Before the germ theory of disease was widely known, my understanding is that going to a hospital of doctor would, all-in-all, probably cause more harm than good.
How long did it take for this to be widely adopted so that the huge mortality rates in hospitals started falling? Approximately what year could you go into a hospital and reasonably expect to come out again?
BTW, this thread is inspired by the Bramwell series on PBS, with Jemma Redgrave as the title character, bringing rationality to medicine in 1890s England. Was it much earlier than this?
Depends on what you were in for - in general, not just germ theory, but all sorts of practices and procedures were reformed by the 1920’s in the US - somewhat earlier overseas, especially in Germany. Modern medicine did not take place before the old Aristotelian school of thought was replaced by an empirical school of thought - what we call the modern scientific methods. Up to the 20th century, in the US at least, you could in theory go to medical school and never ever see a live patient. For a good overview, you might want to look at the Great Influenza - the author is Barry. It is the story of the great flu epidemic of 1917 - but it reads half like “the final report on the modernization of medical theory, education and practice in United States, 1880 - 1918,” and half like Stephen King’s The Stand.
Depends on where you were, too, and in what ward sometimes - there’s an interesting book called The Doctor’s Plague - it’s about Ignac Semmelweis, who before the invention of germ theory, just from observation, figured out that women got puerpural fever from their doctors and tried to eliminate it by instituting hand washing. The book is really about why it didn’t work (mostly because he was crazy and didn’t want to publish and experiment as was the newer model), but it’s got some interesting stuff on how in the Vienna hospital there were two maternity wards, one with midwives in training and one with doctors in training. The midwives weren’t allowed to do gross anatomy on cadavers, while the medical students would poke around in a woman who had died of massive infection and then go right upstairs and stick their hands up inside a woman in labor, no hand washing in between. The casualty rates for the midwife ward were far lower than for the other one.
In other words, there were a lot of variables, and everybody ran their hospital as they saw fit - when Semmelweis was in charge, the rate of puerperal fever dropped dramatically, but then when he wasn’t it went right back up. Everybody had their own theories and worked with their own methods in conjunction with contemporary scholarship, and it really depended on what was wrong with you, where you went, even what ward you got put in.
Zsofia, I’ve heard about that Semmelweis guy before - or did they include a scene like this in that Louis Pasteur movie from the 30s? Anyway, when was he around? Were there others like him?
I don’t recall which book it was, but several years ago I recall reading a book that stated that it wasn’t until (about) 1920 that it was even odds (50%) that a doctor would help or harm you. That statement has always stayed with me, because at the time, I was astounded that you stood a statistically better chance of improving by avoiding the doctor.
Back then a doctor and a surgeon were two completely different things. Before general anesthesia the only thing a surgeon did was amputations. So they were looked down upon by ‘real’ doctors as being sort of ‘tradesmen’ while they were more aristocratic.
The book is packed away at the moment, but I think I remember the main action being in the 1840’s or so. Other people in other hospitals were trying similar things, some because they heard about what Semmelweis was doing in Vienna, some because they were doing the right thing based on the wrong theory, some by coming up with a similar idea at the same time. Obviously everybody was trying to help their patients, but before germ theory and its wide acceptance, success was hit or miss - the miasma theory was still popular, for example, and while you might come up with some things that are helpful from a wrong theory (getting rid of the open sewers, for example), health is such a complex system that it’s hard to figure out what works and why when you don’t know what we know and you don’t have the scientific system set up to find out what we know.
Also, then as now politics in hospitals and universities played a big part - one of the sad things about the Semmelweis story is how much he got done under a friendly administration and how he didn’t have the temperment to be effective in an unfriendly one. (He may have had early onset Alzheimers or something similar that made him such a pain in the ass to deal with - he alienated his friends as well as his enemies and was an awful communicator.) The point of the Semmelweis book wasn’t so much that here’s this guy who did this amazing thing, it was more here’s this guy who was doing amazing things like a lot people who if they’d just lived thirty years later would have made amazing breakthroughs, but here’s why you’ve never heard of him. Fascinating and sad - he died in an asylum, fairly young.
Yeah, this is exactly the sort of info I am looking for. Boy, I’d love to know that cite! Was it some sort of medical history book?
I find it tough to believe, though; I would think they were doing pretty well with sanitary conditions by World War I, no? Weren’t they scrubbing up, using clean bandages, needles, etc., by then? I know they weren’t in the Civil War; what about the Spanish-American War, or any other wars that you’d care to mention?
Could the 50% be related somehow to infections that they couldn’t cure, because they didn’t have antibiotics yet? I’m a little more interested in whether what the doctor’s treatment was (meaning, whether he had a clue how to treat you) would kill you, although I am still interested in whether just being in the hospital will kill you due to your getting an infection from someone else.
A while back, I attended a “class,” essentially a sales pitch, for disinfectants. The pitchman claimed that the number 3 cause of death in hospitals was infections that the patient got after entering the hospital. IIRC, he called them “nosocomial” infections. If this is true, we’re not really out of the woods yet.
All this strikes me as a little unfair to pre-modern medicine. I don’t doubt that mortality in hospitals was as bad as advertised, but you didn’t go to a hospital unless you were awfully sick to begin with. For lesser ailments, doctors made house calls, and they were sometimes effective. Even in medieval times, after all, a doctor (or, per Hail Ants, a “surgeon”) could bandage or cauterize a wound, set a broken bone, remove a cataract or a bladder stone or a diseased tooth, or administer a pain reliever or a laxative or a purgative. Hospitals were pretty much worthless, but in other venues a doctor probably wouldn’t kill you, and might actually make you better.
I would want to point out that historically, and for a long time, hospitals weren’t anything like we know now. They were shelters for the ill, but also for the beggars, for the old, for the demented.
Except for surgery, and even then, not so until a late period, a reasonnably well off person wouldn’t ever set a foot in a hospital. They would receive care at home, even for the most serious conditions. Only the poors would go to the hospital.
I somehow doubt doctors were that awful until the 1920’s. In any case, for a significant number of conditions, like those mentionned by ** Freddy **, they could only help you, the alternative being dying, going blind, etc…
Also, historically, and generally speaking, the surgeons were much more helpful than the doctors. They, at least, always have known something actually useful and could sometimes save your life or improve your condition.
While I’m not sure of the exact portion, I have heard something similar. There’s just so much sickness (and so many new vectors like needless) in hospitals that new infections are irritatingly common, and all of our best procedures simply can’t get rid of them all. It a matter of having way too many germs to be able to stop them.
Just to emphasize, as per EvilAsh’s post, before 1920 the estimate was that the doctor could not help 50%, which is not the same as making it worse. This estimate was from the Harvard medical historian.
Another sentence in the same reference did say the chance of harm was greater than not, but it was less sharply defined.
A fascinating book on medical history, with some emphasis on the treatment of women and childbearing (sadly I can’t remember either author or title*), went into this in some detail. He made the point that women in childbirth in primitive conditions had better outcomes than women in Europe, and American cities, up until quite recent times. He specified why.
I’d like a related question. Our ‘medical history’ normally refers to European history, where for generations they used blood-letting, for instance, and mercury-containing medicines, etc. I wonder what the statistics were for, say, Japanese medieval practices? Were they better than European ones?
Actually, it may be that you might find a lot of societies in every continent each had one or more specific traditional methods that worked better for a given medical condition than the European practice for the same condition. You would expect proper science to improve practices however. So, once science was getting results, presumable cultures in the scientific tradition would get better medicine.
Back to the OP, it sounds as if you could be better off in the Crimean War with Florence Nightingale in charge than you would be in half the hospitals around 1900.
*I’ll post it if I find it