tag:blogger.com,1999:blog-19922276.post5203847901548221706..comments2023-11-29T07:39:34.401+00:00Comments on Carla Nayland Historical Fiction: Early medieval surgical knowledgeCarlahttp://www.blogger.com/profile/11901028520813891575noreply@blogger.comBlogger13125tag:blogger.com,1999:blog-19922276.post-60531045719020927262010-04-28T10:32:13.306+01:002010-04-28T10:32:13.306+01:00Elizabeth - thanks. There are various recipes for...Elizabeth - thanks. There are various recipes for dwale from the Middle Ages, and I think they generally feature hemlock, henbane, opium and various other ingredients. Somewhere around I have an article from the BMJ on the subject.Carlahttps://www.blogger.com/profile/11901028520813891575noreply@blogger.comtag:blogger.com,1999:blog-19922276.post-85637953343461558082010-04-28T00:26:40.879+01:002010-04-28T00:26:40.879+01:00Very interesting post thank you Carla. I remember...Very interesting post thank you Carla. I remember reading a few years ago about an anaesthetic called Dwale. I think it was related to Annis' mention in terms of ingredients, although the entire list was uncertain as were the quantities.Elizabeth Chadwickhttps://www.blogger.com/profile/16911841862257909703noreply@blogger.comtag:blogger.com,1999:blog-19922276.post-24877415965651236882010-04-20T18:48:55.463+01:002010-04-20T18:48:55.463+01:00Good question. Bleeding might conceivably have be...Good question. Bleeding might conceivably have been of some temporary help in high blood pressure, I suppose, but that's about the only rationale I can come up with. I imagine it was so persistent because it comes directly from the flawed four humours model and there was no way of testing it (if you even wanted to) until someone came up with scientific method and the randomised controlled trial. It also <i>looks</i> frightfully dramatic and impressive, so you could see the physician was Doing Something. And sometimes the patient would get better (from a self-limiting condition), in which case the treatment and physician probably got, or at least claimed, the credit. <br /><br />The healthy living advice proposed by classical doctors - varied diet, moderation, regular physical exercise, get plenty of sleep, not too much alcohol, staying mentally active, etc - has hardly changed at all. <br /><br />Re your earlier point, I dimly recall that monastic cemeteries indicate that monks did fairly well in the longevity stakes, though how much of that is attributable to monastic physicians and how much to efficient sanitation, good diet and a peaceful existence (pace Viking raiders) is a different question.Carlahttps://www.blogger.com/profile/11901028520813891575noreply@blogger.comtag:blogger.com,1999:blog-19922276.post-27212539235787209102010-04-20T18:09:05.678+01:002010-04-20T18:09:05.678+01:00Yes, it does make sense. Very roughly it correspon...Yes, it does make sense. Very roughly it corresponds to injuries, which tend to be straightforward, versus diseases, whose symptoms may have no obvious connection to the underlying cause.<br /><br />I've read that until well into last century, there wasn't a lot a physician could actually do about most diseases other than give a prognosis - whether it was time to get your affairs in order, or a week of bed rest and you'd probably be fine. <br /><br />Thinking about the theory of humors, though worthless substantively, it is all about balance, and might have produced a lot of generally good health advice. Eat a varied diet, and in moderation, yada yada. <br /><br />On the other hand, how did people ever convince themselves that bleeding patients was a good idea?Rickhttps://www.blogger.com/profile/16932015378213238346noreply@blogger.comtag:blogger.com,1999:blog-19922276.post-54257043485431839962010-04-20T17:15:47.739+01:002010-04-20T17:15:47.739+01:00[continued]
On top of this, the tools available to...[continued]<br />On top of this, the tools available to a premodern physician were very much more limited than his modern counterpart. No antibiotics, for a start - honey may be a reasonable antiseptic for topical application to a wound, but it won't do anything for a lung infection or septicaemia. Whereas the tools for simple surgery - a sharp knife, needle and thread - were all known technology thousands of years ago. <br />So although there may be a grain of truth in the idea that the low-status barber-surgeon might have been a better bet than the high-status physician, that's perhaps more a reflection of the different problems they were trying to solve and the tools they had available, rather than a comment on the practitioners themselves. It might be fairer to say that the sort of condition a barber-surgeon would treat was inherently more treatable with premodern technology than the sort of condition a physician would treat. Does this make sense?Carlahttps://www.blogger.com/profile/11901028520813891575noreply@blogger.comtag:blogger.com,1999:blog-19922276.post-36120248276583996432010-04-20T17:15:21.483+01:002010-04-20T17:15:21.483+01:00Rick - I'd say that the effectiveness or other...Rick - I'd say that the effectiveness or otherwise of treatment depends on the nature of the condition, the ability to make an accurate differential diagnosis, and