Tag Archives: medicine

A Brief History of Modern Surgery

Apr 08, 2013

So a few weeks ago I begged the question “Are we healthier now than we were 100 years ago?”. The answer seems to be that while we have the potential to be healthier, we choose not to be, opting for convenience instead. One of the things I mentioned in that post was that there are a lot of supposedly modern things that have been around for far longer than people realize. And realizing just how long some of our “modern” conveniences have existed might change your perception of what life was like back in the day.

I have no idea, but it made me laugh.  A lot.

I have no idea, but it made me laugh. A lot.

Surgery is one of those things that people assume is an invention of the last fifty years or so. Actually, it’s not. Surgery – operating on the human body to remove, relieve, or alter something that is causing disease – dates back to prehistoric times. Yep, it does. Archeological evidence and ancient documentation from cultures in the Indus valley, Egypt, and China all include references to surgery and surgeons. Granted, these were primitive procedures, amputations, removal of external tumors, and trepanation (drilling holes in the skull to relieve pressure – also sometimes a spiritual practice), but significant evidence exists that patients survived these procedures.

The Classical world had a thriving surgical practice, led by the efforts of the Greek physician Hippocrates (you may have heard of him) and dedicated to the healer-god Asclepius. The Ancient Greeks attempted and even succeeded at surgeries that were reasonably complicated. The surgeon Galen (who also contributed much to the theory of the humors) is even recorded as having performed brain and eye surgeries. Things that no one attempted again for nearly two thousand years.

Of course, as with everything else, a lot of knowledge was lost in the Middle Ages. But that didn’t mean medieval physicians didn’t achieve their own advances. As the university movement grew in the High Middle Ages, universities, particularly in Bologna, began experimenting with surgery again, including caesarian births and even cancer surgery.

But the era of modern surgery, surgery as we would recognize it, was a more recent invention. How recent, you ask? Surely mid to late twentieth century, right? Nope. Try mid nineteenth century, with some key advances coming as early as the seventeenth century.

The Gross Clinic, by Thomas Eakins - 1875

The Gross Clinic, by Thomas Eakins – 1875

The key to advancing modern surgery came with the recognition that for it to be a viable form of medical treatment, three things had to be controlled: blood loss, pain, and infection.

Blood loss was the first hurdle that was cleared. Before the Early Modern era, cauterization was used to close serious wounds and stop blood flow. But it was problematic in the long run. It was the 16th century battlefield surgeon Ambroise Paré who returned to a method of stopping blood flow long enough to operate used in the ancient world – ligatures. With the rediscovery that you could tie off blood vessels, treatment for gunshot wounds and other dire situations advanced.

But there were still the problems of pain and infection. It was difficult to operate on a patient who was screaming and writhing as you cut into them. In the ancient world patients had been drugged with opiates to keep them steady, but by the nineteenth century, more was needed. The discoveries of ether and chloroform and their practical use in the 1840s by James Young Simpson and John Snow meant that you could put a patient under, giving you time to operate. And no, that wasn’t a typo. 1840s. That’s probably about a hundred years before most people assume something like that was possible.

Of course, the biggest factor in bringing surgery into the modern world as an effective tool for treating disease was the control of infection. The work of Louis Pasteur and the advancement of the germ theory of disease helped people to understand infection, but even before they understood it they realized it was an issue.

In 1847 a Hungarian physician, Ignaz Semmelweis, noticed that there were fewer incidences of mother and infant death from infection when doctors washed their hands before delivering babies. He made the connection … but was laughed at. But others were beginning to notice the connection as well. John Lister, who studied Pasteur’s work, began using phenol during surgeries as a “disinfectant”. Lister published an article on surgical disinfectants in 1867. Others built on those advances and experimented with other means of disinfecting instruments, surgeries, and wounds. Note that, 1867.

