# Were pre-modern doctors any good? **URL:** \ **Category:** Factual Questions\ **Created:** [November 26, 2022, 9:43am UTC](https://boards.straightdope.com/t/were-pre-modern-doctors-any-good/975580 "2022-11-26T09:43:23Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![RivkahChaya](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/rivkahchaya/32/8919_2.png) [@RivkahChaya](https://boards.straightdope.com/u/RivkahChaya)\ **Post date:** [November 26, 2022, 8:25pm UTC](https://boards.straightdope.com/t/were-pre-modern-doctors-any-good/975580/21 "2022-11-26T20:25:57Z")
People who practice homeopathy _today_ (who receive nothing but scorn from me) like to point to a single instance in history of a cholera epidemic when Hahnemann’s patient mostly lived while patients treated by traditional doctors of the time mostly died. At this time (some time around 1800 that I don’t remember exactly), most people with cholera were given emetics and purgatives, as well as bled, and this just sped up their death from dehydration. Hahnemann’s patients got his homeopathic concoctions, which is to say, glasses of sterile water to drink. It was completely an accident, but yeah, in this one instance, homeopathic _treatment_, which is to say, the delivery system, (not the “medicine” itself) saved people. Mainly because traditional medicine was so bad. ---
**Author:** ![Whack-a-Mole](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/whack-a-mole/32/141_2.png) [@Whack-a-Mole](https://boards.straightdope.com/u/Whack-a-Mole)\ **Post date:** [November 26, 2022, 8:29pm UTC](https://boards.straightdope.com/t/were-pre-modern-doctors-any-good/975580/22 "2022-11-26T20:29:54Z")
Was there ANY formal system of medicine back then? As in, “We have observed that X works and Y doesn’t?” And then that knowledge was passed around? Which then suggests the question: When did a formalized notion of practicing medicine based on observed results come into effect? (I really do not know) ---
**Author:** ![RivkahChaya](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/rivkahchaya/32/8919_2.png) [@RivkahChaya](https://boards.straightdope.com/u/RivkahChaya)\ **Post date:** [November 26, 2022, 8:45pm UTC](https://boards.straightdope.com/t/were-pre-modern-doctors-any-good/975580/23 "2022-11-26T20:45:45Z")
Actually, Hahnemann tried, and may have been the first, but no one else picked up the idea from him. His mainly seemed to have involved giving concoctions to healthy people and observing and recording the results. Unfortunately, he also observed that smaller amounts often were followed by greater results, and jumped to the conclusion that smaller amounts of an ingredient produced greater effects, rather than suspecting that he’d made a post hoc error. He also noted that after carrying concoctions in saddlebags they seemed to work better, he concluded that sticks covered in horsehair used to agitate containers of his special water made it work better. It sounds funny to us, but he was trying. He had no foundation to build on, and just stumbling on the idea of observing and recording data (he did record copious reams of observations) was a huge breakthrough. It’s the reason that I think if he were transported into today, and shown modern, evidence-based medicine, and the things doctors could now accomplish, he’d abandon homeopathy, and want to practice modern medicine. That, and the fact that his original motivation for his treat-and-observe method was the fact that he realized that what he’d been doing just didn’t work. ---
**Author:** ![Hari\_Seldon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hari_seldon/32/5173_2.png) [@Hari\_Seldon](https://boards.straightdope.com/u/Hari_Seldon)\ **Post date:** [November 26, 2022, 9:40pm UTC](https://boards.straightdope.com/t/were-pre-modern-doctors-any-good/975580/24 "2022-11-26T21:40:21Z")
> [@RivkahChaya](#): > > 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. It is worth noting that by about 1950, Hahnemann Medical College in Philadelphia had mutated into a standard medical school. As far as I could tell (I once tried to figure this out) the transition started around 1920 and was complete by 1950. In one of his Lewis Thomas said that until anitbiotics came along, the main thing doctors did was make accurate diagnosis and give a prognosis. I am not when medical schools started, but many, maybe most, doctors simply apprenticed to a doctor and became doctors that way. I think Thomas said that that was how his father became a doctor. Before Semmelweis (and for some time after) most doctors made no attempt at cleanliness and carried disease from one patient to the next. And Semmelweis was widely excoriated and, IIRC, ended up in an insane asylum. ---
