LESSONS LEARNED #70: ” There is no such thing as ‘consensus’ in science.” -Old Pithy

Posted by PITHOCRATES - June 16th, 2011

State of the Art Medicine – Balancing the Four Humors

Early science was sometimes by consensus.  Arrived at by some guesses that were almost educated.  Early medical science, for example.  The human body was and is a complex thing.  Most of our knowledge was based on the excretions we observed coming from the body.  Someone with a cold had a runny nose.  Someone with a fever sweated.  Someone with an upset tummy vomited.  And, of course, there’s poop and pee.  If you didn’t excrete enough of either there’s probably something wrong with you.  Even today we look at our poop and pee.  For things like blood.  Or other abnormal secretions.  Because that can be a problem.  So the human body is a plethora of excretions.  Or fluids.  Each telling a story.

Early medicine broke these fluids down into 4 basic fluids.  The four humors.  Black bile, yellow bile, phlegm and blood.  A healthy body had the four humors in balance.  A sick body had an imbalance.  Too little of one.  Or too much of another.  So early medicine looked at putting the four humors back into balance.  Either through putting humors into the body.  As in herbs or food.  Or taking humors out of the body.  As in bloodletting or inducing vomiting.  Or applying a poultice.  Out with the bad.  In with the good.

This was state of the art medicine at its time.  They even used it on George Washington in 1799.  The most important man in America.  He was making his rounds on horseback, inspecting his plantation one day in the rain and snow.  Got a bit of a sore throat.  Came in that evening for dinner.  Didn’t change out of his wet clothes so as not to inconvenience his guests.  The next day his throat was worse.  And he had a fever.  He also had trouble swallowing.  Today we’d see our doctor and ask for some antibiotics.  Before antibiotics, though, you tried to balance the four humors.  So they bled Washington.  State of the art medicine back then.  Washington died 6 days later.  Having never recovered from his sore throat.  Despite using what was then the consensus for the finest medical care.  Bleeding.

The Fight against both Smallpox and the Medical Consensus

Interestingly, George Washington was a healthy man.  He lived longer than most Washington men.  Even survived a run in with Smallpox in his youth.  Which makes his death from something starting out as a sore throat sadder still.  Because Smallpox was a killer.  People feared it like the plague.  In time, though, people found a way to make themselves immune to the disease.  By infecting themselves with a little of it.

England learned of this procedure from the Turks.  Lady Mary Wortley Montagu brought the practice (variolation) back from Turkey.  The king volunteered subjects for experimentation in England.  Which proved to be a success.  Even though there was a risk of death (about 1 in 1,000).  And during the procedure people were highly contagious.  Still, it was a whole lot better than dying from the pox.  So the Royal physician inoculated the Royal family.  And the practice slowly spread.  African slaves were doing it, too, and brought the practice to the New World and taught the procedure to the Reverend Cotton MatherEdward Jenner conducted further experiments.  Found a safer way to inoculate using cowpox.  Without the higher death rate.  Or with people being highly contagious during the process.  And the Smallpox vaccination was born.

But the acceptance of inoculation wasn’t easy.  The accepted medical practice did not include such a radical procedure.  Those in medicine belittled the procedure and anyone practicing it.  The medical consensus was that these were just some misguided people playing God who were going to turn people into cows after injecting them with cowpox.  But fear of dying can change minds.  Especially when there is a Smallpox epidemic in your country.  Which there was during the American Revolutionary War.  More soldiers died from Smallpox than were killed in battle.  A lot more.  More than half of the army.  Soldiers inoculated themselves using the puss from the pustules on infected soldiers.  John Adams’ wife, Abigail, inoculated her own children.  The inoculations saved the army.  And many of the cities.  And it was the successful fight against Smallpox that allowed the fight for independence to proceed.  Thanks to those who went against the consensus.

Contagions, not Bad Air, make you Sick

Part of the reason the disease was so contagious was because of poor sanitary conditions.  Soldiers cramped together in barracks.  Or in hospitals.  Crowded cities.  A lot of sick people in contact with a lot of healthy people got a lot of healthy people sick.  Some understood this and tried to stay away from sick people.  But they didn’t really understand germs.  They tried to stay away from sick people so they wouldn’t catch what they had.  By breathing the same air.  Not necessarily the breath they were exhaling.  But the air they were breathing in that made them sick in the first place.

A common medical opinion was that ‘bad’ air caused illness.  Thomas Jefferson believed this.  That’s why he hated leaving Monticello during the summer.  When the tidewater air was ‘bad’.  The coastal towns.  Where the government met.  He hated going to New York, Philadelphia and Washington.  Because they all had ‘bad’ air during the summer.  And that ‘bad’ air could give you malaria.  Of course, it wasn’t the air.  It was the mosquitoes who liked the marshy tidewater areas.  And understanding this was the first step in (almost) eradicating malaria.

Benjamin Franklin didn’t believe in ‘bad’ air.  Well, not the kind other people worried about.  He didn’t believe cold air gave anyone a cold.  Or the flu.  No one knew anything about germs or viruses yet, but he had an open mind.  And constantly questioned things.  He was, after all, America’s greatest scientist.  Why did he not get sick when traveling in the coldest of winters?  Yet he could catch cold in a warm and comfortable room when someone with a cold was in that same room?  The answer was obvious.  Bad air.  Created by the sick person exhaling their sickness into a room with no fresh air.  Whereby he had no choice but to breathe in this same air.  A contagion spread the sickness.  Not cold air.  Sure of this he would forever sleep with the window open.  Even during winter.  Even when sharing a bed with a sick John Adams during a diplomatic mission to discuss possible terms with the British on Staten Island to stop the rebellion.   There was no room at the inn.  So they had to share.  And they discussed Franklin’s theory.  Adams had a cold and wanted to close the window.  Franklin didn’t want to catch Adams’s cold and insisted on leaving the window open.  Adams returned to bed while listening to Franklin opine.  And fell asleep.  With the window open.  He was no sicker in the morning.  And Franklin did not catch his cold.

Before Modern Science there was Consensus and Bad Medicine

Poor sanitary conditions and a lack of understanding of germs killed a lot of people.  During the American Civil War, doctors would go from patient to patient without washing their hands.  After an amputation, they just wiped their saw on their apron before moving on to the next patient.  These were approved medical procedures.  The consensus was that it wasn’t necessary to wash your hands.  Or your saw.  And the result was an epidemic of gangrene.  And high mortality rates in Civil War hospitals.  Louis Pasteur‘s work on the germ theory of disease began to change things.  And Joseph Lister introduced the modern sterile and antiseptic operating room.

We were making progress.  Modern medicine was coming into being.  But we were still doing a lot of questionable things.  Even though it was accepted by the medical community.  Sometimes we just didn’t know any better.  Like giving people heavy doses of toxic mercury.  Then there were things where we should have known better.  Like sticking an ice pick through someone’s eye socket into the brain to sever the connections to and from the prefrontal cortex during the popular lobotomy craze of the early 20th century.  We don’t do these once accepted medical practices anymore. 

Before modern science and modern surgical tools and equipment there was little more than consensus in medicine.  No one knew anything.  So they started by guessing.  And if a guess won a popular vote, it became an accepted medical procedure.  For it was the consensus of the medical community.  Which until real science came along was the best they could do.  Thankfully, today, we have real science.  We no longer have to guess.  Or win popularity contests.  Which has greatly reduced the amount of bad medicine in our lives.  Thanks to those lone voices in the crowd.  The few who dared to go against the consensus.

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