What was medical school like in the 1700's?

[TexasTriathlete]

---

Members do not see this ad.

Anyone know anything about the history of medical education? I'm curious as to how people were educated to be physicians a few hundred years ago.
In the 1800's, everything came to a head. Medical education was so ****ty, for the most part, that everyone was starting their own branch of medicine, and breaking away from the traditional pathway to becoming a physician. People were operating medical schools out of their basements and ****.

Naturopaths, osteopaths (much different from the DO's of today), chiropractors, and all kinds of other weird **** started popping up, and the sad thing is that most of these guys were no better or worse than your average MD. Only the doctors trained at the very best institutions could really be counted on to know what the hell they were doing. Then, in the early/mid 1900's, the Flexner report came out and caused everybody to either fall in line or go away quietly. Since then, everything has gotten better. The MD's and DO's are doing the heavy-lifting, chiropractors give badass massages and manual therapy, and naturopaths and the like are probably still quacks.

But what were the common practices before the 1800's, when people started to question if physicians were being trained adequately?

I am assuming that most medical education was carried out by the church? But they were doing **** like bleeding and all kinds of nonsense. How did they learn this?

Obviously, they didn't spend 2 years in a classroom learning about electrochemical gradients and PLP transaminations. They also probably didn't spend two years rotating at affiliated hospitals and learning how to treat patients. What was the structure of medical education? Was it standardized at all, or would there be two schools teaching medicine entirely differently.

What if some kid in 1750 wanted to go into medicine? How would he go about this?

 

[Asp]

All medicine was quackery up until about the 20th century, when seeing a doctor became (marginally) more likely to cause good rather than harm.

 

[Asp]

Even today, it is fairly established that AT LEAST half of medical care has no impact on health. So my question is, what should medical education be like in 2100 such that most medicine practiced has positive utility?

 

[RySerr21]

All medicine was quackery up until about the 20th century, when seeing a doctor became (marginally) more likely to cause good rather than harm.

agreed. i took history of medicine last semester. it was pretty insane the stuff they believed. they really had no idea what they were doing and knew nothing about the body. it wasnt til the mid 1500s that someone actually started to care about what was actually in the human body. thats when vesalius came out with his drawings and his dissections. he kind of overthrough the church and the way they were teaching medicine. even though he had a lot of followers and people started to realize that what they were doing was pointless, no one really listend til a few hundred years later. at that point they were still blood letting, talking about humors, etc.

its not til the 19th century that you are start to see great progress into what is now modern medicine. that is when you see the invention of things like the stethoscope, inoculation, vaccination, germ theory, asepsis and anesthesia allowed surgery to become safe...the sad part is that they were doing surgery all the time before asepsis and anesthesia and everyone was dying.

im glad im livin in the 21st century

 

[Crixivan]

The Hippocratic Oath distinguishes physicians from surgeons, and I think that some countries still train them separately, so I suppose surgery could be considered a separate field that got merged into medicine.

In the traditional sense, medical education has chiefly been a mentor/apprentice sort of thing.

http://en.wikipedia.org/wiki/History_of_medicine

Today, medical care is basically defined by insurance companies. If there is a code you can bill for, it's a medical condition.

 

[xrevision]

Can't say that I knew what it was like in the 1700's but this topic reminded me of a painting I went over in History of western art:

Eakins, The Gross Clinic 1875

http://www.artchive.com/artchive/e/eakins/gross_clinic.jpg

 

[Bacchus]

From my POV a lot of the medicine of today stemmed from the military. At times of need we "delivered". Wrote a paper about 5 years ago (11th grade) on military medicine.

 

[neuroprotector]

The Hippocratic Oath distinguishes physicians from surgeons, and I think that some countries still train them separately, so I suppose surgery could be considered a separate field that got merged into medicine.

In the traditional sense, medical education has chiefly been a mentor/apprentice sort of thing.

http://en.wikipedia.org/wiki/History_of_medicine

Today, medical care is basically defined by insurance companies. If there is a code you can bill for, it's a medical condition.

