How useful was pre-1935 medicine?

[Raphael]

As I've already mentioned over in the Venting Thread, I'm currently reading Ben Goldacre's book Bad Science, a very nice book about mostly medical pseudoscience.

Thing is, at one point, he writes the following about the history of medicine:

Before 1935 doctors were basically useless. We had morphine for pain relief—a drug with superficial charm, at least—and we could do operations fairly cleanly, although with huge doses of anaesthetics, because we hadn’t yet sorted out well-targeted muscle-relaxant drugs. Then suddenly, between about 1935 and 1975, science poured out an almost constant stream of miracle cures. If you got TB in the 1920s, you died, pale and emaciated, in the style of a romantic poet. If you got TB in the 1970s, then in all likelihood you would live to a ripe old age. You might have to take rifampicin and isoniazid for months on end, and they’re not nice drugs, and the side-effects will make your eyeballs and wee go pink, but if all goes well you will live to see inventions unimaginable in your childhood.

It wasn’t just the drugs. Everything we associate with modern medicine happened in that time, and it was a barrage of miracles: kidney dialysis machines allowed people to live on despite losing two vital organs. Transplants brought people back from a death sentence. CT scanners could give three-dimensional images of the inside of a living person. Heart surgery rocketed forward. Almost every drug you’ve ever heard of was invented.

And I'm not sure what to make of that. It doesn't feel quite right to me. He himself acknowledges that there was already a lot of surgery before 1935. Aside from that, the 19th century had seen the germ theory of disease, which provided the theoretical foundation for many advances in hygiene and the prevention of illness - though, of course, a lot of the actual work related to that was done by civil engineers, construction workers, and plumbers, rather than doctors. Still, it looks to me like the revolution in the 1935-1975 period that he talks about was only possible because of the improved understanding of the human body achieved in the 200-400 years before 1935.

Perhaps what he means is the specific question of what your GP, personally, could do for you if you arrived at their place already ill?

[zompist]

I think your book is mostly correct, with caveats. It fits, for instance, with James Herriot's memoirs of being a veterinarian: pretty much all the medicine he learned in school was wrong, and was replaced with actually effective antibiotics in the 1930s.

Goldacre admits surgery as an exception, and it's a really big exception. Premodern surgeons could do surprisingly well, though I'm not sure I trust Wikipedia's blithe assurance that Arab medicine included effective general anesthesia. (Their own account says that the procedure was introduced to Europe, but apparently wasn't used in the 1800s when opiates, nitrous oxide, and then ether were used.)

You mention the germ theory of disease, but recall that Ignaz Semmelweis was roundly mocked for telling doctors to wash their hands, up till his death in 1865. Under such conditions, visiting a doctor could as likely kill you as cure you. Only in the 1870s were his ideas accepted, and that's only half a century before the period Goldacre is describing.

The first vaccine was developed in 1796. Prevention of scurvy was established by 1799— but then lost.

Elsewhere I've cited Bernard Lewis's descriptions of European vs. Muslim physicians given two patients during the Crusades: the Muslim physicians administered things like poultices and bed rest; the Europeans thought that was crazy and tried brutal methods which immediately killed both patients. Less praiseworthy: all over Eurasia physicans believed that antimony was an effective medicine, and as contemporary methods could not separate it from arsenic, undoubtedly killed many of their patients.

Where Goldacre is perhaps wrong is in how much of a doctor's practice consists of curing disease. There's a lot of minor interventions, assisting births, mitigation of problems that couldn't be solved completely, counseling and handholding. Goldacre mentions TB, which immediately brings Thomas Mann's The Magic Mountain (1924) to mind. The patients at the sanatorium were not cured, but it seems the doctors were able to prolong their lives significantly.

[Raphael]

Thank you, interesting! Since you bring up Semmelweis, I'd like to note that he apparently wasn't a germ theory pioneer; he seems to have believed that handwashing worked by removing toxic substances of some kind.

[Rounin Ryuuji]

I remember reading about him once. I had to look it up, but he apparently believed it to be cadaverous material, which isn't too terribly far off, though I do wonder that not many people thought, in all the time since microorganisms were discovered, that they might be a cause of disease.

[doctor shark]

A cut-off of 1935 is strange: penicillin was first used in 1930; arsphenamine/Salvarsan, the first synthetic antimicrobial used to treat syphilis, was introduced around 1910; and tetanus vaccination dates back to 1924 and pertussis to 1926. There was even a plague vaccine as early as 1897!

[hwhatting]

A cut-off of 1935 is strange: penicillin was first used in 1930; arsphenamine/Salvarsan, the first synthetic antimicrobial used to treat syphilis, was introduced around 1910; and tetanus vaccination dates back to 1924 and pertussis to 1926. There was even a plague vaccine as early as 1897!

Perhaps Goldacre figures in the time it took for the new methods to spread and about 1935 modern methods came to be used widely, instead of only by a couple of pioneers? Just guessing, I don't know much about the history of medicine.

[dhok]

David Wootton's Bad Medicine is a very good read on this question and argues that the delay in medical modernity, compared to technological modernity, was basically a fluke--the only real prerequisite for Pasteur was Leeuwenhoek, but a gap of two centuries separates them.

