What would a modern day physician be able to do in a medievel society?

Factual Questions
21

[QUOTE=ExTank]
True, and more is the pity when you think about the state of Islam today.
[/QUOTE]

It’s about the 1300s or so by the Islamic calendar. They seem to be in their own Dark Ages. Maybe there’s some sort of cosmic rule that societies have a Dark Age period about that time.

My old Environmental Health professor maintained that cleaning up the water supply would all by itself eliminate most disease in the Third World. Teaching personal hygiene and getting rid of the rats would do a lot. Unfortunately, getting people to listen to him before he was burned at the stake by the Catholic Church would be no mean trick.

22

You might do better going back to the first century AD and establishing a religion with basic sanitation as part of its dogma. Think Missionaria Protectiva meets Red Cross. It would superficially fit right in with the restrictions and rituals observed by Jews (and any time-travelling Muslims stopping by) but it would be based on science and rational thought.

23

[QUOTE=alphaboi867]
(bolding mine)

Would a female physician even be able to get people to listen to her in the first place? Did female physicians (as opposed to midwifes and local wise women) even exist in Europe during the Middle Ages?
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Probably not. I guess that’s a good point. I guess I’m more intersted just in what would be technically and theoretically possible than social plausibilities.
If anyone is curious, my question is based on a story idea I have which doesn’t actually have anything to do with time travel but with a precocious, medievel scientist.

24

[QUOTE=Diogenes the Cynic]
If anyone is curious, my question is based on a story idea I have which doesn’t actually have anything to do with time travel but with a precocious, medievel scientist.
[/QUOTE]

As in The Name of the Rose, by Umberto Eco?

25

Being aware of the hazards of eating rotting grain (ergot poisoning) would also help.

Don’t discount personal hygiene. Your best defense even today is proper handwashing and an intact skin.

What about trepanning or was that mentioned?

I think other successes would come from not practicing quackery as mentioned. But I also think that some herbal treatments would do some good–if only to relieve symptoms. St John’s wort for melancholia, lavendar to aid sleep, sage tea for mouth sores, fennel and peppermint for nausea and indigestion (gas) etc. Doesn’t comfrey do something as well. By herbal, I do not mean homeopathic stuff–but since I’m not a wise woman, I have no idea how to make an infusion, a draught, an elixir or a plaster…

The MDs here may disagree with me, but IMO a lot of OB skills have been lost with the rise in Csection rates. My father, an MD, was taught in the 1950s how to turn a baby in utero to improve the presentation etc. He says that’s no longer taught-don’t know if he is correct (although he does now teach residents neonatal Pathology…) Anyway, stuff like that would be helpful.

Other than that, clean drinking water, basic sanitation, and crop rotation would help immensely.

26

Would any kind of makeshift anesthesia be possible for simple surgeries?

27

[QUOTE=Siam Sam]
As in The Name of the Rose, by Umberto Eco?
[/QUOTE]

Actually, that was an inspiration, yes. I’m trying to take it a step further in an alternate universe setting, though. Think George A. A. Martin without any supernatural elements.

28

[QUOTE=Diogenes the Cynic]
Probably not. I guess that’s a good point. I guess I’m more intersted just in what would be technically and theoretically possible than social plausibilities.
If anyone is curious, my question is based on a story idea I have which doesn’t actually have anything to do with time travel but with a precocious, medievel scientist.
[/QUOTE]

If you are planning to write such a story, I suggest you investigate herbal remedies to some extent. IMO, a modern MD would perhaps be better at using such things more effectively. Perhaps he could meet a wise woman and between the two of them provide fairly decent care to the villeins?

Oh, and don’t discount the influence of the Church or other body that governs social mores strictly. The inability of medical men to perform autopsies held anatomy back for centuries.

29

[QUOTE=Diogenes the Cynic]
Actually, that was an inspiration, yes. I’m trying to take it a step further in an alternate universe setting, though. Think George A. A. Martin without any supernatural elements.
[/QUOTE]

That was a fantastic book. I would love to read more stories like that.

30

[QUOTE=eleanorigby]
Perhaps he could meet a wise woman and between the two of them provide fairly decent care to the villeins?
[/QUOTE]

And would any of the villeins be villains?

31

[QUOTE=Siam Sam]
And would any of the villeins be villains?
[/QUOTE]

Yes, and the wise woman and MD would have a love interest develop…he would use his superior tech knowledge to devise a functional condom. Oh, and he can “re-invent” the obstetric forceps as well!

If** DtC** doesn’t write this, I will… :slight_smile:

32

All of these answers are very helpful, by the way. I appreciate all them. Thanks especially to QtM. I was hoping he’d have some thoughts. I’d like to hear from Dr. J. too if he happens to wander in here.

I suspected that the possibilities would mostly have to do with preventative care, sanitation, hygene and nutrition. I’m really hoping to find out what kind of drugs could be rendered from raw materials, but it doesn’t sound like it would be all that much.

