Be careful what you rationalize

evolutiontheorist Disease, , ,

The first few thousand years of “medicine” were pretty bad. We did figure out a few things–an herb that’ll make you defecate faster here, something to staunch bleeding there–but overall, we were idiots. Doctors used to stick leeches on people to make them bleed, because they were convinced that “too much blood” was a problem. A primitive form of CPR invented in the 1700s involved blowing tobacco smoke up a drowned person’s rectum (it didn’t work.) And, of course, people have periodically taken it into their heads that consuming mercury is a good idea.

Did pre-modern (ie, before 1900 or so) doctors even benefit their patients, on net? Consider this account of ancient Egyptian medicine:

The ancient Egyptians had a remarkably well-organized medical system, complete with doctors who specialized in healing specific ailments. Nevertheless, the cures they prescribed weren’t always up to snuff. Lizard blood, dead mice, mud and moldy bread were all used as topical ointments and dressings, and women were sometimes dosed with horse saliva as a cure for an impaired libido.

Most disgusting of all, Egyptian physicians used human and animal excrement as a cure-all remedy for diseases and injuries. According to 1500 B.C.’s Ebers Papyrus, donkey, dog, gazelle and fly dung were all celebrated for their healing properties and their ability to ward off bad spirits. While these repugnant remedies may have occasionally led to tetanus and other infections, they probably weren’t entirely ineffective—research shows the microflora found in some types of animal dung contain antibiotic substances.

Bed rest, nurturing care, a bowl of hot soup–these are obviously beneficial. Dog feces, not so much.

Very ancient medicine and primitive shamanism seem inherently linked–early medicine can probably be divided into “secret knowledge” (ie, useful herbs); magical rites like painting a patient suffering from yellow fever with yellow paint and then washing it off to “wash away” the disease; and outright charlatanry.

It’s amazing that medicine persisted as a profession for centuries despite its terrible track record; you’d think disgruntled patients–or their relatives–would have put a quick and violent end to physicians bleeding patients.

The Christian Scientists got their start when a sickly young woman observed that she felt better when she didn’t go to the doctor than when she did, because this was the 1800s and medicine in those days did more harm than good. Yet the Christian Scientists were (and remain) an exception. Society at large never (to my knowledge) revolted against the “expertise” of supposed doctors.

Our desire for answers in the face of the unknown, our desire to do something when the optimal course is actually doing nothing and just hoping you don’t die, has overwhelmed medicine’s terrible track record for centuries.

Modern medicine is remarkably good. We can set bones, cure bubonic plague, prevent smallpox, and transplant hearts. There are still lots of things we can’t do–we can’t cure the common cold, for example–but modern medicine is, on the whole, positive. So this post is not about modern medicine.

But our tendency to trust too much, to trust the guy who offers answers and solutions over the guy who says “We don’t know, we can’t know, you’re probably best off doing nothing and hoping for the best,” is still with us. It’s probably a cognitive bias, and very hard to combat without purposefully setting out to do so.

So be careful what you rationalize.

10 thoughts on “Be careful what you rationalize”

  1. Nevertheless, the cures they prescribed weren’t always up to snuff. Lizard blood, dead mice, mud and moldy bread were all used as topical ointments and dressings

    One of those stands out as likely being beneficial.

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  2. This reminded me of two things:

    1. In Selections from the Taiping Guangji there is a story that goes like this:

    Jinyang district was experiencing a drought, and the magistrate sought out a shaman to intercede with Heaven on behalf of the district. She promised that rain would come, as long as the magistrate remained “absolutely sincere” for three days. When, three days later, the rain didn’t come, she blamed the magistrates lack of virtue, applied again to Heaven, and said that rain would come in seven days.

    Seven days later, there was still no rain, but “Guo [the shaman] subsequently expressed an urgent desire to return to Bing prefecture”. The magistrate asked her to stay and help the people, and she scolded him, saying that Heaven was unwilling to send rain and there was no point in her staying.

