Monday, March 5, 2012

Medical Mondays: A Little History Lesson in Yuck

An Amputation Below The Knee. From Gerssdorjf*s woodcut, reproduced in Gurlfs "Geschichte der Chirurgie"
A good friend of mine, Dr. Phillip Smith, is a poet and an infectious diseases expert. He and several of his colleagues just published a paper, "Infection control through the ages."

As you may know, infection control today goes without saying--hand washing, cover your mouth when you cough, use sterile everything when doing surgery...

So obvious, right?

'Twas not always so. Hold on to your hats, yo.

Medieval Era (5th to 15th Centuries)
For background, remember that in the mid 1300's, the bubonic plague killed 1/3 of the population in Europe.
  • Hospital death rates were so high that sometimes a requiem mass was held for people entering the hospital, as if they'd already died. (Can we say "glass half empty" any louder?)
  • Some wounds were treated with cautery. A burning iron was pushed into a wound until it hit bone, or boiling oil and treacle was poured into the wound. (And you though salt was bad.)
  • Corpse removal was not immediate. We take this for granted. During this time, immediate removal would be thought odd. Sometimes, bodies in rigor mortis remained in the same bed with with other living patients for over 24 hours. (*looks for trashcan; dry heaves*)

Early Modern Era (1500-1800)
Infectious diseases continue to be the most common cause of death in Europe and the U.S. Yellow fever hit, (you must read Laurie Halse Anderson's Fever 1793 for a great fictional account of this time), measles and smallpox were serious killers, and massive outbreaks of cholera hit in the early 1800s.
  • The first "clinical trial" for smallpox happens in 1796--an 8 y/o boy is inoculated with blisters from a milkmaid with cowpox. The boy then survives a smallpox challenge.
  • Bloodletting is a common form of treatment. One woman is described to have been bled 1309 times before dying at age 31. (Gee. I wonder why she didn't make it to #1310.)
  • Most women undergoing Cesarean section died.
  • 40% of those undergoing amputation died from infection. Most instruments such as metal probes and saws were not cleaned between patients and were caked with pus and blood. (Under these circumstances, 60% survival rate is not that bad...)
  • There is a proposal to ban spitting on the hospital wards. (Yay! Personally, I'd like to ban spitting all the time.)

This paper is such a great find for writers doing any historical research!
Healthcare is always an issue in historical fiction. If you would like to read more, you can download the PDF here.
("Infection control through the ages." Smith et al. American Journal of Infection Control. 2012; 40:35-42)

Congrats Phil, Kristen, and Dr. Hewlett on your publication, and thank you for doing all that exhaustive research!

I hope some of you will find this helpful if you ever need research for your novels during any of these eras. Happy Monday!

If you've got a fictional medical question, let me know! Post below or email me at
  All I ask is that you become a follower and post a link on your blog when I post your answer. This is for fictional scenarios, only. Please check out the boring but necessary disclaimer on my sidebar ---> Also, don't forget to stop by Laura Diamond's Mental Health Mondays and Sarah Fine's The Strangest Situation for great psychiatric and psychological viewpoints on all things literary. :)

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49 comments:

Laura Pauling said...

Fascinating but oh so scary. I know we're not perfect today, but I'm so glad I didn't live in the medieval period!

SA Larsenッ said...

I'm always astounded at how archaic most medical methods were back then. All sound horrible, but the hot iron to the bone is really turning my stomach. *shivers*

Sarah said...

What a great informational resource! Now ... I need to go think of other things, so I can actually eat my breakfast. :)

Dianne K. Salerni said...

Urrghh. One of my books is set in 1867, and I consulted a guns expert on how I could arrange for one of my characters to survive a gun shot to the chest. He suggested a shoulder wound, but cautioned the ball (bullet) would have to be removed under as sanitary conditions as I could make believable.

I researched the heck out of it, trying to save my character, and determined that enough medical articles on washing one's hands and one's surgery instruments had been written by 1867 that a young doctor might've been convinced -- although most older doctors would've believed it to be hogwash.

Em-Musing said...

Thanks! I needed a good 'yuck, yuck' this morning. I think the one practiced that really grossed me out when I read about it was when doctors didn't wash their hands after delivering a baby, then would go to the next poor mother and delivered hers. Many women didn't survive the infection. Glad I didn't live in any of those times because I'm so germaphobic. But then, maybe I would have invented sterlization? :)

Natalie Aguirre said...

Thanks for warning us this was Yuck! It was, but interesting. It'll be interesting to see how they look at what we do now in 200 years.

Old Kitty said...

Oh the amazing history of medicinal yuck! LOL!!

Thanks for the pdf link - very very interesting!

Take care
x

Ciara said...

I agree, spitting should be banned everywhere. It is just gross.

Stina Lindenblatt said...

So cool yet so yuck! Makes you wonder what people will think of us in 200 years.

Connie Keller said...

Wow! I can't wait to read the pdf.

I have to agree with Stina--what will future generations think of us. But you do the best you can with what you know. And I'm so thankful that the body does such an amazing job of healing.

Clarissa Draper said...

I was just thinking that there may be things we are doing now in the hospitals that we will look back on and say, 'were we crazy!'

Alex J. Cavanaugh said...

It's a wonder anyone lived through the Middle Ages!

Justine Dell said...

*shudders*

Thanks for ruining my lunch! ;-)

Seriously though, thank god for advances in medicine.

~JD

Colene Murphy said...

