Were pre-modern doctors any good?

Factual Questions
41

The Minie ball was actually the worst standard infantry round in all of history to get shot with. It was a very large hunk of lead traveling at just under the speed of sound. It made worse wounds than the round musket balls that came before it and it made worse wounds than the cartridge rounds that came after it. A modern round performs a lot better ballistically, but a Civil War era Minie ball makes an absolutely HUGE wound channel compared to a modern round.

For those who don’t know what a Minie Ball is, this is what they looked like. Civil War era Minie balls were typically .58 cal. and about 500 to 600 grains in weight. For comparison, a modern 5.56 NATO round is about .22 cal. and about 55 to 60 grains. So a Civil War Minie ball was over twice the diameter and about ten times the weight of a modern round.

This is what a Minie Ball would do to your femur, the thickest bone in your body.

This is what it would do to your skull.

So yeah, they made absolutely horrific wounds that would be difficult to treat even with modern medicine.

In the Civil War, if you got shot in the arm, they would cut off the arm. If you got shot in the leg, they cut off the leg. Repairing such badly mangled limbs was beyond their abilities. I don’t know how well modern medicine would be able to do against such damage.

If you got shot in the torso, they would just dope you up with morphine and set you aside. If you got shot in the head, you probably weren’t going to live long enough to even get to the field hospital.

Civil War doctors often ran low on medical supplies, so quite a few limbs were sawed off without anesthesia. That’s not really something that I want to spend a lot of time thinking about. Yeesh.

A Civil War era surgeon’s kit looks a lot more like modern carpentry tools than modern surgical kits.

Modern surgeons can at least treat wounds to the torso, and won’t just dope you up with morphine, set you aside, and hope for the best. And of course the modern knowledge of keeping things sterile and antibiotics would make a huge difference.

But there is definitely a point to be made that even with modern medicine, a wound from a Civil War era musket would be a bit of a challenge.

42

If the doctors had left the bullet alone and Garfield had died, they likely would have been skewered as being negligent and incompetent. To protect their own reputations they had to DO something, even if it was worse than nothing. “First, do no harm [to myself].”

43

Hey, that trauma kit has a trephine like mine! The cone shape of the cutter means you won’t plunge into the brain once you breach the skull.

[Album] Trephine
44

One other thing I haven’t seen mentioned yet is that there’s a powerful placebo effect to having an authority figure listen to your symptoms and prescribe you a particular course of treatment. So at least some good was done despite the doctor’s best efforts re: bleeding, purgatives, weird diets, and filthy hands.

45

Again, much of our impressions of early medicine is based on what a few prominent people wrote down and which was also preserved and popularized. There is no reason to believe earlier people were all ignorant, did not consider some genuine advances to be trade secrets, wrote stuff down which did not survive or widely propagate, or were universally like some later doctors in mocking hygiene and sounder practice.

46

There’s the old poem I recall from grade school, about the king who is ill. The funny line is about the self-important quack who is supposedly a good physician…

“If they lived, they paid him well,
If they died the heirs paid double.”

The eventual prescription from the poor honest doctor (or was it the other?) was for the king to spend one day in the shirt of a happy man. The gotcha, of course, the king’s people scour the land for a happy man, and when they find one - he’s happy but he doesn’t even own a shirt.

47

John of Ardene was a 14th century physician who had a bunch of reason to his methods.

"Writing when he was 70 years of age, John of Arderne was the first to advocate that surgeons should trust their own clinical experience ‘Wele ymagynyng subtile things’ rather than following the directions of others, even including those advocated by himself. "

A fascinating illustrated manuscript of his teachings has survived from the 1400’s:

48

I’ve heard that the reason why the Chinese traditionally attributed all kinds of healing property to tea was because ancient physicians noticed that their patients did much better if they first boiled their instruments in tea. Now we know that it was because of the boiling water instead of the tea.