A doctor who treated Bach and Handel with disastrous results | Hacker News Reader

A doctor who treated Bach and Handel with disastrous results

tedgioia.substack.com

134 pointslycopodiopsida71 comments

This is a bit unfair, all doctors were fucking terrible before the late 19th century, and lowered the lifespan of everyone they touched. They also seemed to prescribe mercury for everything.

The only rational use for a doctor back then was if you needed emergency surgery because you were going to die very soon. It was a situation that they could only make better.

The problem, I guess, is that the confidence and authoritative tone of doctors has been identical from back then, when their interventions were at best useless and on average murderous, to now, when they have some chance of improving your outcome. Upper-class people fell for it, to their peril.

I’ve heard this repeatedly, is there any proof doctors used to be useless? Why didn’t they work other jobs? Were they simply con artists?

That was certainly a popular impression in past centuries. In the book Simplicius Simplissimus (1668), the main character takes time off from the 30 Year's War to do some dentistry. He goes from village to village, using show tricks to hide to audiences how painful and damaging his operations are to his customers.

EDIT: Some nonfiction: an account of quacks from the 19th century https://archive.org/details/monthylygazette00mdgoog/page/n37...

From the wikipedia[1] article on the assassination of Garfield in 1881:

> Most historians and medical experts now believe that Garfield probably would have survived his wound had the doctors been more capable.[66][67] However, most American doctors of the day did not believe in anti-sepsis measures or the need for cleanliness to prevent infection.[68] Several inserted their unwashed fingers into the wound to probe for the bullet, and one doctor punctured Garfield's liver in doing so. Also, Bliss had supplanted Garfield's physician Jedediah Hyde Baxter. Bliss and the other doctors who attended Garfield had guessed wrong about the path of the bullet in his body; they had probed rightward into his back instead of leftward, missing the location of the bullet but creating a new channel which filled with pus. The autopsy discovered this error and revealed pneumonia in both lungs and a body that was filled with pus due to uncontrolled sepsis.

[1]: https://en.wikipedia.org/wiki/Assassination_of_James_A._Garf...

That only speaks for the 1800s, though. There were a lot of incorrect beliefs among scientists during that time that weren't commonplace before; race biology comes to mind.

Soap has been around for a long time, and thousand-year-old religions have rules about cleaning oneself. My impression was that doctors actually stopped believing in disinfection during the rise of modern science, as they began see these beliefs as unscientific superstitions. I don't currently have a source for this, though.

Proof, I am not sure, but Molière targeted a lot doctors in his plays,typically https://en.m.wikipedia.org/wiki/The_Imaginary_Invalid

In Europe, traditionally the local barber was also the surgeon.

And for long time today's pinacle of the medical profession (if you go TV drama series), surgeons, were not even considered doctors to begin with.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1569979/

That's a book review of a readable book that makes the case quite compellingly.

> I recently read George Bernard Shaw's The Doctor's Dilemma and experienced an unexpected sense of insult on behalf of my profession. In this celebrated play, Shaw serially indicts various kinds of late 19th century doctor—the hypocrite, the self publicist, and (most dangerous of all) the blinkered zealot. While I admired the plot construction, I suspected that Shaw had created such character extremes for comic effect. However, having read David Wootton's Bad Medicine, I am now no longer insulted and, on behalf of my profession, feel somewhat grateful to Shaw for his restraint. For, as Wootton painstakingly argues in this short but undoubtedly explosive new book, the history of medicine has been nothing less than a failure and doctors have been the culprits.

The BBC did a series called Victorian Pharmacy[1] where they set out to operate a pharmacy from the era and try out the various "remedies" of the time. If you watch the series you'll quickly notice a common theme: there are very few victorian remedies the show could actually try today because it would be unethical. And some of the cures they could try seemed a lot like instruments of torture. Like the Malvern Water Cure, for example, which starts at ~38 minutes in this YouTube video: https://www.youtube.com/watch?v=jXnVTMzSy3s

[1]https://en.wikipedia.org/wiki/Victorian_Pharmacy

I won't disagree that medicine has come a long way but I'm going to say that this is a giant disservice to some very great doctors in history.