That's absolutely true. Surgeons used to practice along with barbers, and were regarded as quite a bit lower than physicians. In England, at least, they're proud of their heritage, and still insist on being called "Mr." or "Ms." rather than "Dr."

 

[kronickm]

I am fairly sure that medicine in the olden days was sort of master/apprentice type stuff. There was no formal medical education. It was also often restricted to families.

I did find this if you want to read.

http://www.blackwell-synergy.com/doi/pdf/10.1111/j.1365-2929.2006.02393.x?cookieSet=1

 

[Crixivan]

I am fairly sure that medicine in the olden days was sort of master/apprentice type stuff. There was no formal medical education. It was also often restricted to families.

Ditto on that being referenced in the Hippocratic Oath as well...

"To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else."

Of course, it also says something about not having heterosexual or homosexual relations with the slaves of your patients. Maybe that was a problem in the time of Hippocrates. It amazes me how much people regard the oath in such high esteem even though we really only uphold one or two of the sentences in it. Bring back free medical tuition!

 

[mc4435]

Ditto on that being referenced in the Hippocratic Oath as well...

"and if he is in need of money to give him a share of mine"

LOL

 

[DrZaius]

Even today, it is fairly established that AT LEAST half of medical care has no impact on health.

And probably >90% of the care that DOES have impact is surgery

 

[inaminute]

the internet was slower and girls minded the home and children so the mens could be Marcus Welby, MD

next question

 

[dideoxy]

And probably >90% of the care that DOES have impact is surgery

I'd think that vaccination and antibiotics have had the single greatest impact on peoples' health. Without them, even most surgeries would be futile given the festering boils that would inevitably result from the procedures.

 

[MossPoh]

If you want to read a fairly interesting book involving medical history, try "Knife man" it is about John Hunter. Hunter is considered by many to be the founder of "modern" medicine. Before him, anatomy was never reallly considered. Surgeons/dentists were generally barbers (and remained to be so to some degree) while the traditional sense of a physician was the voodoo we associate with today. In the mid 1700s there was EXTREME competition to get medical students at these somewhat fly by night medical schools. The major attraction tended to be the ability to dissect, which while frowned upon by the church, was starting to rise in importance. Legal means of getting bodies led to maybe 2 or 3 per year...if they were lucky. In today's world of preservatives that isn't much of an issue, but keep in mind they didn't really have those. Dissections were conducted during the winter and frigid rooms to keep the body from rotting too fast. John Hunter never attended a formal medical school at first I believe, he left his farm home to work with his brother in the big city of london. (He was a scot). His brother essentially charged him with getting bodies and preparing examples. He did hundreds of dissections over time (in a poorly lit basement) and developed quite the surgical ability. He then got some formal training as well as served a stent in the arm, which fine tuned those abilities. He is quite the character compared to many of the people. He was a short stout little guy that was used to farm labor. He drank like a true scotsman, and cussed like a real sailor. He fit in perfectly with the crowd of body snatchers he worked with. One of his major projects was to map out the lymphatic system, which he later got in a fight with some french guy about. He also had an interest in mapping out the stages of development with a human fetus. (Leaving the homunculus days)

Now, the formal "medical schools" tended to deviate little from the greek texts they had for a thousand years. They thought about problems, but rarely ever did experiments to see if it were correct. Rarely questioned what they were learning. As such, they killed lots of people later on. I consider those barbers extracting teeth and doing surgeries the first true doctors, even if surgeons were considered second class citizens compared to their doctor counterparts.

 

[ChePibe]

Lots of tasting, smelling, and what could be considered withcraftery nowadays.
Now that I think about it... it IS a lot like today's medicine.😱

 

[Timmythemic22]

Even today, it is fairly established that AT LEAST half of medical care has no impact on health.

Care to back that up with a reference?

 

[MossPoh]

Lots of tasting, smelling, and what could be considered withcraftery nowadays.
Now that I think about it... it IS a lot like today's medicine.😱

Tasting is my favorite. Hey, it makes sense for things like diabetes though. Not much they could do later on.

 

[Begaster]

It was a lot like Stewart University, the #1 medical school in America.

