Popular history often gives the impression that until like 80 years ago, the field of medicine was little but a collection of nonsense-treatments. What's the history of actual functioning medicine?

by maneyan

There is no limit to the amount of bizarre stories and images out there showing all sorts of "treatments" from the past. Of course memes aren't facts, but nevertheless it often seems like for the longest time, going to the doctor was going to end up with you being told you had ghosts in your blood and that you should take cocaine to treat it. What's the history of procedures/medicines that actually worked and were widely used?

DanKensington

A lot more than people are expecting. This post is copied from my Middle Ages are Best Ages compilation, which means it's a bit focused there, but the first link should give you a decent grounding in general before we go deep into the Medieval Period.

But the real star of this post is u/BRIStoneman drawing from the 9th Century medical text Bald's Leechbook:

Bonus: Bald's Leechbook is available in all its digitised glory here.

And as always, should anyone wish to address this topic with a new post, please don't let this linkdrop stop you!

BedsideRounds

Just to be clear, 80 years ago was 1942. This is 60 years into the movement known as "scientific medicine" (by 1942, that term wasn't even used anymore as it had become dominant) which had seen laboratory science melded with the practice of medicine. If I were at the end of my career in 1942, I would have seen the first anti-infective (salvarsan) introduced at the beginning of my career, and syphilis become a curable disease. I would have seen the even more miraculous introduction of insulin (1920s) which turned diabetes from a horrific death sentence into a manageable chronic disease. I would have seen the retreat of infectious diseases -- first with public health measures, then with antitoxins, and then with the tetanus, diphtheria, and pertussis vaccines. I would have seen adrenaline (epinephrine) come into common use. I would have seen the invention of warfarin (coumadin) and the beginning of treatments for heart attacks and strokes -- with the promise that these previously intractable conditions might be treatable or curable. I would have seen the develop and standardization of x-rays -- literally seeing in people's bodies. I would have seen the first sulfa drugs, used as diuretics to replace literally sticking trochars in the legs of heart failure patients, and used an antibiotics. And of course, I might be aware of some of the exciting news on penicillin being used in the war.

By 1942 -- and really, by 1900 among physicians -- traditional Western medicine, based on a humoral nosography -- had completely died out. Physicians had professionalized and largely pushed out alternative therapeutics (they lasted longest in the US, but Flexner report was published in 1910, which basically enshrined scientific medicine and the Hopkins model in this country). I should also point out that in the first half of the 20th century, the idea of efficacy was no longer controversial, and it was understood that all new therapeutics needed to demonstrate not only SAFETY but also efficacy (though the primacy of the RCT is from the 1940s).

I also don't entirely know the memes you're talking about -- but cocaine is a potent vasoconstrictor, and still used today by ENTs (my hospital stocks it), and was widely used as an anesthetic before lidocaine (as well as a stimulant, most famously used by Sherlock Holmes). And no physician, even in the 13th century, would have said you had "ghosts in your blood" -- traditional Western medicine has been naturalistic since antiquity (that is, believing that diseases come form nature, are understandable by observation, and treatable). However, a traditional Western nosology was based on the (inaccurate) humoral/balance model of disease, and certain things they considered natural -- for example, the orientation of the stars and planets, the influence of comets -- seem mystical to us now. But for those practitioners, this would have been completely natural. I don't want to over-simplify -- there have always been overlaps between religious ideas of demons/curses competing with naturalistic explanations, and for most of European history, classically trained physicians would have been in the minority of health providers (as opposed to lay healers, herbalists, and barber-surgeons).

I hope that answers your question. There's a lot of nuance in this discussion (especially int he 17th-early19th century, when there's an explosion of experimentation in Western mainstream medicine, as well as the flourishing of alternative practices). But I generally find that the public conception of the history medicine is far divorced from its reality.