    The magistrate has her executed, shocking everyone, and… clouds gather and rain falls. The local military commander sends a memorial to the emperor describing the whole affair, and gets back a very interesting response. In relevant part:

    Seeing that this Heaven-sent calamity was greatly afflicting the people, he [the magistrate], as was correct, pleaded and prayed for rain at the Jinyang shrine and, in like manner, ‘drowned the shaman in Ye District.'[24]

    Footnote 24 (of the modern commentary):

    This line alludes to an anecdote about an upright official named Ximen Bao who lived during the Warring States period. Appointed as magistrate of the city of Ye, he put an end to the practice of annually sacrificing a young maiden to the river god in order to prevent floods. He instead drowned the three female shamans responsible for the previous maidens’ deaths.

    2. Time on the Cross presents a fairly detailed investigation of the circumstances of slaves in the American South. One aspect the authors look into is medical care. They conclude that slaves got somewhat worse medical care than free workers did, but not because of any malice on the part of the slaveholders. Rather, slaveholders gave their slaves the same care they gave to their own family members, and because large slaveholders were generally wealthy, that care was fashionable medicine from expensive doctors — which was somewhat worse than the nothing that poor white laborers provided for themselves.

    Preventing floods is even more important than curing disease, and the theme attracts con artists equally. But we see that popular resistance can arise when the shaman overreaches. (The Taiping Guangji story is fictional, but the figure of speech, drowning the shaman in Ye district, is real.) This leads me to suspect that one reason for professional medicine’s surprising track record is that fashionable medicine was expensive and only available to a very small portion of the populace. This would have made its failings much harder to notice.

    On an unrelated note, during a moment of adblocker downtime I noticed some fairly intrusive advertising on your site. Are you running that intentionally? (It shows up for me across multiple machines, so I hope it’s not a problem on my end, but I can’t rule that out.)

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      • I found and reread the relevant section of Time on the Cross; I think my summary above was a little unfair. Here’s most of the discussion of the negative aspects of slave health care:

        That it was generally the intent of planters to supply slaves with medical care of a relatively high quality does not imply that the objective was usually realized. Not only was the state of medical knowledge and arts quite primitive during the antebellum era, but the prevailing theory of disease frequently led to treatments which were inimical to the recovery of patients. Disease was assumed to be caused by “poisons emanating from decaying animal and vegetable matter,” which were transmitted to human beings by “impure airs and waters.” To rid the body of these poisons, doctors resorted to bleeding, blistering, and purging. Bleeding and purging were a standard treatment for such diseases as dysentery, cholera, and pleurisy. In each case, of course, the prescribed treatment removed from the body fluids that were vital to recovery. The therapy, no doubt, hurried to their graves many patients who might have survived if they were spared the services of doctors.

        For many of the illnesses that affected slaves, especially pneumonia and diseases of the gastrointenstinal tract, the services of doctors were either useless or harmful.

        But there were good points:

        It was only in limited cases [of disease], such as smallpox and malaria (after the 1820s when sulphate of quinine became generally known), that doctors possessed effective pharmaceutical weapons.

        Doctors were effective in cases requiring minor surgery, such as opening abscesses, removing teeth, and the setting of broken bones. They were also helpful in dealing with hernias, which were quite common among slaves. Although they lacked the surgical knowledge needed to repair the rupture, they did prescribe the use of trusses.

        The prevailing theory of disease did have one quite salutary effect. It led many planters to adhere to a hygienic regimen. Few matters were more frequently emphasized in the instructions to overseers than the need to ensure not only the personal cleanliness of slaves but also the cleanliness of their clothes, their bedding, and their cabins.

        The punishment [on James Hammond’s plantation] for slaves who failed to keep themselves personally clean was a forced scrubbing by the driver and two other blacks.