 

[Asp]

Care to back that up with a reference?

Of course. See the massive, seminal RAND Health Insurance Study

http://www.rand.org/pubs/reports/2006/R3055.pdf

and see economist Robin Hanson's blog post at

http://www.overcomingbias.com/2007/05/rand_health_ins.html

for the correct interpretation of this study.

I warn you: the links I gave could change your view of medicine drastically! It did for me.

 

[Asp]

Oh, just to clarify, I don't claim that the RAND study proves that half of medicine today is useless, but that the 30-40% extra care the free insurance group (versus co-pay group) received did not improve aggregate health. So the marginal benefit of medicine is approximately zero. So it's not unreasonable to assume from this that 40% less care today (by taxing medicine until that was achieved) would result in a similar level of aggregate health. But this idea is far from proven (we'd actually need to do it to know for sure); just wanted to give that caveat lest someone calls me on it.

 

[Asp]

And probably >90% of the care that DOES have impact is surgery

I don't see how you can be so confident when so many surgical procedures aren't based on randomly controlled trials, the only ones that can reliably prove these procedures are beneficial.

For instance see
http://www.allacademic.com/meta/p151738_index.html

Quote from the abstract:
"A leading example is arthroscopy for knee arthritis, which a landmark study has shown works no better than a placebo operation...Surgeons have attacked the study on questionable methodological grounds yet they have not insisted on the follow-up trials that would address the problems they claim undercut the study's unwelcome conclusions. In deference to expert opinion, the government has maintained broad coverage of the procedure under the Medicare program. These outcomes are unsurprising. Medical procedures are not subject to rigorous scientific evaluation in general. While drugs and devices are routinely tested for efficacy, there is no FDA for surgery. We argue that the systematic underevaluation of medical procedures reflects the simultaneous presence of market failures and government failures, and that this problem is not self-correcting."

And, besides, remember the four rules of medicine
1. If it works, keep doing it
2. It it doesn't work, stop doing it
3. If you don't know what you're doing, don't do anything

and, finally, the fourth rule:

Strong version: Never call a surgeon
Weaker version: Never call a surgeon, unless you want a surgery

 

[Asp]

I'd think that vaccination and antibiotics have had the single greatest impact on peoples' health. Without them, even most surgeries would be futile given the festering boils that would inevitably result from the procedures.

That sounds reasonable, but how can you be sure? I'm aware of recent studies that have shown other public health measures (such as improved sanitation and water quality) have marginal to no impact on health (as measured by child mortality). If you can produce a reference that shows a significant effect of either vaccination or antibiotics on lifespan in the Western world in the 20th century (preferably randomized controlled trial), I'd like to see it.

 

[KeyzerSoze]

Oh, just to clarify, I don't claim that the RAND study proves that half of medicine today is useless, but that the 30-40% extra care the free insurance group (versus co-pay group) received did not improve aggregate health. So the marginal benefit of medicine is approximately zero. So it's not unreasonable to assume from this that 40% less care today (by taxing medicine until that was achieved) would result in a similar level of aggregate health. But this idea is far from proven (we'd actually need to do it to know for sure); just wanted to give that caveat lest someone calls me on it.

So, you took a 128 page study which no one here will actually read, assumed that one particular interpretation is correct, made baseless extrapolations from that interpretation, and blandly declared that "it is fairly established AT LEAST half of medical care has no impact on health"?

 

[Jolie South]

That sounds reasonable, but how can you be sure? I'm aware of recent studies that have shown other public health measures (such as improved sanitation and water quality) have marginal to no impact on health (as measured by child mortality). If you can produce a reference that shows a significant effect of either vaccination or antibiotics on lifespan in the Western world in the 20th century (preferably randomized controlled trial), I'd like to see it.

I beg to differ. From what I saw being at the "triage" area of a rural health clinic in a developing country, intestinal parasitic infections, diarrhea, and malaria covered 75% of cases that came in. All 3 of these can be related to substandard sanitation and lack of access to potable water. While these conditions aren't universally fatal, they do cause a large degree of morbidity. When you're seriously ill 6-7 times a year, that takes a toll on everything from academic success in children to farm productivity for adults. The diseases described above can also ****** growth in children or have serious sequelae.