Omg...omg omg omg...UGGGH!! What the hell!? The same dirty instruments?! SPITTING!? Umm...duh, much!? Ouuuhhh...I already told my husband, yesterday actually, that if I ever got a severe injury that needed cauterization for some reason, just let me die. There is nooooooo freaking way I'm doing that junk. OOKIE! But still cool!!! I think I'm morbid, like that. This stuff is always fascinating!

J.L. Campbell said...

Fascinating stuff. Half the time, we don't realize just how far we've come or how lucky we are to be living at this particular time. Can't imagine watching one of my limbs being amputated. Cauterization much have felt like hell on earth.

Meredith said...

How absolutely disgusting! Thank goodness we've learned more about germs and infections since then!

lbdiamond said...

Wow. Glad I'm living now. Yikes!

LTM said...

dry heave is RIGHT! Holy cow--the cauterization one. eye yi yi!!! I think I'm still clenched. :D

This is so great. THANK YOU for that link! What a handy research tool.

and Hey! Like that new picture! I'm like a million years behind, but it looks great. You're very thoughtful trying to find that extra hour~ <3

Matthew MacNish said...

There was a scene in the John Adams miniseries (I think it was HBO) where Mrs. Abigail Adams, infected her children with something as a inoculation (I think it was smallpox). Man, that scene was so powerful but so gross.

julie fedderson said...

I find it bizarre that I can read this and then immediately think about where I'm going to lunch. My favorite infection control story is about how water fountains came to be shaped the way they are in order to provide the least amount of back wash for the next person. Yummy.

Belle said...

I often think the only reason I like living in this era is because of antibiotics. Otherwise I would prefer the old agrarian society.

Krispy said...

As much as I like period pieces/historicals, I realized early on that I could never live in those times - mostly because of the yuck factor. It's just so...unsanitary... :P

Cold As Heaven said...

Looks like great fun to be a doctor in the Medieval times. Nothing to loose, and they probably didn't get sued for their mistakes. Not much fun to be on the patients side though.

Cold As Heaven

Emily Rose said...

Wow, that is uber yucky, especially the amputation tools.:*

mooderino said...

Boiling oil and treacle... nice of them to sweeten the deal like that.

Karen Lange said...

Ok, so I had to officially fight off feeling nauseous...but these are all good things to know and avoid. I am glad we have advanced beyond this!

Amanda Borenstadt said...

Some lunchtime reading. Yum! LOL

Jeremy said...

Oh, how far we have come.

K. Turley (Clutzattack) said...

Thank goodness I didn't get to this post until after lunch!

Won't it be great when we get those laser pens like in Star Trek and can just push a button and it fixes everything without having to cut the skin open?

Deb Salisbury said...

Definitely yuck! But my grandfather insisted people only went to the hospital to die.

He did die in a hospital after a stroke (in the 1980s), so I suppose he was right.

Donna Hole said...

a great resource for fantasy authors. Thanks for sharing it. Quite gruesome though.

.....dhole

Nas Dean said...

So fascinating but scary! Recently we had extensive floods and people have dies of Typhoid since then- scarier still- in this modern time.

Tracy Jo said...

When you read stuff like this you realize how far we have come! Not immediate corpse removal...ugh. Hope you had a great Monday!

Carrie Butler said...

Gag-worthy, but interesting. :) I'm sure that paper will be a great resource for the historical writers around here. Thanks for sharing!

Melissa said...

Thanks. Great post! I saved the PDF, since I write historical fiction. I'm a nurse, but even I need to do the research. LOL

Heather said...

*shudders* An excellent reminder of how far we've come and how good we have it. Thanks for this. I'm working on a historical and this is awesome!

Linda Gray said...

This is a great resource, Lydia, thank you! (And I'm totally with you on the spitting issue. Please (!) ban)

Alleged Author said...

What a great post! Though no one does plague like King. :)

Sarah said...

Gross as it may be, I love learning about this stuff. So fascinating!

Sarah Pearson said...

I want to read more, but I think I'll let the memory of this lot die down first!

Susan Fields said...

Great post - thank you, Lydia! The burning iron pushed into a wound until it hits bone is still make me shiver!

Mark. K. aka - EvilDM said...

Now that is just horrifying, but at the same time so absorbing to read.

I can't even begin to imagine the terror of having a red hot iron thrust into an open wound until it touched the bone!?

Thank you for that post, great info for the fantasy buff that I am ;)

E.J. Wesley said...

"proposal to ban spitting on the hospital wards."

Stupid suits and their useless rules ... next they'll tell us we shan't smoke in the delivery rooms! Harrumph, harrumph, harrumph!

Rachna Chhabria said...

Interesting post, Lydia. It did make me a little queasy, but I continued reading ;)

Tamara Narayan said...

I've done some research for the nineteenth century and was also horrified at the blood-letting, burning, purging, etc. Plus they drank calomel (mercury) for certain ailments until their hair and teeth fell out. What madness?

Of course, we've done some wacky things with mercury recently, like inject it our veins with vaccines.

Stephen Tremp said...

I have to wonder if medical community a hundred years into the future will view some of our practices as barbaric. I wonder if even 25 years from now the medical advances will be so much more sophisticated.

Carol Kilgore said...

Please pass the trashcan when you're done. I'm glad I didn't live back then.

Barbara Watson said...

Ewwwww! Don't clean hands and washed medical equipment just seems to make sense, regardless if people understood germs and how they spread?

Coleen Patrick said...

Ew, but still great (and interesting!) information. Thanks Lydia :)

 
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