My favorite example is John Bradmore, who saved the life of King Henry V after he was shot in the fucking head with an arrow. Not only was John Bradmore a surgeon, he was also something of metalworker (and in fact, was arrested for making counterfeit coins; he had to be pulled out of jail to save the king's life). He used that skill to design a bespoke tool to pull the arrowhead out of the king's head, creating an antibacterial environment with honey and disinfecting the wound with alcohol (though this was before germ theory). Henry V would later go on to rule for 19 more years (he would die for seemingly unrelated reasons, heatstroke). By the way, this was in 1403.

There's also a problem with your criticism in the sense that it implies that doctors were blindly confident, and not for a particularly good reason. While obviously certain incorrect beliefs persisted for quite some time in history, it's from within medicine and from other doctors that these views were more often than not corrected and updated. Obviously, Galen believed incorrectly that the human heart has sinuses from which blood flowed across and was filtered, but to his defense he was not allowed by the state to perform human dissections. If anything, the neo-Galenists were to blame (as Andreas Versalius so often harshly criticized, to the detriment of his Latin grammar, funnily enough). But it's only through the work of people like Ibn al-Nafis, Vesalius, and William Harvey (the latter two's frustration with Galen comes across pretty clearly in their writing) that we have the perspective to say that beliefs like Galen's were wildly off the mark. What I mean to say is, that it's very easy to say that those early doctors were far too confident in their pseudo-scientific theories, yet that's the nature of scientific knowledge and the epistemology of medicine; we know better only because of social changes, technological improvements, and/or particularly clever insights.

Here is an image of the tool:

https://pbs.twimg.com/media/EyiqN6UXMAAZbrM?format=jpg&name=...

I must admit it's pretty clever.

Not only that, but crucially (quote from Wikipedia): "Over a period of several days, John Bradmore, the royal physician, treated the wound with honey to act as an antiseptic, crafted a tool to screw into the embedded arrowhead (bodkin point) and thus extract it without doing further damage, and flushed the wound with alcohol."

Despite the clever tool, if the wound had gotten infected, the then-prince would have probably died. So the knowledge of what to use to disinfect wounds already existed, but apparently wasn't undisputed until much later...

> So the knowledge of what to use to disinfect wounds already existed, but apparently wasn't undisputed until much later...

Not sure he had the right theory, though? He might have used honey 'by accident'?

Even if the theory was probably still lacking, a solid empirical basis would still be infinitely preferable to none at all.

Yes, but I don't know whether he had a solid empirical basis?

Compare https://idlewords.com/2010/03/scott_and_scurvy.htm a store about how the cure to scurvy was found and lost and found again.

There's certainly other examples of inventions preceding understanding. Pasteurization was invented many times, Louis Pasteur was the last inventor, and the only one who understood germ theory. Citrus rations to prevent scurvy predate the discovery of vitamins.

I want to say I've heard of wounds being treated with honey in translations of Greek myths, but I couldn't swear to that.

I've heard of wound remedies written in Old English (the type that even English speakers need a translation for) that were shown to work remarkably well as an antiseptic.

This might be the right reference: https://scitechdaily.com/medieval-medicine-remedy-found-in-9...

That is ingenious and terrifying.

You don't seem to be truly in disagreement with OP, you're just using being more charitable in your description and interpretation of events.

A doctor whose patient lives on 19 years after removing an arrow from his head does not sound terrible at all, yet that doctor preceded gp's cutoff date by centuries.

I'd say that's sufficiently clear disagreement.

Also, apparently he died of entirely different causes (weakened by disentery and possible heatstroke).

Not really, Op says: > The only rational use for a doctor back then was if you needed emergency surgery because you were going to die very soon. It was a situation that they could only make better.

Having an arrow in your head qualifies as needing emergency surgery, and it was a situation that they certainly made better.

They don't disagree on the facts, its just one description is an extremely uncharitable and insulting to the skills of our ancestors. There were talented and skilled healers who did the best they could with the knowledge of the time.

Some of them were definitely noble people but they were still bad at it. Sometimes (often?) the cost of progress is measured in bodies.

But that story with the arrow sounds exactly like the “you needed emergency surgery because you were going to die very soon”. So I don’t see how what you wrote is in disagrement with what GP wrote.