This is anecdotal, but my Peace Corps colleagues saw the same things. It's hard to believe that improving sanitation and access to clean water wouldn't have a huge effect. The number of people that I personally knew that died of random preventable things was immense. Seriously, to hear of people you know dying of diarrhea was unbelievable, but it happened all the time.

The rest of people were there for pregnancy related care (they give birth A LOT), HIV/AIDS, or random traumatic injuries.

 

[skinnylindsay]

Quote from the abstract:
"A leading example is arthroscopy for knee arthritis, which a landmark study has shown works no better than a placebo operation...Surgeons have attacked the study on questionable methodological grounds yet they have not insisted on the follow-up trials that would address the problems they claim undercut the study's unwelcome conclusions. In deference to expert opinion, the government has maintained broad coverage of the procedure under the Medicare program. These outcomes are unsurprising. Medical procedures are not subject to rigorous scientific evaluation in general. While drugs and devices are routinely tested for efficacy, there is no FDA for surgery. We argue that the systematic underevaluation of medical procedures reflects the simultaneous presence of market failures and government failures, and that this problem is not self-correcting."

A placebo operation? How would that even work?

 

[Asp]

So, you took a 128 page study which no one here will actually read, assumed that one particular interpretation is correct, made baseless extrapolations from that interpretation, and blandly declared that "it is fairly established AT LEAST half of medical care has no impact on health"?

Wow, way to go for the jugular eh. I already explained that I wasn't saying in that initial sentence that I'd proved at least half of medical care was useless -- just that it was actually a fairly good estimate given the one data point we have, the RAND study. So instead of "fairly established" I should have said "reasonable to infer."

Now, actually look at the RAND study. I wasn't "assuming" one particular interpretation. I believe this is the correct interpretation based on something called logic. You don't have to read all the pages, and certainly I didn't. The important point is that there were two groups, one which had co-payments on medical care and one for whom medical care was free. The group with free medical care consumed 30-40% more medicine, but this "extra" medicine was judged just as qualitatively useful by doctors.

So substitute for health something like Vitamin C if that's easier to understand. If you know that taking 30-40% more Vitamin C than you currently are has no benefit, is it not unreasonable to assume (given the fairly conservative assumption of local linearity) that taking 30-40% less Vitamin C will also have no impact? *start hand-wavey explanation* After all, in normative economics, marginal benefits don't just jump from a positive value to zero -- they taper off. If you're already at zero marginal benefit, you probably have been for a while. *end hand-wavey explanation*

Criticize my word choice all you want. It's an internet forum, and I was just making a provocative statement to get someone's interest (that I can back up and justify, but not prove). Cut me some slack 😛. Or go ahead and rip me apart.

 

[Asp]

A placebo operation? How would that even work?

Placebos aren't perfect but I assume you're not criticizing placebos in general. The point is that you convince the patient you did do the surgery to eliminate the placebo effect.

And yes, they make an incision, and yes apparently it's considered ethical enough to do given patient consent.

See
http://www.worldchiropracticalliance.org/tcj/2002/sep/sep2002kent.htm
for a description.

Not claiming that's a reliable source, you hyenas, but it points to reliable sources.

 

[MWK]

Anyone know anything about the history of medical education? I'm curious as to how people were educated to be physicians a few hundred years ago.
In the 1800's, everything came to a head. Medical education was so ****ty, for the most part, that everyone was starting their own branch of medicine, and breaking away from the traditional pathway to becoming a physician. People were operating medical schools out of their basements and ****.

Naturopaths, osteopaths (much different from the DO's of today), chiropractors, and all kinds of other weird **** started popping up, and the sad thing is that most of these guys were no better or worse than your average MD. Only the doctors trained at the very best institutions could really be counted on to know what the hell they were doing. Then, in the early/mid 1900's, the Flexner report came out and caused everybody to either fall in line or go away quietly. Since then, everything has gotten better. The MD's and DO's are doing the heavy-lifting, chiropractors give badass massages and manual therapy, and naturopaths and the like are probably still quacks.

