REASONABLE HEALTH 12/8/24

Stephen S. Brady DO

Before this point little earth-shattering has happened since antiquity Starting now the changes to medicine and the system start to pick up, so I will be dealing with only one or two per post.

Last time we made it to the end of the 1700s – the 18^th Century. The American Revolution has produced a branch point between American and European medicine. Before the Revolution most American physicians were trained in Europe or Apprenticed to one who was. They charged high fees, and most people didn’t get seen by a doc. For the majority, healthcare was home care with home remedies. ‘Snake Oil’ cures were becoming a thing. Surgery amounted to draining abscesses and rapid amputations. European physicians were adopting the lessons of The Enlightenment and were starting to study the results of their treatments. What they discovered was that less aggressive or no interventions yielded the best results. American physicians and the patients wanted nothing to do with that. ‘Do something, even if it doesn’t work’ was the motto. It would be another century before the European model would start to take hold.

Here the Wild West model was taken to heart. Nothing was regulated – not medicines, not medical education, no licensing, no collection of morbidity or mortality data. Americans didn’t and don’t like to be told what to do. Medical schools were totally unregulated - required no diagnostic or laboratory training, no anatomy, and little else. Some granted degrees to illiterate students. It was not so different from some of the latter-day online degree ‘programs’. And, of course, the states didn’t require testing or other documentation of competence to practice medicine, such as it was.

The common causes of death remained the same. Infectious diseases continued to ravage populations. Significant numbers of children continue to die of the results of Measles and Mumps. Epidemics of Smallpox and Spinal Meningitis move through small to large towns and sporadically out in the west. Even though some Americans had heard of Jenner’s discovery of vaccination, not having a handy cow infected with Cow Pox was an impediment to progress. The industrialization of vaccine production doesn’t come until well into the 20^th Century. Chicken pox moves in waves through the population and nearly everyone gets it in childhood. But because pregnancy is an immunocompromised state pregnant women who were exposed to an infected child had a high deathrate from acquiring it again.

Waterborne diseases – Salmonella, Cholera, Dysentery, Typhoid and a plethora of others were common causes of death and debility. ‘The Germ Theory of Disease’ wouldn’t be out there until mid-century and contaminated water was common. City water was drawn from rivers where sewage was released. Private wells were common in more rural areas and were shallow. Nobody knew to locate the outhouse well away from the well. Handwashing was not common. These things and the close quarters in which most families lived, led to whole-family illnesses. Small wonder so many children died before the age of 5. If you lived past 5, you were more robust than the average kid who was already dead.

Many people dealt with the dirty water problem by drinking beer and wine all the time. The alcohol killed or stunted the microorganisms in the water and, from an infection point helped. However, alcoholism was rife and lead later to the robust Temperance Movement toward the end of the century.

Treatments for diarrheal diseases mostly involve giving people purgatives, enemas, large volumes of water either to drink or if they are too sick, by sticking a tube down their throats, and giving just about anything else which came to mind. The theory was that diarrhea was caused by something toxic the victim had encountered - frequently a miasma, and the Healer was going to flush it out of them or know the reason why! Remember they don’t yet understand about germs and disease and still believe in the theory of the imbalance of humors.

While now we know that you cannot give people with bad diarrhea water alone (think Gatorade and Pedialyte) they didn’t know about electrolytes then. The treatments likely killed a lot of the ill – why I refer to them as victims. One of the hallmarks of 19^th Century Medicine is the lack of effective treatments. Few people understood basic anatomy, let alone physiology. Without those, understanding how diseases work – pathophysiology – is impossible and rational understanding of therapeutics (application of medications to the treatment of disease) is as vague as the miasmas they were ascribing disease to. Think about one common disease in warmer areas – Malaria – Italian malo + aria (bad air) is nothing, but a disease blamed on the stench in swamps – a miasma. Nobody knew about mosquitos transmitting the parasite which causes Malaria.

So, let’s recap. One life table I found showed that life expectancy in Massachusetts in 1850 was 40 for men and 43 for women. Remember that includes children who had a high death rate before age 5. Men probably had a lower expectancy because of accidents, injuries and violence. Useful medications are pretty much limited to Opium and Quinine (for Malaria which was not declared eradicated in the US until 1950). Surgery was a last ditch treatment because the death rate was about 80% and anesthesia hadn’t been discovered yet. Infections after surgery were the norm. Sterile surgical technique was years in the future and even handwashing with soap and drying with clean towels was heavily resisted by surgeons, let alone people on the street. Somewhere I once read that people in the Stone Age lived “short brutish lives”. Nothing much had changed well into the 1800s.

Next up: some glimmers of hope.