Exceptions also don't make the rule. If out of a 100 doctors there was 1 actually helpful one (and probably not in every scenario), I think you're free to call the service quite terrible in general.

In hindsight I was probably too excited to share that particular story. A better example might have been some of the Islamic physicians who were writing treatises and books in the 10th and 11th century. A good review article on a few such treatises (republished on a British charity org site, originally published in Historical Aspects of Pediatric Surgery)[^1] gives an idea of what I assume would be more routine, less everything-on-the-line treatments.

Though, the distinction from what is life threatening and what is routine has not always been so clear as in this modern period, and it has also shifted around, making this point of contention a bit difficult to judge.

[^1]: https://muslimheritage.com/paediatric-urology-1000-years-ago...

I often hear the lament about "illegal to perform dissection!" But let's be honest. If you dissect a pig, you could have made all those discoveries about how the heart worked and what lungs were for and which organs connected to what. You didn't need a human subject.

How would you KNOW it worked the same as a human heart if you have never seen the insides of a human. This is pre-darwin so the common evolution of mammals is not yet understood.

people were not stupid back then. you could dissect dozens of animals and see the clear similarities. lets not pretend we woke up with science just yesterday.

I thought there were plenty of stories of doctors/curios people buying dead people.

Even Leonardo da Vinci

Wikipedia[1] has some more details and slight corrections:

- Henry V was operated on 16 years old (1403), but became king only 10 years later (1413) (your wording isn't incorrect, just incomplete)

- He ruled for only 9 years, until 1422 (his death). He did live for 19 years after the surgery though, that's correct.

- The arrow/arrowhead seems to have missed the brain[2]. (You didn't say it hit it, and I don't know how much of a difference that makes.)

[1] https://en.wikipedia.org/wiki/Henry_V_of_England [2] https://en.wikipedia.org/wiki/John_Bradmore

One of the first surgeons to break this trend was Robert Liston, who practiced in the early/mid 19th century and was renowned for his speed and results.

It definitely seems to me that they were simply unfortunate to be living in the time they were - I’m not sure there were many skilled enough in ocular surgery at that time to have actually aided in their respective recoveries.

This was the same guy, by the way, who managed to have a surgery with a 300% mortality rate[1]. Sometimes speed is not everything.

[1] https://history101.com/the-surgery-300-death-rate

He himself recognized when circumstances changed such that speed was less important.

http://www.grandroundsjournal.com/articles/gr049006

Lest we forget, for surgeries & blood letting with a more positive outcome, the comon men went to ask the barber (thus the blood stained rotating poles). Doctors were really something only nobility could employ.

By modern defibitions, doctors during medival period were more theologs than medical professionals.

Barbers and mid wifes were the people to go to. Whej it came to non-organ surgery those were surprisingly good, guven theblimited knowledge and means they worked with.

in my city, there has been a centures old tradition of old greek medicine which is actually practices still today in small cases. the barber is interesting because our physicians were doctors of greek medicine while the surgeons were called literally "barbers" or "naevid" in kashmiri. these were the two types of medical professionals until modern medicine was brought by christian missionaries around 200 years ago.

> Doctors were really something only nobility could employ.

Not true. The concept of hospices civils existed for centuries in western europe and were usually supported by religious organizations.

> The only rational use for a doctor back then was if you needed emergency surgery because you were going to die very soon. It was a situation that they could only make better.

Didn't you go for a barber for these kinds of problems anyway? Or later on, to a surgeon, who was very much not a doctor.

That's me making excuses for doctors since we include surgeons with doctors now, so I gave doctors credit for surgeons' work then. Anatomists and surgeons were actually accomplishing something in medicine, so although surgeons would still kill you half the time, if you were dying anyway a coin-flip's chance was a blessing.

I was impressed by the story of Phineas Gage, a railroad worker who, in 1848, accidentally had a gunpowder tamping iron blasted through his head. A doctor was somehow able to treat the wound, such that he was able to make a near-complete recovery.

https://en.wikipedia.org/wiki/Phineas_Gage

rail spike through the dome definitely puts you in the "you needed emergency surgery because you were going to die very soon" category. you're going to the doctor no matter what because they can't plausibly make your life worse at that point.

I suspect it's rather like economics today. There were likely a fair few practitioners at the periphery that were well aware of just how dangerously wrong the orthodox views were, but they were largely ignored.