But what were the common practices before the 1800's, when people started to question if physicians were being trained adequately?

I am assuming that most medical education was carried out by the church? But they were doing **** like bleeding and all kinds of nonsense. How did they learn this?

Obviously, they didn't spend 2 years in a classroom learning about electrochemical gradients and PLP transaminations. They also probably didn't spend two years rotating at affiliated hospitals and learning how to treat patients. What was the structure of medical education? Was it standardized at all, or would there be two schools teaching medicine entirely differently.

What if some kid in 1750 wanted to go into medicine? How would he go about this?

Well if you want to be specific, 1750 might as well have been 1350. In the 1780s, John Hunter was among the first to challenge the centuries of thought (humors, etc) since the days of Galen. He was among the first grave diggers and really emphasized anatomy. It slowly began rolling from there. Before that, it was basically whatever potions and treatments you could sell the public. Bloodletting and enemas.

The book "Knife Man" is an account that I picked up at Barnes and Noble last year. It was a good read, a great account of the times.

 

[Asp]

I beg to differ. From what I saw being at the "triage" area of a rural health clinic in a developing country, intestinal parasitic infections, diarrhea, and malaria covered 75% of cases that came in. All 3 of these can be related to substandard sanitation and lack of access to potable water. While these conditions aren't universally fatal, they do cause a large degree of morbidity. When you're seriously ill 6-7 times a year, that takes a toll on everything from academic success in children to farm productivity for adults. The diseases described above can also ****** growth in children or have serious sequelae.

This is anecdotal, but my Peace Corps colleagues saw the same things. It's hard to believe that improving sanitation and access to clean water wouldn't have a huge effect. The number of people that I personally knew that died of random preventable things was immense. Seriously, to hear of people you know dying of diarrhea was unbelievable, but it happened all the time.

The rest of people were there for pregnancy related care (they give birth A LOT), HIV/AIDS, or random traumatic injuries.

Jolie, I see what you are saying, and respect you for doing the things you have done. One day I aspire to do the same. However, there is a vast gap between your concrete experience of giving modern antibiotics and suddenly seeing relapse in fever and other disease symptoms... and aggregate statistics.

Aggregate statistics tells us that antibiotics and good sanitation have done very little to further human lifespans. I have reference or two in mind for these assertions, and can produce them on request (but apparently no one on this forum will read them, which is surprising, given that you all want to be doctors). In fact, medicine as a whole can account for little more than a year of the increase in average lifespans (in the West during the last century).

So maybe you did genuinely save and improve lives, Jolie. But what I'm saying isn't about you, or your friends in the Peace Corps. I'm just talking about the cold numbers. And they tell us that on average, you and your friends and pretty much the entire medical establishment, have made little difference, if even that.

 

[KeyzerSoze]

Aggregate statistics tells us that antibiotics and good sanitation have done very little to further human lifespans. I have reference or two in mind for these assertions, and can produce them on request (but apparently no one on this forum will read them, which is surprising, given that you all want to be doctors). In fact, medicine as a whole can account for little more than a year of the increase in average lifespans (in the West during the last century).

Are these references also 128 page tomes?

 

[45408]

Aggregate statistics tells us that antibiotics and good sanitation have done very little to further human lifespans. I have reference or two in mind for these assertions, and can produce them on request (but apparently no one on this forum will read them, which is surprising, given that you all want to be doctors). In fact, medicine as a whole can account for little more than a year of the increase in average lifespans (in the West during the last century).

What accounts for the other 35 years that have been added to the average person's lifespan from the 1500s? I'm not sure why you're arguing it this way - smallpox killed 30% of the people it infected. I'm quite sure those people would have rather lived now. Malaria kills millions of children around the world every year, but other than those who have traveled outside of the country, none in the US.

 

[confettiflyer]

Can't say that I knew what it was like in the 1700's but this topic reminded me of a painting I went over in History of western art:

Eakins, The Gross Clinic 1875

http://www.artchive.com/artchive/e/eakins/gross_clinic.jpg

Oh so that's the painting I kept hearing about on my campus tour the other week. Jefferson Medical College sold this for $60M+ to a museum in Philadelphia. Apparently it's huge.