**Author:** ![Moriarty](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/moriarty/32/49_2.png) [@Moriarty](https://boards.straightdope.com/u/Moriarty)\ **Post date:** [November 26, 2022, 10:07pm UTC](https://boards.straightdope.com/t/were-pre-modern-doctors-any-good/975580/25 "2022-11-26T22:07:24Z")
Although Semmelweis has received mention a few times (and it appears that he may have been entering into early stages of Alzheimer’s when he was put in an asylum), Joseph Lister deserves credit as well for promoting antiseptic medical techniques. Of course, as has been mentioned, doctors in America were oh so snooty, and didn’t take kindly to being lectured by others. So Lister - an Englishman - and his ideas were slow to catch on in America. But surely modern medicine - in terms of being aware of the importance of a sterile environment- was being practiced somewhere by the 1870s (if not sooner). > **[Joseph Lister’s antisepsis system | Science Museum](https://www.sciencemuseum.org.uk/objects-and-stories/medicine/listers-antisepsis-system)** > > Not so long ago even the smallest procedure could be deadly if infection entered the body. Antisepsis gave us a way to make surgery safe. ---
**Author:** ![Whack-a-Mole](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/whack-a-mole/32/141_2.png) [@Whack-a-Mole](https://boards.straightdope.com/u/Whack-a-Mole)\ **Post date:** [November 26, 2022, 11:36pm UTC](https://boards.straightdope.com/t/were-pre-modern-doctors-any-good/975580/26 "2022-11-26T23:36:39Z")
> [@RivkahChaya](#): > > It sounds funny to us, but he was trying. He had no foundation to build on, and just stumbling on the idea of observing and recording data (he did record copious reams of observations) was a huge breakthrough. Did he draw any conclusions from that pile of data? Conclusions that he then worked into his process to make ever better and more useful concoctions? Recording data is all well and fine but useless unless it is properly compiled and lessons can be drawn from it all. ---
**Author:** ![Dr\_Paprika](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr_paprika/32/3042_2.png) [@Dr\_Paprika](https://boards.straightdope.com/u/Dr_Paprika)\ **Post date:** [November 27, 2022, 12:14am UTC](https://boards.straightdope.com/t/were-pre-modern-doctors-any-good/975580/27 "2022-11-27T00:14:14Z")
Until at least the discovery of microscopes, the idea that boiling surgical instruments would help is not particularly obvious. It is not impossible this was done before modern times. In any case, there do seem to be ancient examples of people surviving surgery to their skull and limbs. In the 1860s, the average life expectancy in wealthy countries was still in the low to mid thirties. ---
**Author:** ![Whack-a-Mole](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/whack-a-mole/32/141_2.png) [@Whack-a-Mole](https://boards.straightdope.com/u/Whack-a-Mole)\ **Post date:** [November 27, 2022, 12:18am UTC](https://boards.straightdope.com/t/were-pre-modern-doctors-any-good/975580/28 "2022-11-27T00:18:41Z")
> [@Dr\_Paprika](#): > > In the 1860s, the average life expectancy in wealthy countries was still in the low to mid thirties. Isn’t this a quirk of statistics? I thought this low number was due to lots of babies and children dying young for a variety of ailments kids are prone to (also young women giving birth). But, if you survived to be 20 you had a good chance of living to 60 or more. I made up those numbers but something like that. It’s not like there were few people over 30…there were lots of people over 30 and there were plenty of people over 60. ---
**Author:** ![Dr\_Paprika](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr_paprika/32/3042_2.png) [@Dr\_Paprika](https://boards.straightdope.com/u/Dr_Paprika)\ **Post date:** [November 27, 2022, 12:31am UTC](https://boards.straightdope.com/t/were-pre-modern-doctors-any-good/975580/29 "2022-11-27T00:31:37Z")
Yes and no. It varied from country to country. Some of it is a quirk due to infant mortality, but only partly so. And people in their fifties and sixties back then were not rare, nor really common. I have seen thousands of patients in their 90s and one as old as 110. People now in their nineties and older are neither rare nor really common today, despite much lower levels of childhood morbidity and higher expectancies. ---
**Author:** ![outlierrn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/outlierrn/32/3005_2.png) [@outlierrn](https://boards.straightdope.com/u/outlierrn)\ **Post date:** [November 27, 2022, 9:00pm UTC](https://boards.straightdope.com/t/were-pre-modern-doctors-any-good/975580/30 "2022-11-27T21:00:10Z")
I would speculate that some of this is the bizarreness effect. Things like bloodletting and useless treatments for infectious diseases stand out, but how many fractures or dislocations were set with decent results? Even if infection rates were high, how many wounds which would have bled to death were controlled? ---