Cancer surgery in 1949Wikimedia Commons

Cancer surgery in 1949
Wikimedia Commons

Last year when I was reading the book The Emperor of All Maladies: A Biography of Cancer, by Siddhartha Mukherjee, I was struck by his extensive description of cancer surgeries and tumor removals, including mastectomies, that were happening in the 1870s and 1880s. That book and Mukherjee’s research is what inspired me to look into the question of how long ago were major surgeries being performed. The answer surprised me, and I’m a history apologist. The fact is, but the second half of the nineteenth century, surgeries were being performed with an ever-increasing survival rate. Granted, they weren’t as common as they are now, but the knowledge and technical advances were all there.

So next time you think of medical treatment in the nineteenth century as being gross and archaic, stop and think again. This was an era when scientific advancement was all the rage and progress was a daily occurrence. From the 1840s on the technical know-how did exist. It would take a while for it to become mainstream, especially for the poor, and as the understanding of infection and later the invention of penicillin came to light it would become more effective with a smaller mortality rate, but surgery has been a part of our medical history for well over a hundred and fifty years.

Are We Healthier Now Than 100 Years Ago?

Mar 18, 2013

So you know me. I’m a History apologist. I happen to believe that life back in the day wasn’t as bad as some (*cough* ignorant and uneducated *cough*) people like to say it was. Sure, we didn’t have TV or the Internet, antibiotics or chemotherapy a hundred years ago. Electricity and automobiles were brand new back then. But what was life like? More importantly, was life worse or better?

Well, every once in a while I get a bee in my bonnet and start looking things up. One bee that has been in my bonnet for years is the issue of health. Specifically, are people healthier now than they were a hundred years ago? My long-held belief is that no, people are not healthier now. We just live longer. But that’s not the same thing.

But am I right?

Okay, a little backstory.

Children and nurse 1900I’ve been on this kick for the last year or so of trying not to eat processed foods. It’s been a slow evolution, but as time goes by I’ve been weaning myself off of anything that comes in a frozen package or premade with ingredients that I wouldn’t be able to identify if they were lying out on a table in front of me. I’ve started doing things like making my own bread and pesto and trying (sometimes in vain) to eat less sugar.

But I’ve noticed something else in the process of spending ten minutes kneading bread dough or hand-washing my unmentionables. It takes muscle! And I am a wimp. I sit in my cube all day at work and in front of my computer writing all night. Yes, there have been times when I have gotten winded carrying a box to my car or going on a long (mile) walk. I’ve gained about 20 pounds since I turned 35, and I can’t blame all of it on age and hormones.

I come from a pretty darn healthy family. We don’t get sick very often (although I have a cold as I write this). The women on both sides of my family tend to live into their 90s, whereas the men on both sides tend to have problems with heart disease and say goodbye in their early 70s. But my Mom died of breast cancer at age 57 (no other family history of breast cancer) and my half-brother passed away very suddenly of lung cancer at age 41 less than a year ago. The suspicion is that Mom’s cancer was caused by stress and my brother’s by toxins where he worked.

Okay, that’s all well and good, but what about the health of the whole rest of the world? Are we healthier now, in 2013, than we were in, say 1910? This is where my curiosity and subsequent digging revealed some interesting information.

I went online to the CDC website where they have mortality records going back to the 1890s and looked up the top ten leading causes of death for the past hundred years. What I found was fascinating. Here it is.

Causes of Death 1910-2010

Whoa! Did you notice what I noticed? A hundred years later, we’re still dying of more or less the same things! Sure, we’ve cured TB and the introduction of antibiotics has wiped Diarrhea, Enteritis, & Ulceration of the Intestines off the list. But look how Diabetes snuck on there. And Suicide? Suicide! It’s a modern menace!