 

[Asp]

What accounts for the other 35 years that have been added to the average person's lifespan from the 1500s?

According to the WHO [1], average lifespan in 1900 was

31 years globally
<50 years in the top Western countries

Average lifespan today is

65.6 years globally
>80 years in the top Western countries

That's a pretty big increase (are you saying there was an additional 35 years increase from 1500s to 1900? I doubt that, seeing as it would place average lifespan at -4 😱). And I'm saying medicine only accounts for about five years of that increase [2]. Apologies, I underestimated this figure in an earlier post. But the point remains -- medicine accounts for a small fraction of life expectancy gains in the 20th century.

I'm not sure why you're arguing it this way - smallpox killed 30% of the people it infected. I'm quite sure those people would have rather lived now.

Yes, I think you are right to say eradicating smallpox had a definite impact on lifespan. I think there are quite a few vaccinations that are effective in this regard. However I do not believe they alone account for the other 30 years of lifespan increase in the 20th century. But that's beyond of the scope of what I originally was trying to say, which is that a significant fraction of contemporary medicine is unnecessary, and medicine can't account for most of the lifespan increase in the modern age.

Malaria kills millions of children around the world every year, but other than those who have traveled outside of the country, none in the US.

Right, and the most effective way of stopping malaria is liberal use of DDT. That's not medicine. But again this is beyond the scope of my argument. I'm not some kind of extremist that believes nothing can be done for dying African babies, or that doctors might as well all quit the field. I'm just saying that there are severe limitations to what medicine has accomplished and is accomplishing, and premeds should know that going into the field.

[1] http://www.who.int/global_health_histories/seminars/presentation07.pdf
[2] http://www.milbank.org/720203.html

 

[Asp]

Are these references also 128 page tomes?

A tome? The Bible is a tome. PDR is a tome. If it's not heavy enough to crush your metatarsals when dropped, it's not a tome!

In any case, here's a reference on the effect of sanitation on child mortality for you:
http://dx.doi.org/10.1016/S0304-4076(96)01813-1

And since you seem to be the Cliff Notes type I took the trouble of copying the abstract and even the relevant sentence in the conclusion:

Abstract
"A framework is set out for estimating the effects of interventions on child health that considers changes in the allocation of family resources, who among children survive (survival selectivity), and changes in the health of surviving children net of family resources. Estimates based on structural-equations semi-parametric models applied to data describing households from rural areas of two low-income countries indicate that conventional reduced-form estimates understate the effectiveness of improving sanitation facilities. This is due to the reduced allocation of household resources to children in households with better facilities but not to mortality selection, which is negligible."

---------------------
Excerpt from conclusion
"Moreover, neither variation in water sources nor improvements in sanitation facilities appeared to significantly affect child survival, although wealth and parental schooling levels were significantly and positively associated with higher survival."

 

[TheRealMD]

According to the WHO [1], average lifespan in 1900 was

31 years globally
<50 years in the top Western countries

Average lifespan today is

65.6 years globally
>80 years in the top Western countries

That's a pretty big increase (are you saying there was an additional 35 years increase from 1500s to 1900? I doubt that, seeing as it would place average lifespan at -4 😱). And I'm saying medicine only accounts for about five years of that increase [2]. Apologies, I underestimated this figure in an earlier post. But the point remains -- medicine accounts for a small fraction of life expectancy gains in the 20th century.


Yes, I think you are right to say eradicating smallpox had a definite impact on lifespan. I think there are quite a few vaccinations that are effective in this regard. However I do not believe they alone account for the other 30 years of lifespan increase in the 20th century. But that's beyond of the scope of what I originally was trying to say, which is that a significant fraction of contemporary medicine is unnecessary, and medicine can't account for most of the lifespan increase in the modern age.


