Pre-modern doctors (for the sake of argument say prior to 18th century, but could go much later than that if you felt like it) on the whole get have a fairly bad reputation. What with the lack of antibiotics, anesthetic and most importantly any understanding of germ theory and the importance of sterile conditions.
But doctors have been a somewhat successful profession for an awfully long time without any of those things. And there are plenty of historical description of apparently successful treatment and even surgery (warning rather unpleasant surgical description).
So what conditions could pre-modern doctors successfully treat with a reasonable chance of success? Most infections were mainly untreatable until the 20th century. Any remotely invasive surgery would most likely end if fatal infection. What about simple wound treatments? It seems whatever treatment that didn’t involve washing the wound would be counterproductive.
Basic broken bones maybe? Except for the lack of an xray it seems the treatment for those (a splint, bandage or cast) would be the same in any era.
What about surgery itself? If you had an unusually strong immune system and managed to survive the dirty finger poking around in you, for which conditions was there enough correct medical knowledge about for the treatment to do any good?
Seeing how some of our drugs are derived from plants and herbs, A doctor could use those to treat some conditions. They wouldn’t be as effective as an extract, but they’d still have some use. According to Dr. Wikipedia,
I am not a doctor, nor do I play one on TV. But I think the strongest asset of a doctor from any century before the 20th was the ability to hold a patient’s hand, make them feel like somebody cares whether about their health, and give the patient confidence that they would be healed. The human body will heal itself in the vast majority of illnesses. The doctor’s job was to reassure the patient. They could also give some herbal remedies, which mostly work by the placebo effect, which again relies on confidence.
There are examples of trephination being performed in the ancient world, and of patients who lived long past the surgery. I don’t think it’s known whether the procedure was performed for an actual medical reason like a buildup of fluid in the skull, or to “let the demons out.”
Coincidentally, I’ve been reading David Oshinsky’s Bellevue, which talks about 19th century pre-Lister surgery, and the success rate for amputating limbs (without killing the patient) was about 50%, since post-op infection was very common.
Besides which, the lack of effective anesthesia made things dicier even if you survived. Supposedly surgeons at Bellevue had an “informed consent” procedure at the time which involved asking the patient “Will you have the leg off?”. If the patient lost his nerve and said no, he was taken back to the ward. If the patient said yes, they proceeded to saw off the leg as fast as possible, ignoring all protests/screams while holding down the patient till the amputation was finished. :eek:
Small Pox vaccinations were not uncommon in the 18th century. Washington had a good number of his troops inoculated during the American Revolutionary War. (That was a Jeopardy question a few days ago.)
Lewis Thomas talks about this in one of his books of essays, perhaps The Lives of a Cell. His father was a physician around 1900. His primary occupation was making house calls and, as an earlier poster remarked, his job was primarily to provide authoritative moral support to the patient and family. A good doctor was an excellent diagnostician, who could help his patients understand the nature of their illness and the prognosis. He could counsel them on simple remedies, like bed rest and therapeutic heat and cold. There were a variety of medications he might prescribe, but few, if any, provided more than a placebo effect. Thomas mentioned the smallpox vaccine as an extreme outlier, out of place with the other ineffective items in the physician’s arsenal.
Thomas’s books are wonderful. I read several about 40 years ago and the memory of their content has faded, but I clearly remember how much I liked them.
Presumably either the Doc was from 1900BC or your memory really has faded. A Doctor in 1900AD had quite a lot of effective medication and diagnostic techniques. Quinine for pain. Carbolic acids for infection. Aspirin. Radiation therepy for cancer. Plus X Rays
Quinine is an anti-malarial, not a pain medication. (Though they did have Salicylic Acid and Opiates, but you’d need a doctor for neither of them, just a pharmacist.) Aspirin did exist at the time, but was still quite new (as in, Bayer didn’t even think about mass-producing it until 1897.)
Carbolic acid is a disinfectant, like for cleaning surgical instruments, it’s not something you take as a drug to treat infections. (It does have some use as a drug; it’s the active ingredient (in small, dilute, doses) in throat spray.)