And before you start to argue numbers and percentages, stop right there. The ratio of cause of death to population is roughly the same then as it is now. No, more people did not die more frequently of the things on the list for 1910. And look, Infant Mortality is still on the list in 1960. I kind of always thought of the 60s as part of the modern era. And Cancer, something I hear a lot of people bandying about as only being so prevalent now because nothing else kills people first, is still there on the list in 1910.

old coupleI’ll give you this though, the average life expectancy has gone up. We may be dying of the same things, but in 1910 we were dying younger. Or perhaps you could say that in 2013 we live with these causes of death longer. In 2013 the average life expectancy (of someone in the western world) is 77.5 – 80 years. On the surface it looks like life expectancy in 1910 was 47-51 years, but as this neat website points out, those figures are misleading and that 11.4% of the population of the US in 1910 was over age 65.  Kind of looks like a net gain of 5-10 years of life in the last 100 years.

So yes, people live longer now, but do we live better? Modern medicine is able to keep people alive, but what kind of life is it? Obesity is at an all-time high. Diabetes keeps creeping higher up the list. Suicide made the top ten as all of our medical and social advances marched to the fore. Is this better?

One of the articles I read in prep to write this included a lengthy comments section (that I had to stop reading because it made me too angry). One commenter was fiercely adamant about how much better life is today, saying that if we want to look at what life used to be like all we need to do is go to a third-world country. But guess what, buddy? It doesn’t work like that.

The political, economic, and agricultural problems of third-world countries in the 21st century are in no way, shape, or form living demonstrations of a less advanced and therefore historically accurate setting. They are the result of political, economic, and agricultural problems in the 21st century. The United States in 1910 did not look or feel like Nigeria in 2013. Far from it. In fact, I think most people in 2013 radically underestimate the technology and infrastructure that did exist in 1910, or in the 19th century, for that matter.

In fact, I think I’ll make that my next research project: to look up technology and innovations that existed long before you thought they did. Stay tuned for more!

Medieval Monday – When Medicine was “Humorous”

May 21, 2012

In his book The Emperor of All Maladies: A Biography of Cancer, Dr. Siddhartha Mukherjee traces the history of cancer as it has been seen in the past and continues on through the innovations in cancer treatment in the 20th century and on to the exciting research going on now and the possible future of cancer treatment.  It’s a really cool book.  But one of the things that struck me was his statement that cancer has always existed and has been identified since ancient times, but that other diseases generally killed people before cancer could take hold.

Mukherjee spends some time talking about cancer in the Middle Ages in his book.  The observations he makes about how Medieval doctors viewed what we would later call cancer are not only fascinating, they are surprisingly advanced.

Medical knowledge in the Middle Ages, as you might imagine, was light years behind what we know now.  This was before germ theory, before an understanding of contagion, and well before almost all effective surgery and anything but naturopathic medicines.

The concept of the Four Humors was originally devised by none other than Hippocrates, the father of Western medicine.  In around the 4th century BC he proposed the theory that the human body was comprised of four cardinal fluids, or humors: blood, black bile, yellow bile, and phlegm.  Sickness, in Hippocrates’ view, was caused by an imbalance of the humors.

Several hundred years later, in around 199AD, the Roman physician Claudius Galen advanced the theory by stating that all illnesses could be classified in relation to these four humors.  All of the humors were created inside of the body, rather than inhaled or ingested, but the foods that a person ate or the stage of life that someone was in could affect the balance of the humors.  To regulate the body and relieve illness it was sometimes necessary to purge the excess of one humor or another.

Galen and Hippocrates

This is where the long-held idea of bleeding in cases of fever came from.  Blood was the hot and moist humor, so if someone was too hot and moist they had too much blood.  Break out the leeches!

The ideas of Hippocrates and Galen shifted east after the fall of the Roman Empire.  In the Islamic world they were merged with similar medical theories coming out of India.  The idea of the humors continued and was used for centuries while medical knowledge in the west floundered.