the tools available to treat it. If the patient has an obvious injury - a broken bone, a dislocated joint, or a wound - the problem is easily identified. The effect of the intervention is likely to be apparent - the wound heals up, the bone mends, the joint becomes functional again, or doesn't - so it's possible to observe a direct link between intervention and effect. This makes it possible to build up and test a body of practical knowledge based on some sort of empirical evidence, even if imperfect. <br />In contrast, a symptom like, say, difficulty in breathing could arise from many different underlying causes. Off the top of my head I can think of: viral infection, bacterial infection, cancer (primary or secondary), chronic inflammation e.g. asbestosis, allergic reactions, bronchoconstriction, pulmonary oedema secondary to congestive heart failure. There are probably plenty more. A treatment that was effective against any one of these underlying causes would work in patients in whom the symptom was due to that cause but have no useful effect in the others - e.g. bronchodilators work fine in asthma but not in lung cancer, digitalis might help congestive heart failure but won't do anything for cancer. Furthermore, some of the conditions may be self-limiting and get better by themselves without, or despite, intervention - e.g. infection may be cleared by the immune system, allergic reactions resolve if exposure to the allergen is removed or reduced. Chronic conditions that take years to build up may be impossible to reverse once they have passed a certain stage. This makes it very difficult to disentangle the effect of intervention from all the other factors that influence the patient's condition, and consequently difficult to tell the difference between treatments that improve the patient's condition, treatments that have no effect either way, and treatments that make the patient worse. If the patient gets better, you can't tell if it was because the treatment worked or because they had a self-limiting condition that resolved itself. If the patient dies, you can't tell if it was because they were beyond help, because the treatment didn't work, or because the treatment was toxic. Without differential diagnosis you can't tell if a treatment that appeared to work in one patient will also work in another with similar symptoms. (As an example in modern practice, it's only just becoming possible with imaging to tell the difference between an occlusive stroke, which you treat with a clot-dissolving agent, and a haeorrhagic stroke, which a clot-dissolving agent is likely to make worse). All of which makes it very difficult for a physician to identify treatments that are useful, harmful or neutral (and in which patients) until the placebo-controlled trial was invented. So a barber-surgeon may be dealing with an inherently simpler problem than a physician, because it's much easier to identify what's gone wrong - you can see the injury. A medieval physician, on the other hand, is facing a problem rather more like trying to fix a Swiss watch that's stopped ticking, without being able to take the back off, without a map of what all the components do, and probably blindfolded into the bargain.Carlahttps://www.blogger.com/profile/11901028520813891575noreply@blogger.comtag:blogger.com,1999:blog-19922276.post-17150916969332052202010-04-19T16:44:19.508+01:002010-04-19T16:44:19.508+01:00I wonder how this fits in with the perception, whi...I wonder how this fits in with the perception, which we discussed here not long back, that premodern medicine was worse than worthless. <br /><br />It may be a matter of different branches of medicine, and perhaps different classes of patients. I don't know how it was in either imperial Rome or AS England, but in the Renaissance surgeons were basically craftspeople, with much lower status than formally educated physicians.<br /><br />The irony of humble barber-surgeons knowing what they were doing, while physicians were practicing sheer quackery, is so rich that it triggers a warning light that we might be stereotyping the past, a sophisticated version of 'medieval people never took baths.'<br /><br />For one thing, the practice of formal physicians was pretty much confined to the elite, pushing them toward 'celebrity medicine.' The king, like Michael Jackson, got the treatment he wanted, not the treatment an independent doctor would recommend.<br /><br />It would be interesting to know the health outcomes in well educated monastic orders, where medical care presumably followed the theories of the time, but the doctors weren't the patients' servants.Rickhttps://www.blogger.com/profile/16932015378213238346noreply@blogger.comtag:blogger.com,1999:blog-19922276.post-90668329668719123552010-04-18T18:15:58.673+01:002010-04-18T18:15:58.673+01:00Annis - many thanks for the link! I've come a...Annis - many thanks for the link! I've come across the Soutra research before (though not the Bitter Vetch - that was a new one on me! I wonder if anyone's researching it for modern use?). I agree, it seems entirely possible that the medicinal uses of plants may extend back to earlier times. Medieval Islamic medicine made great advances in surgery. Maintaining the delicate balance between being sufficiently unconscious not to feel (or at least not to remember) pain while still being able to breathe unaided must have been quite a feat!