Right, and the most effective way of stopping malaria is liberal use of DDT. That's not medicine. But again this is beyond the scope of my argument. I'm not some kind of extremist that believes nothing can be done for dying African babies, or that doctors might as well all quit the field. I'm just saying that there are severe limitations to what medicine has accomplished and is accomplishing, and premeds should know that going into the field.

[1] http://www.who.int/global_health_histories/seminars/presentation07.pdf
[2] http://www.milbank.org/720203.html

For the most part, medicine isn't really about increasing the average life expectancy but decreasing early life deaths. Suffice to say, medicine will continue to many our younger years better, but won't make them last longer.

 

[Asp]

For the most part, medicine isn't really about increasing the average life expectancy but decreasing early life deaths. Suffice to say, medicine will continue to many our younger years better, but won't make them last longer.

Ugh, I hate to be contrarian yet again, but two points:

1. decreased early life deaths => increased average life expectancy
2. Actually, many would argue that medicine had extended the later years we have, while not making them any better (think of all the people kept alive for a few more painful months through terminal illness, or all the myriad conditions that ravage us in the last months or years of our lives)

 

[TheRealMD]

Ugh, I hate to be contrarian yet again, but two points:

1. decreased early life deaths => increased average life expectancy
2. Actually, many would argue that medicine had extended the later years we have, while not making them any better (think of all the people kept alive for a few more painful months through terminal illness, or all the myriad conditions that ravage us in the last months or years of our lives)

You eventually hit a limit after a while.

 

[45408]

But the point remains -- medicine accounts for a small fraction of life expectancy gains in the 20th century.

Rather than telling us what it's not, why don't you tell us what IS responsible for the changes? You deny that applying DDT is medicine, but it IS public health, and you also claimed that those measures are unsuccessful, when some have clearly made an enormous difference.

 

[coldweatherblue]

boooo medicine!

 

[Maxprime]

It was awesome enough that Darwin dropped out after watching his first unanesthetized surgery.

 

[skinnylindsay]

Placebos aren't perfect but I assume you're not criticizing placebos in general. The point is that you convince the patient you did do the surgery to eliminate the placebo effect.

And yes, they make an incision, and yes apparently it's considered ethical enough to do given patient consent.

See
http://www.worldchiropracticalliance.org/tcj/2002/sep/sep2002kent.htm
for a description.

Not claiming that's a reliable source, you hyenas, but it points to reliable sources.

Yeah, that's what I was trying to figure out. Whether they actually made incisions to simulation that surgery had taken place. I had no idea that would be ethically okay since people are put at risk of complications from surgery or anesthesia without actually receiving a procedure. You learn something every day.

 

[LizzyM]

Yeah, that's what I was trying to figure out. Whether they actually made incisions to simulation that surgery had taken place. I had no idea that would be ethically okay since people are put at risk of complications from surgery or anesthesia without actually receiving a procedure. You learn something every day.

Heck, at least one placebo controlled trial drilled holes in people's skulls to make them think that they'd received the active treatment.

Placebo controlled trials of surgical procedures are controversial but in several well publicized cases they have been found to be valuable in identifying treatments that are useless.

 

[Asp]

You deny that applying DDT is medicine, but it IS public health, and you also claimed that those measures are unsuccessful, when some have clearly made an enormous difference.

First, I never claimed all public health measures were unsuccessful, just that the effect of good sanitation, water access, and antibiotics is overstated. You really should read carefully before making unfounded accusations.

Rather than telling us what it's not, why don't you tell us what IS responsible for the changes?

I don't know. I don't think anyone knows, though some might have theories. Medicine can account for five years. If you think public health accounts for the other 25 years in increase, please make your case. I'd like to hear it.

Oh, and if you can explain the Flynn effect too, I'd like to see that as well.

You act like some of the biggest puzzles of the last century have already been solved and neatly filed away, whereas they are still open and interesting questions.

 

[MossPoh]

Well if you want to be specific, 1750 might as well have been 1350. In the 1780s, John Hunter was among the first to challenge the centuries of thought (humors, etc) since the days of Galen. He was among the first grave diggers and really emphasized anatomy. It slowly began rolling from there. Before that, it was basically whatever potions and treatments you could sell the public. Bloodletting and enemas.

