an important distinction.

For iteresting info on lost medical skills thwt could be beneficial now, see Victoria Sweet’s books.

The theory of humours sounds like quackery, with reason. But, if you agree with books like The Myth Of Normal, it is making a comeback of sorts.

Medicine, surgery and their foundation disciplines are difficult. Some places and some specialties did better than others.

Babies have been a thing for ten thousand generations and obviously something has been learned in that time. Antiseptic technique and obstetrical knowledge help improve survival of both mother and baby. But some knowledge is pretty ancient, and antisepsis requires soap and clean water. How far back are you going?

Pharmacology has its origins in botany. Herbal knowledge varied from place to place since it is local. Some places had “milk of the poppy”, alcohol, drugs that induced visions or dissociation. There was some benefit some of the time, at best.

The best doctors did as little as possible since “God heals and the doctors take the credit”. Surgeons, without reliable anaesthesia, advertised how quickly they could do procedures. In well chosen cases, surgery did improve the odds of survival. Some were surely better than others - part of the problem is incentive - the surgeons were incentivized to operate when it was not needed. This is a problem in medicine and dentistry and other health and health-tangential disciplines that has not fully gone away.

Similarly, knowledge of anatomy, physiology, pathology, microbiology, immunology, epidemiology, chemistry, nutrition, community health, general surgery, orthopaedics, neurology, psychiatry, radiology, emergency medicine, trauma and critical care, hospital medicine, etc. took very different paths. Basic orthopaedics is very old knowledge. Emergency medicine was pretty useless before the 1980s, not organized nor recognized as a discipline.

In general terms, with enormous variations from case to case and depending on the ailment, your chances of statistically improving your condition did not improve when visiting a doctor until around the First World War.
Me, had I been born one hundred years earlier or more I would not have survived past my 10th birthday. Anecdotical, I know.

I thought I remembered reading similar threads in the past. Here are some that a search turned up:

Samuel Pepys was operated on for kidney stones in 1658. A person who have to be very desperate, or in very great pain, to risk this operation, without anaesthetic. His surgeon, Doctor Hollier, is known to have cut thirty people for the stone in one year, who all lived. But after, did four, who all died, probably from infection carried on the instruments. It involved making a cut slightly left of the centerline between the scrotum and the anus, about three inches long, down to the bladder, which was then opened. It probably left Pepys sterile (though not impotent).
In old age, the wound broke open again.

We don’t need to go back that far. The first US president, George Washington, was made worse and then died by the medicine of the time (1799…almost 1800). One would suppose he had access to the “best” doctors of the day. He was not poor.

That night, Washington woke his wife Martha to say he was feeling very sick, and that he could hardly breathe or talk on his own. The former President asked his overseer, Albin Rawlins, to bleed him. Doctors then arrived and bled him four more times over the next eight hours, with a total blood loss of 40 percent.

Washington also gargled with a mixture of molasses, vinegar and butter; he inhaled a steam of vinegar and hot water; and his throat also was swabbed with a salve and a preparation of dried beetles. An enema was also used. By late afternoon, Washington knew he was dying and asked for his will. ~SOURCE

Midwives worked on one pt at a time, doctors moved from encounter to encounter. They weren’t lax on sterility, they didn’t know about it. Neither did the midwifes.

Apparently doctors of the time would go from working on cadavers to working on women about to give birth. No washing up.

A guy at the time suggested washing their hands. He was discredited and ended up being committed to an insane asylum.

No telling how many women died as a result (lots and lots).

This well-known story is probably based on the real history of Semmelweis. Which proves that, then as now, some doctors were good, and many were not. IMO it is more important for a competent physician to be able to acknowledge his or her limitations and fallibility, for example by being willing to consult with others on certain cases and by keeping up to date on the latest advances, than for us to expect every doctor to win the Nobel Prize for medicine.

Not all doctors need a Nobel Prize but, IIRC, Semmelweis had actually proved that washing hands provided notably better results. Much, much better results.

The medical community (at that time) still ruined his career for suggesting it and ignored the results. It offended their notions that they were special somehow.