<br /><br />Gabriele - Roman surgery seems fairly practical and solidly based, but I can't say I have much faith in the four humours :-) There unquestionably were female medical practitioners in the Roman empire, as the tombstones prove. Whether they were the equivalent of moden obstetrics and gynaecology specialists or practiced medicine more generally, or both, seems to be uncertain.Carlahttps://www.blogger.com/profile/11901028520813891575noreply@blogger.comtag:blogger.com,1999:blog-19922276.post-79173433662808113932010-04-17T16:24:00.505+01:002010-04-17T16:24:00.505+01:00Trepanning goes long back into history. And suffer...Trepanning goes long back into history. And suffering from the occasional bout of migraine, I can understand that you may reach a point where the idea that someone drills a hole into your skull to let the evil spirit out sounds pretty good. <br /><br />Roman medicine is a fascinating topic. It's amazing how much they already knew, and a pity how much of it got lost during the Middle Ages - though it seems you were still better off in the 7th century than the 13th. ;) Another interesting aspect is the fact that there must have been female physicians in Rome. Two burials have been found at the Rhine, and if you consider how few burials get discovered in the first place, the must have been some girls around. :)Gabriele Campbellhttps://www.blogger.com/profile/17205770868139083575noreply@blogger.comtag:blogger.com,1999:blog-19922276.post-14078170643139783322010-04-17T05:40:46.408+01:002010-04-17T05:40:46.408+01:00Fascinating stuff, Carla.
Re operating on patient...Fascinating stuff, Carla.<br /><br />Re operating on patients without anaesthesia, results of examinations at the medieval Augustinian monastery and hospital at Soutra shows that the monks used opium, black henbane and hemlock, presumably to deaden pain and during surgical procedures, and it seems to me quite possible that earlier healers would also have known of and used herbs in similar ways.<br />Article <a href="http://medieval-social-history.suite101.com/article.cfm/augustinian_medieval_medicine" rel="nofollow">here</a>Annishttps://www.blogger.com/profile/02367569632016734415noreply@blogger.comtag:blogger.com,1999:blog-19922276.post-77274316032279182532010-04-16T19:39:36.468+01:002010-04-16T19:39:36.468+01:00Doug - Yes, he was :-) Or, if you prefer, Eadwine...Doug - Yes, he was :-) Or, if you prefer, Eadwine was diagnosed using the girl at Stiklestad's technique. As Celsus says, a doubtful hope is preferable to certain despair, so I would imagine that surgery for traumatic injuries was often worth a try. The mention of repairing hare lips, which as you say are not fatal, suggests to me that the success rate from surgery of that type was pretty good and the risk low. <br /><br />Agreed, the major technical advances that made modern surgery possible are antisepsis and anaesthesia. Applying honey to a wound is probably nothing like as effective as Lister's carbolic spray, let alone modern antibiotics, but it would be a good deal better than nothing. Pre-anaesthesia surgery relied largely on speed, and complicated procedures would have been out of the question, as would most deep surgery in the absence of muscle relaxants. A trauma patient might be unconscious from shock, which could be a very crude approximation to general anaesthesia (!), and there were sedatives like henbane and opium as well as alcohol that might have taken the edge off the pain, but they would have been terribly hit and miss.<br /><br />Bernita - indeed. Isn't there evidence of trepanning from way back in the Neolithic?Carlahttps://www.blogger.com/profile/11901028520813891575noreply@blogger.comtag:blogger.com,1999:blog-19922276.post-63366843362950463592010-04-15T11:39:42.937+01:002010-04-15T11:39:42.937+01:00I've always been of the opinion that surgery h...I've always been of the opinion that surgery has been practised in some form from the time we've had sharp things and needles.<br />The widening of the intestinal wound to facilitate repair indicates considerable practise.Bernitahttps://www.blogger.com/profile/05264585685253812090noreply@blogger.comtag:blogger.com,1999:blog-19922276.post-39969439993702769492010-04-14T22:08:40.269+01:002010-04-14T22:08:40.269+01:00So Thormod was diagnosed using Severa's techni...So Thormod was diagnosed using Severa's technique! No doubt it was always worth a try cutting somebody open and sewing them up, if the alternative was death, although I am surprised that they repaired hare lips, which are not fatal when an operation might have been. Feeding the patient smelly herbs to see if the smell escaped is quite a sophisticated notion, however. The major advances in surgery in recent times are usually thought to be antisepsis and anaesthetic, and it is fascinating to see that they had antiseptic techniques. I believe the standard anaesthetic was to have the patient hopelessly drunk, which must have had risks of its own.Doughttps://www.blogger.com/profile/02204909202506240971noreply@blogger.com