The book "Knife Man" is an account that I picked up at Barnes and Noble last year. It was a good read, a great account of the times.

Guess you didn't see my nice long post. 😉 Good book though wasn't it? I mean, good enough as far as history books go. Half the stuff made me flash back to the scrubs episode with the "they had it so much worse back then" scene. Medicine almost seems to follow Moore's law. Check out how they did Prostatectomies in the the late 60s and compare it to now. It is really quite amazing how fast things evolve. Nearly everything is much less invasive and relatively easier on the patient than in the past. We still have fairly humiliating things such as the defecogram, but I'll take my chances with that humiliation over many other things. Still sounds better than the "through and through" of the old prostatectomies.

 

[45408]

First, I never claimed all public health measures were unsuccessful, just that the effect of good sanitation, water access, and antibiotics is overstated. You really should read carefully before making unfounded accusations.

Close enough. 🙄

I don't know. I don't think anyone knows, though some might have theories. Medicine can account for five years.

That's how you feel, but I don't buy it.

 

[Monarch Kong]

Mostly consisted of learning anatomy while fighting the redcoats.

 

[45408]

Medicine can account for five years. If you think public health accounts for the other 25 years in increase, please make your case. I'd like to hear it.

I don't see what else it could be. Let's start early - and all of these are things that have been implemented due to medical advances or public health measures - when your mother was pregnant, she took enough folic acid to ensure you didn't get a neural tube defect. She was vaccinated against rubella, which prevented you from getting birth defects. She was screened for the Rh antigen, so you didn't get fetal hydrops. She was then monitored for pre-eclampsia so she didn't die and bring you with her. Then she was monitored for group B strep, so you didn't get infected during birth. Then when you were born, you had antibiotics put on your eyes, so you didn't go blind from maternal gonorrhea, and you were supplemented with vitamin K so you can synthesize clotting factors. Then you were screened for metabolic disorders (PKU, MSUD, etc) that could cause mental ******ation if not caught within a few weeks of birth. Then you were vaccinated against a number of diseases that kill people at a young age all around the world, and you were saved by herd immunity of other diseases. Furthermore, other diseases like tuberculosis, leprosy, malaria, etc. are all very low risk in this country because they're aggressively eradicated.

And that's within a year or two of birth. Five years, seriously? I can't even believe you're serious.

 

[MossPoh]

Touch&#233; salesman

 

[Asp]

I don't see what else it could be. Let's start early - and all of these are things that have been implemented due to medical advances or public health measures - when your mother was pregnant, she took enough folic acid to ensure you didn't get a neural tube defect. She was vaccinated against rubella, which prevented you from getting birth defects. She was screened for the Rh antigen, so you didn't get fetal hydrops. She was then monitored for pre-eclampsia so she didn't die and bring you with her. Then she was monitored for group B strep, so you didn't get infected during birth. Then when you were born, you had antibiotics put on your eyes, so you didn't go blind from maternal gonorrhea, and you were supplemented with vitamin K so you can synthesize clotting factors. Then you were screened for metabolic disorders (PKU, MSUD, etc) that could cause mental ******ation if not caught within a few weeks of birth. Then you were vaccinated against a number of diseases that kill people at a young age all around the world, and you were saved by herd immunity of other diseases. Furthermore, other diseases like tuberculosis, leprosy, malaria, etc. are all very low risk in this country because they're aggressively eradicated.

And that's within a year or two of birth. Five years, seriously? I can't even believe you're serious.

I'm serious. The things you cite do make a difference, but they don't add up to more than a handful of years.

Here's another reference

http://links.jstor.org/sici?sici=0160-1997(197722)55%3A3%3C405%3ATQCOMM%3E2.0.CO%3B2-6

Abstract

"Legislators, practitioners, and the public may deem it "heretical," but analysis of United States data shows that introduction of specific medical measures and expansion of services account for only a fraction of the decline in mortality since 1900. Even acknowledging that "mortality" and "health" are not synonymous, analysis of age- and sex-adjusted rates still suggests important trends and generates hypotheses for informed social action."