**Author:** ![Dr\_Paprika](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr_paprika/32/3042_2.png) [@Dr\_Paprika](https://boards.straightdope.com/u/Dr_Paprika)\ **Post date:** [November 27, 2022, 9:40pm UTC](https://boards.straightdope.com/t/were-pre-modern-doctors-any-good/975580/31 "2022-11-27T21:40:30Z")
The question is how much local knowledge was considered proprietary or never passed on. It is fashionable to consider ancestral knowledge as basic but this was often far from the case. With prominent patients and/or difficult cases there is pressure to do something. Even believe a sham or quack treatment provides strong benefit. This survives to modern times, more careful studies have shown even many fairly recent treatments to be mediocre, or much worse. One can point fingers or admit complex things are complicated. ---
**Author:** ![Saint\_Cad](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/saint_cad/32/18907_2.png) [@Saint\_Cad](https://boards.straightdope.com/u/Saint_Cad)\ **Post date:** [November 27, 2022, 11:24pm UTC](https://boards.straightdope.com/t/were-pre-modern-doctors-any-good/975580/32 "2022-11-27T23:24:07Z")
> [@Jackmannii](#): > > halved gunshot-wound mortality from Civil War levels to about 7.4%. I wonder how much of that was because of the huge swath of damage a Minié ball would cause. I have heard that even with modern medicine most battlefield gunshot wounds in the Civil War would still be fatal. ---
**Author:** ![Mk\_VII](https://avatars.discourse-cdn.com/v4/letter/m/5f9b8f/32.png) [@Mk\_VII](https://boards.straightdope.com/u/Mk_VII)\ **Post date:** [November 28, 2022, 8:13pm UTC](https://boards.straightdope.com/t/were-pre-modern-doctors-any-good/975580/33 "2022-11-28T20:13:27Z")
Anything more complicated than a simple fracture merited amputation (certainly on the battlefield, they didnt have time to do anything else.) Quite large numbers of people survived amputation pretty well, if post-operative infection didn’t get them. The Eastern Theater, where the soil had been fertilised with animal dung for generations, produced tetanus more readily than the virgin lands of the Western Theater. ---
**Author:** ![Marvin\_the\_Martian](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/marvin_the_martian/32/2898_2.png) [@Marvin\_the\_Martian](https://boards.straightdope.com/u/Marvin_the_Martian)\ **Post date:** [November 28, 2022, 11:13pm UTC](https://boards.straightdope.com/t/were-pre-modern-doctors-any-good/975580/34 "2022-11-28T23:13:58Z")
I’ve recently read that leeches inject anticoagulant into their host after they latch on in order to keep the blood from clotting. Would applying leeches work for the sorts of conditions (like strokes) where an early dose of aspirin improves outcomes? ---
**Author:** ![beowulff](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/beowulff/32/542_2.png) [@beowulff](https://boards.straightdope.com/u/beowulff)\ **Post date:** [November 29, 2022, 12:11am UTC](https://boards.straightdope.com/t/were-pre-modern-doctors-any-good/975580/35 "2022-11-29T00:11:44Z")
“Busting” clots takes a large dose of anticoagulant delivered right where it’s needed. Leech anticoagulants are being used to develop better medicines, but it’s unlikely that simply letting them suck on your skin is going to be very helpful if you have had a stroke. ---
**Author:** ![outlierrn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/outlierrn/32/3005_2.png) [@outlierrn](https://boards.straightdope.com/u/outlierrn)\ **Post date:** [November 29, 2022, 3:03am UTC](https://boards.straightdope.com/t/were-pre-modern-doctors-any-good/975580/36 "2022-11-29T03:03:36Z")
I would expect leeches, and vampire bats, only produce small amounts of anti-coagulant, just enough for their own bites. ---
