Friday, November 12, 2010

The Good Old (Bad Old) Days Of Health Care

By Nancy Mattoon

Hans von Gersdorff.
Feldtbüch der Wundartzney.
Strassburg: Durch Joannem Schott, [1517].
(All Images Courtesy of Lilly Library, Indiana University.)
This is the first image of an amputation ever printed.

The latest struggle over health care reform in the United States has made some nostalgic for "the good old days" of medicine. Remember when the trusted family doctor, the same one who delivered you, made house calls and looked after the health of your family from cradle to grave? Neither do I. Realistically, the only way that scenario ever played out was due to the high mortality rate during childbirth, and the frequent untimely deaths of young people from contagious diseases, infections, and unsanitary conditions.

Jakob Rüff.
De Conceptu et Generatione Hominis ...

Zurich: Christophorus Froschouerus, 1554.
Ruff was responsible for the training and licensing of all midwives in Zurich.

At least in terms of medical science, we are fortunate to be living in the 21st century. A look back at rare books from the 16th and 17th centuries, courtesy of Indiana University's Lilly Library, makes two things abundantly clear. It was a time of some of the greatest medical discoveries in history, including the first understanding of the circulation of the blood, and it was a time you are very lucky NOT to have experienced firsthand as a patient.

Johannes Scultetus.
Wund Artzneyisches Zeüg–Haüsz ...

Frankfurt: In Verlegung Johann Gerlins ...
Buchhändlers in Ulm,
Gedruckt bey Johann Gerlin, 1666.
Torture or surgery? You be the judge...

Until the usage of ether, in the 1840's, surgical anesthesia was truly a hit or miss proposition. Mandrake, henbane, devil's trumpet, and thorn-apple were all used as herbal anesthesia, but the problem here was not enough meant excruciating pain during the operation, but too much meant freedom from pain entirely, forever... So the next time you're getting a tooth pulled or drilled, be thankful that most of the pain will be masked, and you'll probably live to tell the tale, too. And that's the tip of the pain iceberg--think about undergoing abdominal surgery while fully alert--or don't.

George Bartisch.
Ophthalmodouleia, das ist Augendienst ...

[Dresden: Matthes Stöckel], 1583.
This illustration shows off the latest tools of the opthalmology trade.

Many of the great medical advances of the 17th century came about as a result of plant, animal, and human dissection and vivisection. As an exhibit of the Lilly Library's first rate collection of historical medical texts tells us, "Anatomia Animata is a phrase used at the time referring to vivisection...but it also conveys the sense of animation that can be seen in many of the striking images of anatomical and medical books on display." Many of these images are classically beautiful, but just as many look like they came straight out of the latest torture porn fest. (Thankfully without the latest cinematic visual "advances" a la Saw 3D-The Final Chapter.)

Gaspare Tagliacozzi.
De Curtorum Chirurgia per Insitionem: Libri Duo ...

Venice: Apud Gasparem Bindonum Iuniorem, 1597.
A nose job, 16th century style. From the first plastic surgery book ever printed.

Another thing those longing for the old days of the family physician would do well to remember is that for centuries the actual "hands on" of medical care was deemed beneath the dignity of a physician. University trained doctors would study texts, perform experiments and dissections, and document findings, but the actual surgeries, deliveries, and applications of treatments were handled by barbers, midwives, and apothecaries. Something to think about before you make a stink about that Physician's Assistant or Nurse-Practitioner taking care of your ailment rather than an M.D.

Thomas Bartholin.
Acta Medica et Philosophica Hafniensia.

Copenhagen: Sumptibus Petri Haubold, 1673–[80].

The "baby" in David Lynch's Eraserhead, only 300 years earlier.

And at least our physicians now have a general understanding of how the human body functions. They no longer believe women's ovaries are "female testicles" that manufacture sperm, or that conception came about when sperm combined with menstrual blood, or that lustful thoughts during intercourse created monstrously deformed offspring. (And you thought your Gynecologist was judgmental!)

Giulio Cesare Casseri.
De Vocis Auditusque Organis Historia Anatomica ...

Ferrara: Excudebat Victorius Baldinus, [1600–1601].
Does the title page show some of the Casseri's less fortunate patients?

Whatever improvements are still needed in our medical care, we've come a long way in the last 400 years. Four centuries from now--if mankind is still here on earth-- our technologies and treatments today will certainly appear barbaric and backward. But for now, compared to any other time, the industrialized world is in a medical golden age. We all know, at least in the United States, health care could be a lot better. But looking backward brings home the fact that in the "good old days," things were a lot worse.

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