X-Rays and Radiation therapy were not widespread, again, they had just started to be used for medical applications at research hospitals. If we make the bold leap that his father wasn’t practicing at a university hospital with access to a physics lab, those techniques would not have been available at all, if he even knew they existed.
I was about to say something exactly like this. There were a limited number of things a doctor could actually help with. There was aspirin and, given anesthetics, a surgeon could remove a sick appendix, but by and large the most they could do was hold your hand and make a prognosis.
And I agree that Lewis Thomas’s book were wonderful.
Though only if they were given to things they could actually treat. Which I am doubtful of. Without some kind of underlying understand of the efficacy of particular plants for particular conditions (which I don’t see any evidence of in most cases) then your chances of actually treating an illness with something that is going to help it is pretty slim.
Yeah this is a really important point. Prior to the invention of penicillin for most infections the best treatment anyone could possibly hope for, even if they were the King of England with best scientific and medical minds on the planet at their beck and call, was “keep the patient warm and well fed, hope they recover”. This is why the rise of antibiotic resistance is a very bad thing and everyone should be more worried about it.
I was thinking about this. I could well believe Cauterization was less effective than washing and bandaging the wound with a sterile bandage. But that wasn’t the alternative in pre-modern times, whatever that alternative was it mean leaving the wound much dirtier than they found it, so I can see Cauterization being the best option.
[McCoy]
My god man, are all people in your time butchers?
[/McCoy] :eek:
A guillotine CHOPS.
No matter how fast, it still chops.
Chopped bone simply crushes and shatters, now you have to cut again up higher past the shattered parts.
Bone joints are not exactly flat with big gaps in them.
Also, how would the surgeon then close the amputation? he didnt get to save any skin and tissue to do it with?
I dont think you can just go about life with your amputation looking like the end of a chicken drumstick, unless you life ends shortly afterwards?
If I, as a modern Family Medicine physician, were transported back a few hundred years in time, I would bring a few useful skills back with me.
Mainly antisepsis in treating wounds. Just washing my hands and washing wounds with soap and water would save lots of lives. Particularly for compound fractures where bone fragments are exposed to open air. And certainly for childbirth.
Incising and draining abscesses would also resolve a lot of infections that would otherwise go on to cause many to sicken further, and often to die.
Using hollow needles to drain fluid accumulations outside the lung or in the abdomen could help in some cases.
If I could get coca leaves, I could make topical anesthetics, enabling me to do more careful and anatomically correct laceration and other injury repairs, which leads to better healing and less disability.
Just promoting better hygiene and boiling water before drinking it in my community would markedly reduce illness and death rates.
I’d also be helpful by not bleeding or purging patients. Or giving them poisons like mercury and other toxic compounds in vain pursuits to cure illnesses.
Promoting the use of condoms for contraception and disease prevention would also help the public health, if it didn’t get me lynched.
Those are the most obvious advantages I’d have in comparison to the practices of other health professionals of the time.
Frankly, I wouldn’t have a lot to offer from a pharmaceutical point of view. Pain control via coca or the tears of the poppy or hemp would be the most likely useful products. Aspirin is a bit of a bitch to extract. As are antibiotics.
Ipecac syrup for the treatment of respiratory congestion. With your superior knowledge, perhaps production of gentian violet and mercurochrome. Treatment of all vitamin deficiency diseases.
And have I missed a mention of bone-setting?. Obstetrics, depending on what is meant by “pre-modern”, obstetric forceps were developed in the 16th century.
It’s kind of funny, given your actual clientele, to think of you as “family practice”.
But isn’t draining abscesses one of the few things which old-time doctors actually could and did do? Though admittedly, they probably didn’t use a sterile needle to do it.
There’s a time-travel series I’ve been reading where the modern folks thrust into the past use chloramphenicol for almost everything, because despite its very serious (though rare) side effects, it’s the only antibiotic they can actually make, and the risks are a heck of a lot better than bubonic plague. Yes, they know that penicillin can be made from mold, but which mold? If you culture a mold and extract it, you’re going to get something, but is it going to be safe and effective penicillin, or something completely different which may not be safe nor effective?