**Author:** ![Kent\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kent_clark/32/105_2.png) [@Kent\_Clark](https://boards.straightdope.com/u/Kent_Clark)\ **Post date:** [November 29, 2022, 4:30pm UTC](https://boards.straightdope.com/t/were-pre-modern-doctors-any-good/975580/37 "2022-11-29T16:30:52Z")
[The University of Pennsylvania began the teaching of medicine in 1765](https://archives.upenn.edu/exhibits/penn-history/18th-century/medical-school/). They offered a Bachelor’s and a Doctoral degree. Here were the requirements for a Bachelors: > - attend at least one course of lectures in the following subjects: anatomy, materia medica (now known as pharmacology), chemistry, and the theory and practice of physick (the art of healing, or medicine) > - attend one course of clinical lectures > - attend the practice of the Pennsylvania Hospital for one year > - be examined privately by medical trustees and professors and other trustees and professors who wish to attend > - be examined publicly An M.D. required three years of practice and writing and defending a thesis. The anatomy sequence included courses in surgery and midwifery. It’s unlikely pharmacology included much more than knowing which berries weren’t poisonous and how to grind them up. But between the courses in anatomy, midwifery and surgery and the one year hospital apprenticeship, the 1765 doctor could probably deliver a baby, cauterize a wound, and amputate a limb without too much unnecessary bloodshed. ---
**Author:** ![Whack-a-Mole](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/whack-a-mole/32/141_2.png) [@Whack-a-Mole](https://boards.straightdope.com/u/Whack-a-Mole)\ **Post date:** [November 29, 2022, 4:52pm UTC](https://boards.straightdope.com/t/were-pre-modern-doctors-any-good/975580/38 "2022-11-29T16:52:25Z")
> [@Kent\_Clark](#): > > …the 1765 doctor could probably deliver a baby, cauterize a wound, and amputate a limb without too much unnecessary bloodshed. Maybe. But, as noted above, doctors in 1800 pretty much killed former president George Washington by trying to save him by bleeding him and administering various concoctions that at best didn’t help. I imagine with so much war doctors might have been ok(ish) at treating wounds (stitching)/setting bones/amputating but they didn’t seem to know much beyond that (and sterile methods were unheard of AFAIK). ---
**Author:** ![Pleonast](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pleonast/32/1183_2.png) [@Pleonast](https://boards.straightdope.com/u/Pleonast)\ **Post date:** [November 29, 2022, 5:02pm UTC](https://boards.straightdope.com/t/were-pre-modern-doctors-any-good/975580/39 "2022-11-29T17:02:06Z")
> [@Kent\_Clark](#): > > [The University of Pennsylvania began the teaching of medicine in 1765](https://archives.upenn.edu/exhibits/penn-history/18th-century/medical-school/). They offered a Bachelor’s and a Doctoral degree. Here were the requirements for a Bachelors: > > > - attend at least one course of lectures in the following subjects: anatomy, materia medica (now known as pharmacology), chemistry, and the theory and practice of physick (the art of healing, or medicine) > > - attend one course of clinical lectures > > - attend the practice of the Pennsylvania Hospital for one year > > - be examined privately by medical trustees and professors and other trustees and professors who wish to attend > > - be examined publicly > > An M.D. required three years of practice and writing and defending a thesis. > > The anatomy sequence included courses in surgery and midwifery. It’s unlikely pharmacology included much more than knowing which berries weren’t poisonous and how to grind them up. But between the courses in anatomy, midwifery and surgery and the one year hospital apprenticeship, the 1765 doctor could probably deliver a baby, cauterize a wound, and amputate a limb without too much unnecessary bloodshed. Thanks for the information. I infer from this that not all physicians were doctors at that time. I wonder when did state begin to license doctors. And when did they require physicians to be doctors? ---
**Author:** ![Kent\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kent_clark/32/105_2.png) [@Kent\_Clark](https://boards.straightdope.com/u/Kent_Clark)\ **Post date:** [November 29, 2022, 5:38pm UTC](https://boards.straightdope.com/t/were-pre-modern-doctors-any-good/975580/40 "2022-11-29T17:38:09Z")
> [@Whack-a-Mole](#): > > Maybe. But, as noted above, doctors in 1800 pretty much killed former president George Washington by trying to save him by bleeding him and administering various concoctions that at best didn’t help. Absolutely. I probably should have added “but not much else” to my final sentence. > [@Pleonast](#): > > wonder when did state begin to license doctors. [Wikipedia says](https://en.wikipedia.org/wiki/Medical_license) there were a couple of attempts in the early part of the 1800s. but they were soon abandoned. Real licensing didn’t start until the 1870s, and even then it was controversial. Licensing tended to shut out practitioners like midwives and osteopaths, who had not graduated from medical school but may have had plenty of real word experience. [Previous page](https://boards.straightdope.com/t/were-pre-modern-doctors-any-good/975580.md?page=1) [Next page](https://boards.straightdope.com/t/were-pre-modern-doctors-any-good/975580.md?page=3)