The problem in the west after the fall of the Roman Empire was the same as any other problem of the Early Middle Ages.  Civilization became rural and isolated and knowledge was controlled by the Church, which had its own agenda.  Early Medieval medicine was a strange conglomeration of folklore and herbalism and Christian mysticism.  Medieval people were just as likely to consult with the local wise woman or blacksmith for herbal remedies and spells or charms as they were to pray for healing or go on a pilgrimage to a distant holy sight.

I have no idea, but it made me laugh. A lot.

Because in this time before germ theory, when the most scientific explanation offered for disease was an imbalance of humors, people were as likely as not to believe that an illness was caused by God’s wrath or some sin on the part of the afflicted.

But it’s not as if Medieval scholars weren’t trying to figure things out.

Medical knowledge and inquiry began to change in the 12th century, the High Middle Ages.  This was the same era that the great universities of Europe were established and began to flourish.  And you guessed it, one popular course of study was medicine.  Although medical advances were just as likely to be discovered and practiced at monasteries, which were some of the first hospitals of the Middle Ages.

Many Medieval medical advances were not so much new discoveries as deeper observation and understanding of long-held herbal remedies.  One increasingly popular theory was that God had created an herbal cure for every disease that existed.  He also “marked” herbs throughout the natural world with their use.  For example, skullcap, an herb used to cure headaches, looked like tiny skulls.  Medieval physicians might not have been aware of the exact properties of the herbs they cultivated or the chemistry of how they worked, but they built an extensive knowledge of what herbs cured which diseases.

Surgery also “advanced”, if you can call it that, to the point where simple operations could be performed with a fair success rate.  Although with the knowledge of infection and the importance of sterilization still hundreds of years off surgery had its own problems to overcome.

So what about cancer?  Mukherjee hints in his book that Medieval physicians discovered a few things about cancer that it would take modern doctors a while to catch on to.  What is that all about?

It all goes back to the humors.

When I first learned about the four humors there was one thing that baffled me.  Blood I get.  Phlegm is a pretty easy concept to understand as well.  Yellow bile makes sense when you consider things like urine and liver fluids.  But black bile?  What the heck was that?

There were only two conditions caused by black bile: cancer and depression.

I’m going to start a whole new paragraph because I believe that’s super important.  Cancer and depression.  Black bile.  The Medieval belief was that black bile was systemic.  It wasn’t located in just one place.  Unless there was something wrong and it built up in a particular area.  Those log-jam build-ups of black bile were also known as tumors.

One thing Galen knew that Medieval physicians agreed with was that if you had an imbalance of black bile, if you had cancer, it was inadvisable to attempt to lance or surgically remove the tumor.  The observation was that even if life wasn’t long, patients still lived longer if you did nothing than if you treated the disease.  This was the precursor to the modern discovery that often a tumor suppresses latent cancer elsewhere in the body.  Yes, medical research within the last few decades has discovered that if you remove a tumor, quite often the cancer metastasizes throughout the body, killing someone faster.  Score one for Medieval medicine!

But what I find even more fascinating is that modern research is confirming more and more that there is a link between depression and stress and cancer.  It is well-documented that patients with a more positive outlook live longer than those who give up.  Coincidence or did they know about that in the Middle Ages?  It goes beyond that.  Stress causes cancer.  More and more studies show a link.  And while that probably has a lot more to do with the physiological presentation of stress in the body, lowering the immune system and interfering with all sorts of other things, the fact that folks a thousand years ago had made the connection is pretty cool to this Medieval Apologist.

Oh, one other thing?  Years ago I worked for an herbalist for quite some time.  I have never been one for taking allopathic medicines.  I’ve always been hypersensitive to them.  I can’t take a Tylenol without being knocked flat.  Three baby aspirins are enough to get rid of my headaches.  So I have found that herbal medicines work really, really well for me.  I’ve taken several different things over the years with very good results.  I think that’s because I have a “clean” system … a Medieval system?  It’s enough to convince me that medicine back in the day was far more effective than modern hubris assumes it was.