Note, however, that it would be a mistake to think that there was no empirical investigation going on in medicine at the time. The miasma theory is a good example: an 18th-century British inventor invented what he called a 'respirator' (basically a gigantic pair of bellows) to pump fresh air into the lower decks of navy ships to try and dilute or flush out the miasma causing diseases among sailors. It actually worked quite well, for the time, and cut deaths from ship's fever by a considerable margin, which led credence to the miasma theory. Looking back, it seems likely that what the respirator was really doing was getting oxygen into horrifically stuffy quarters and flushing out CO₂, which made it easier for sailors to fight off the disease (since they weren't also slowly suffocating to death).

Then there's the question of what "medicine" even means, here, since the vast, vast majority of the increase in life expectancy since the 19th century is a consequence of upgrades in the material environment like sewage systems, clean water and carbolic soap. I suspect that in a century we're going to look back on the building ventilation of the late 20th century as akin to getting your drinking water from the river, given what we now know about how much good ventilation cuts COVID spread. (Improvements in building construction, ventilation and quality in the late 19th and early 20th centuries, I'd hazard a guess, probably cut TB transmission and death rates considerably even before a cure for it was found.)

[Ashtagon]

Oh fine, make fun of me.

[rotting bones]

I remember reading about him once. I had to look it up, but he apparently believed it to be cadaverous material, which isn't too terribly far off, though I do wonder that not many people thought, in all the time since microorganisms were discovered, that they might be a cause of disease.

Although I haven't read old biologists myself, in science, it's almost impossible to draw inferences from isolated facts.

Scientific theories are systems indicating that entire classes of inference are legitimate, and this system of inference is evaluated as a whole on the basis of experimental evidence. Suppose you were to throw a rock at a wall. What happens? It depends, right? What's the mass of the rock? Velocity? Shape? What about the wall's malleability, brittleness, friction?

Similarly, even if an organism is beset by millions of tiny critters, who the hell knows whether they can have a significant impact. There are trillions of bacteria even in a healthy organism. In fact, the number of bacteria is comparable to the number of cells that belong to the organism: https://www.nature.com/articles/nature.2016.19136

[hwhatting]

The delay in medical science can be blamed on the sacking of the great library at Alexandria, which destroyed much research from antiquity,

Oh no, not that old canard again. This guy has a good debunking of that specific myth. Very short version - there were many more libraries than Alexandria; books simply deteriorate; there was a format change (scrolls to codices) - what we lost from antiquity has mostly to do with what medieval scribes (Christian and Muslim alike) found worth copying and what not.

[Moose-tache]

A much bigger challenge took place when a group of Basque monks sailed away with the ancient records of how to read an FMRI scan.

[Raphael]

A much bigger challenge took place when a group of Basque monks sailed away with the ancient records of how to read an FMRI scan.

Someone should make that movie.

[fusijui]

A much bigger challenge took place when a group of Basque monks sailed away with the ancient records of how to read an FMRI scan.

Someone should make that movie.

We have far, far too many time travel-conspiracy-espio-fantasy properties & franchises competing for our eyes and cash already, thank you!

[MacAnDàil]

The delay in medical science can be blamed on the sacking of the great library at Alexandria, which destroyed much research from antiquity,

Oh no, not that old canard again. This guy has a good debunking of that specific myth. Very short version - there were many more libraries than Alexandria; books simply deteriorate; there was a format change (scrolls to codices) - what we lost from antiquity has mostly to do with what medieval scribes (Christian and Muslim alike) found worth copying and what not.

Did some of those things involve local cultures having cures that seemed too pagany?

[hwhatting]

Did some of those things involve local cultures having cures that seemed too pagany?

I have no idea, never having looked into that matter closely. But seeing that medical writers like Galen were copied and taught, I don't think that Christian or Muslim copists had a problem with pre-Christian / Muslim medicine in principle; I guess a bigger issue may have been oral folk traditions that were bound up with pagan beliefs or what the monotheist religions held to be superstitions. But it's a question of how much of that had actually been written down in the first place.

[MacAnDàil]

It's true that Gauls weren't much into writing things down as far as I can tell.

[Moose-tache]

Call me a filthy modernist, but I feel that the idea of effective "folk medicine" is disproven by the fact that modern science hasn't replicated it. I mean, some of it has; we figured out very early that willow bark decoctions ease pain. But I'm very confident that if the Gauls knew about a flower that could cure infection just by shoving it into a wound like in fantasy novels, AstraZeneca would have patented that shit fifty years ago. Lots of medicinal knowledge has been lost, but nothing that we would miss.

[Mornche Geddick]

Well, I suppose if the plant species died out, maybe through over-cropping. That's what actually happened to the medicinal leech species in some areas.

[hwhatting]

It's true that Gauls weren't much into writing things down as far as I can tell.

Well, we actually have a considerable number of Gaulish inscriptions, but none of them seem to be medical treatises.

[Raphael]

Well, we actually have a considerable number of Gaulish inscriptions, but none of them seem to be medical treatises.

I can't really read French - what writing system(s) were they using?