33

George R. R. Martin.

34

[QUOTE=Qadgop the Mercotan]
That’s a toughie. Lacking pharmaceuticals it would be tough.

Applying the principles of cleanliness, lancing abscesses, and using appropriate antiseptics like distilled alcohol would probably save some lives. That and doing a decent job of splinting bones would help make some difference.

Also not bloodletting would be a big step up from the standard practices then.

But otherwise besides using opium for pain relief, foxglove for heart failure, and willow bark for fever, we wouldn’t be able to add a lot. At least I wouldn’t be able to. Not without thinking about it a lot more!
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Just trying to be clean and using alcohol as an antiseptic would save a LOT of lives.

You could probably also develop a rudimentary smallpox vaccine, using someone who had cowpax. You know how Jenner did it, so you can do it.

35

[QUOTE=Stranger On A Train]
It’s true that modern sanitation and water treatment plays a very significant role in controlling the spread of disease-carrying organisms, but this is the result massive public works projects and modern, large scale, civic-funded programs. A physician dropped into the Dark Ages of Europe just isn’t going to have the wherewithal to effect public works on this scale (even though they had been done centuries before in China, Rome, and Constantinople).
[/quote]
My intent wasn’t to say that a physicaian along with a sanitation and a water system engineer could do wonders in a medieval setting. Rather I was just pointing out that disease prevention by modern sanitation and water systems is possibly more important public heath factor than curing diseases after they occur.

Don’t underestimate Semmelweiss’ accomplishment. Through observation and experiment he worked out the idea that contact with a patient resulted in something on the physicians hands that resulted in transferring infection from patient to patient. Unhappily, the medical establishment of the time was still in the dark ages with no regard for the scientific method and antisepsis and the germ theory had to wait another 40 years.

36

Although it wouldn’t affect mortality too much, you could at least make a fair number of people feel better by performing drainage of pleural fluid (i.e.thoracentesis). It’s a pretty easy thing to do and you’re unlikely to kill (too many) people with it. You might even save a life from time to time. Indeed, way back then, fatal pneumothoraxes (more correctly: pneumothoraces) might have been a fairly common occurrence after fights and battles. By simply putting a pin or needle into the affected side, you can take someone from the brink of death to pink healthiness in a matter of seconds.

As Qad noted, heart disease would be pretty rare. That’s true, but only in a sense. Heart disease as we know it would be rare (i.e. coronary disease and heart attacks). Rheumatic fever, though, would be common and so would its sequalae of heart valve damage. In many patients with damaged heart valves, the key to treatment is simply removing fluid from their circulation. So, this would be one instance where you’d encourage blood letting! Less dramatically, but another way to remove fluid from the circulation is with a diuretic. As a 13th or 14 th century doc, I’d bet you could concoct a mercury containing diuretic. There’d certainly be no problem getting mercury and the “medicine” is the elemental mercury itself (albeit in some form of compund).

37

[QUOTE=KarlGauss]
Although it wouldn’t affect mortality too much, you could at least make a fair number of people feel better by performing drainage of pleural fluid (i.e.thoracentesis). It’s a pretty easy thing to do and you’re unlikely to kill (too many) people with it. You might even save a life from time to time. Indeed, way back then, fatal pneumothoraxes (more correctly: pneumothoraces) might have been a fairly common occurrence after fights and battles. By simply putting a pin or needle into the affected side, you can take someone from the brink of death to pink healthiness in a matter of seconds.

As Qad noted, heart disease would be pretty rare. That’s true, but only in a sense. Heart disease as we know it would be rare (i.e. coronary disease and heart attacks). Rheumatic fever, though, would be common and so would its sequalae of heart valve damage. In many patients with damaged heart valves, the key to treatment is simply removing fluid from their circulation. So, this would be one instance where you’d encourage blood letting! Less dramatically, but another way to remove fluid from the circulation is with a diuretic. As a 13th or 14 th century doc, I’d bet you could concoct a mercury containing diuretic. There’d certainly be no problem getting mercury and the “medicine” is the elemental mercury itself (albeit in some form of compund).
[/QUOTE]
I neglected to mention that diagnosing any of the above conditions is usually quite easy to do just using your hands and ears. I won’t go into the details here, but through various combinations of feeling the character of the pulse, appreciating the sound produced by tapping on the chest (percussion) and improvising a stethoscope by listening through any rolled tube, no doc should have any trouble in detecting these maladies.