        While planters worried about slaves who feigned illness to get out of work, they were generally more concerned about losing slaves or impairing their health through the neglect of real illness.Thus Bennet H. Barrow, owner of one of the largest Louisiana plantations, treated slaves as though they were sick even when he thought they were pretending. Nor was Barrow alone in this attitude. In their sick records planters sometimes described the malady which had removed a slave from production as “nothing,” “complaining,” and “more lazy and mad than sick.” James Hammond insisted that “every reasonable complaint must be promptly attended to; and with any marked or general symptom of sickness, however trivial, a negro may lie up a day or so at least.” “Unless it is a clear case of imposition,” wrote still another planter, “a negro had better be allowed a day’s rest when he lays up. A little rest often saves much by preventing serious illness.”

        Slave health care was at its best for pregnant women. “Pregnant women,” wrote one planter, “must be treated with great tenderness, worked near home and lightly.” “Light work” was generally interpreted as 50 to 60 percent of normal effort and was to exclude activity which required heavy physical effort. During the last month of pregnancy work was further reduced, although various planters felt, as did P. C. Weston, that “pregnant women are always to do some work up to the time of their confinement, if it is only walking into the field and staying there.”

        Demographic evidence gives strong support to descriptions of pre- and post-natal care contained in plantation rules, letters, and diaries. Computations based on data from the 1850 census indicate that the average death rate due to pregnancy among slave women in the prime childbearing ages, twenty to twenty-nine, was just one per thousand. This means that out of every 167 women in this age category who gave birth, only one died. The slave mortality rate in childbearing was not only low on an absolute scale, it was also lower than the maternal death rate experienced by southern white women.

        For many, statistics on life expectancy are the ultimate measure of physical well-being. Although the life expectation of slaves in 1850 was 12 percent below the average of white Americans, it was well within the range experienced by free men during the 19th century. It was, for example, nearly identical with the life expectation of countries as advanced as France and Holland. Moreover, U.S. slaves had much longer life expectations than free urban industrial workers in both the United States and Europe.

        (Each of those paragraphs is a separate quote; I just wrapped them all in one block for personal convenience.)

        Urban industrial work is terrible. There unfortunately isn’t a comparison between black life expectancy and the life expectancy of southern white laborers. (There is a comparison of infant mortality, which shows that while black infant mortality was much higher than US white infant mortality overall, it was basically equal to southern white infant mortality.)

        So summing up, American slaves got the fanciest medical care available, and that care was often actively detrimental. However, extending the definition of “medical care” a bit, it’s not at all clear that the slaves were overall worse off than poor laborers. The hygiene and sick leave policies look considerably better than what a lot of people experience today.

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  4. There are modern descendants of earlier stages of scientific medicine that while in modern terms are useless but compared to their peer alternatives in the 19th and early 20th century, were likely merely useless and not actively harmful. I’m talking of course of Homeopathic, Osteopathic and Chiropractic treatments. Homeopathy with its diluting a substance until you just give a patient water, and the Osteopathic and Chiropractic practices of manipulation of the body are similarly not likely to be particularly harmful. In the era’s before antibiotics, avoiding surgery, bloodletting or anything that could cause an infection probably was ideal.

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    • By the way, your comments have been approved. Sorry about not catching them earlier.

      I agree that homeopathy has its uses for people who otherwise might abuse medicines or seek out much worse treatments. It does not seem like much of an advance, though, if one’s new, better medicine is basically “don’t take medicine.”

      I don’t know much about chiro or osteopathy, to be honest, but they sound like fields that could find some good techniques for treating muscle sprains and the like.

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  5. Additional thoughts on homeopathy, I saw this thread on twitter about the the French subsidization of homoeopathy. Anyway it links to an article where a pharmacology professor argues that its a good idea to allow homoeopathy, in order to allow the option to prescribe non-harmful medications (water with/or trace elements) that can’t be abused or overused and prevents dangerous quackery.

    https://mobile.twitter.com/pegobry/status/1132212135839371266
    https://jeanyvesnau.com/2019/04/05/homeopathie-et-politique-la-contre-attaque-de-lindustrie-le-grand-embarras-dagnes-buzyn/

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