History’s long arm
The lesson from pre-1865 medicine is that there is no reason to believe health care will always have an overall positive effect on health, no reason to believe that we can construct a system to which we attach lofty ideals and rhetoric, yet is deadly.
1799, Bristol, UK. A 21 year old Cornish scientist has just published his first major paper. It details how inhaling nitrous oxide gives two effects: manic laughing, and the numbing of pain. It has an immediate effect: laughing gas parties quickly became all the rage among the upper classes.
1842, Rochester, New York. A 23 year old student, and likely partial drug-addict, convinces a dentist friend to give a patient ether while her teeth are pulled out. It works. The student never did it again, nor bothers to write about it.
1846, University College Hospital, London. The greatest surgeon of his day amputates a leg (28 seconds) of a patient knocked out by ether, following similar procedures in the US earlier that year. The technique is introduced as a ‘Yankee dodge’, that it is in some way cheating.
1853, Buckingham Palace. The Queen gives birth with the help of chloroform, administered by John Snow (not that one). With the growing social acceptability of the dodge, the once scream-filled operating theatres fall silent.
This isn’t a blog about the horrors of pre-anaesthetic surgery; we can leave our imaginations (or the BBC’s excellent Quacks) to fill in those blanks. This is a blog about how we conceive health and health care, and what we think success looks like.
The 50 years that it took to level up the mismatch between knowledge of anaesthesia and its application sparks a number of questions – how could it possibly take so long? How did surgeons not join the dots between their own personal drug dabbling, and what they did professionally?
But most startlingly, how did we have a health care system (ostensibly to help patients’ health) which frankly wasn’t interested in quelling pain? When anaesthesia did finally come along, it didn’t come from the centres of medical research, but out of small-town USA, via animals and dentists, and sold as a swizz.
“This is the most important fact in all of medical history, in all of health care. Yet it’s barely known, even less discussed, and never put in the context of what it means for us now.”
Part of the answer is the psyche that the system of the day expected of its clinicians. As put by David Wootton in his magisterial Bad Medicine:
“Imagine training yourself to be indifferent to the patient’s suffering, to be deaf to their screams. Imagine learning to how to be ‘resolute and merciless’… [we need] to recognise the emotional investment surgeons had made in becoming a certain set of person with a certain set of skills and the difficulty of abandoning that self-image.”
But it’s unfair to single out surgeons. Until 1865 (and particularly the use of antiseptic and understanding of germ theory), medicine overall hurt and killed more people than it helped and saved. As our knowledge of physiology developed, medicine had steadfastly refused to follow suit. This is the thesis of Wootton’s book; few dispute it.
Let’s just roll that around once more – for the vast majority of medicine’s history its net effect on health has been negative. Closer to ‘do no good’ than ‘do no harm’.
This is the most important fact in all of medical history, in all of health care. Yet it’s barely known, even less discussed, and never put in the context of what it means for us now. Do we really have the arrogance to say that future generations won’t look back at us with as much disdain as we do now for our 19th century forebears?
Where does this end? The lesson from pre-1865 medicine is that there is no reason to believe health care will always have an overall positive effect on health.
At our Kaleidoscope Melting Pot Punch on 23 August we discussed how to build proactivity in health and care instead of waiting for a crisis to occur. Out of all the topics we offered attendees to talk about, this was by far the most popular.
More than likely you might share the general feeling of the discussions – we know that change is needed but it’s unlikely to happen. Does anyone realistically think that social care is adequately funded? That the impact of wider public services on health is properly thought through? That the government’s line to take on NHS finances is honest? That we do enough to support the emotional burden of care-giving?
Where does this end? The lesson from pre-1865 medicine is that there is no reason to believe health care will always have an overall positive effect on health. That we can construct a system to which we attach lofty ideals and rhetoric, yet is deadly.
We risk becoming the ghosts at the Regency operating theatres. Waving frantically – but never catching the surgeon’s eye. How does that not become our fate?