38

[QUOTE=KarlGauss]
Although it wouldn’t affect mortality too much, you could at least make a fair number of people feel better by performing drainage of pleural fluid (i.e.thoracentesis). It’s a pretty easy thing to do and you’re unlikely to kill (too many) people with it. You might even save a life from time to time. Indeed, way back then, fatal pneumothoraxes (more correctly: pneumothoraces) might have been a fairly common occurrence after fights and battles. By simply putting a pin or needle into the affected side, you can take someone from the brink of death to pink healthiness in a matter of seconds.
[/QUOTE]

:confused: Isn’t the pleural space a negative pressure dependent area? Without being able to apply suction wouldn’t you be turning alot of them into a hemopneumothorax except in instances where is has progressed to (forgive me if I mess this bit of terminology up) medastinal shift type scenarios?

I have seen more than a few chest tube insertions and suction was always part of the plan, is this more for speed of reinflation or isolation of the pleural space from outside air.

Then again as I am typing this I am coming up with ways to apply suction that would be available to such levels of technology…

Damn we need to warm up the time machine for a test…anyone got a good battle in mind?

39

Another factor for the OP’s time travelling doc would be if he brought along any good reference books. Any med or pharm school textbook would be worth its weight in rare spices from far Cathay.

While the plot has quite a different setup, you should peruse a book or two of the series that starts with “1632”. The books have a lot of fluff, but there’s a lot of research behind them. If I recall correctly, they decided the only antibiotic they could reliably create in the early modern period was something called chloramphenicol. I’m not sure, but I think it would also be possible in the medieval period.

Baen Books has a section of their website devoted to a discussion of various research topics related to the 1632 universe. You can probably find some good articles over there.

40

[QUOTE=Qadgop the Mercotan]
I already mentioned cleanliness, (which to me meant public health, I should have elaborated), proper abscess (wound) care, and better orthotics.

The cowpox thing is a good idea.

But even with a pharmacologist in tow, it would be tough.

Doubtless some herbs with antibiotic properties could be found.

The thing to remember is that the modern medical community really does stand on the shoulders of giants. All that technology, all that learning, all the recorded data really underpins our modern efforts.

And a lot of the diseases I’m trained to fight were not prevalent back then. Diabetes? Very rare. Heart disease? Forget it. Most diseases were due to poor nutrition and infection.

Again, just basic hygiene and public health efforts could be what makes the biggest difference.
[/QUOTE]

Right, mostly cleanliness and the germ theory. He’d also possibly know which herbs have real medicinal uses.

Semmelweis ( as David Simmons mentioned) reduced mortality in operations by a huge amount by hand-washing. Bring in boiling medical instruments and clean bandages, and you’d have a vast advantage over other Medical practioners of the time. Add in opiates for pain-killing during operations, and you’d be even further ahead.

Then you add in what Chief Pedant sez about not doing the silly and dangerous crap most “doctors”: of that time, did, which killed many patients.

But although some herbs now have lent themselves to modern cures, some are nigh useless in the herbal form. Sure, Willow bark contains salicin, but salicin is dangerous as is, and the cure might be worse that what you’re treating.
wiki:*Salicylic acid

The Greek physician Hippocrates wrote in the 5th century BC about a bitter powder extracted from willow bark that could ease aches and pains and reduce fevers. This remedy was also mentioned in texts from ancient Sumer, Lebanon, and Assyria. The Cherokee and other Native Americans used an infusion of the bark for fever and other medicinal purposes for centuries.[4] The medicinal part of the plant is the inner bark and was used as a pain reliever for a variety of ailments. The Reverend Edward (Edmund) Stone, a vicar from Chipping Norton, Oxfordshire, England, noted in 1763 that the bark of the willow was effective in reducing a fever.[5]

The active extract of the bark, called salicin, after the Latin name for the white willow (Salix alba), was isolated in crystalline form in 1828 by Henri Leroux, a French pharmacist, and Raffaele Piria, an Italian chemist. Piria was able to convert the substance into a sugar and a second component, which on oxidation becomes salicylic acid.

Salicylic acid was also isolated from the herb meadowsweet (Filipendula ulmaria, formerly classified as Spiraea ulmaria) by German researchers in 1839. While their extract was somewhat effective, it also caused digestive problems such as gastric irritation, bleeding, diarrhea, and even death when consumed in high doses.*

Comfrey has no safe internal uses. wiki “.*..comfrey did indeed have a wealth of medicinal uses in bygone days. Contemporary herbalists view comfrey as an ambivalent and controversial herb that may offer therapeutic benefits but at the potential risk of liver toxicity.”
*

Diane Gabaldon has a series of Romance/Fiction/Fantasy novels where her Heroine is a nurse that travels back to 16th century Scotland. She uses her WWI “Modern” medical knowledgein the novels. Too “romancy” or me, but well-written.

In Household Gods a modern woman is transported back to 2nd century Rome. She has a little modern medical knowledge, although she is a lawyer. Interesting book, but the Protagonist is a whiney self-absorbed bitch. Good historical background, however.

Of course there is L. Sprague de Camp’s classic *Lest Darkness Fall *, but I can’t remember the hero there using much modern medical knowledge.