So of the things it we think of as antiquated an unhelpful such as using maggots to clean infected wounds and what not is actually making a comeback. Maggots are every good at dissolving and consuming dead/infected flesh and produce dozens of anti microbial compounds. And me be a critical tool as various strains develop resistance to antibiotics.

This comes up a lot because it's like the one single example and it's viscerally striking. Are there other examples though?

Medical leeches.

> and lowered the lifespan of everyone they touched

This really isn't true.

Quote from the article: "Dr. Taylor’s standard procedure included administering laxatives and bloodletting from the patient. In addition, Taylor used the blood from slaughtered pigeons as eye drops, and often applied a baked apple to the eye with a bandage. Adding to the abuse, he charged large sums for his procedures—especially if he judged that the patient was wealthy. Bach survived a few weeks after the second procedure, but it seems likely that these failed eye operations directly caused his rapid decline and death. Taylor’s approach was extremely unhygienic, and thus likely to lead to post-surgical infections. I remind readers that antibiotics didn’t exist back then, and an infection, once it had set in, was often fatal. In any event, Bach died on July 28, 1750 at age 65."

You have to remember that's pretty much par for the course for that age. One classic example is the "care" that was administered to George Washington, which likely also hastened his demise:

"Doctors then arrived and bled him four more times over the next eight hours, with a total blood loss of 40 percent. Washington also gargled with a mixture of molasses, vinegar and butter; he inhaled a steam of vinegar and hot water; and his throat also was swabbed with a salve and a preparation of dried beetles. An enema was also used."

(from https://constitutioncenter.org/blog/the-mysterious-death-of-...)

I don't think the argument that "we have a lot of records of this behavior so it was normal" is persuasive, for the reason that our records aren't an even slice of history. We have much much more record of what rich people did and were affected by, and much less about everyone else.

It may have been, probably was, normal for wealthy people to subject themselves to this sort of treatment. But I think the majority of people would have seen a local barber, midwife, or healer, who had different traditions that may not have been more effective but seemed to have generally favored less invasive interventions. The majority of people probably just sat at home and hoped for the best, which likely had better outcomes than what the rich were paying doctors to do to them.

Nice piece.

The guy's name is Georg Friedrich Händel, not Handel. Even if you don't have that letter on your keyboard, you can still find ways to enter it:

https://www.confidentgerman.com/how-to-write-umlaut-a-u-o-s-...

Or just spell it Haendel. Though I've found that's a losing battle with the English world.

Then you have an ambiguity between names where the Umlaut is replaced with "ae"/"oe"/"ue" (Haendel) and names that are actually written with "ae"/"oe"/"ue" (Goethe)...

Yes, but nonetheless that's the official rule for German.

There is nothing ambiguous about it, because it's the same pronunciation. It's a convention of how this particular name is spelled.

But does German have ambiguities here? Yes, it does. In the instrument 'Oboe', the 'oe' is pronounced as two syllables: long 'o' plus schwa. It cannot be written with 'ö'. It should better be written 'Obohe' (my controversial proposal). And dialectally/regionally, 'oe' may be long 'o' instead of the 'ö' sound, like in the city of 'Soest', which could be written 'Sohst', but then people from that city would complain (about tradition, maybe).

there is no schwa in oboe, its oh-bow not oh-bow-uh

ō′bō <-- see? From the American Heritage Dictionary 5th-ed. A schwa is the upside down 'e' which is not present.

They were talking about the German word, not the English one.

https://en.wiktionary.org/wiki/Oboe#German

Handel became a subject of Britain in 1727 by an act of parliament[1]. The text of the act itself[2] clearly referred to him as "George Frederic Handel" with no umlauts. Considering he spent the rest of his life in Britain as a naturalised British citizen there's little reason on insisting to use the umlaut for his name.

[1] https://archives.parliament.uk/collections/getrecord/GB61_HL...

[2] https://digitalarchive.parliament.uk/HL/PO/PB/1/1726/13G1n3

> clearly referred to him as "George Frederic Handel"

That doesn't fit either of the spellings of Frideric used in the linked text.

Put some respect on his name.

No, it's perfectly acceptable, even preferable, to refer to him as Handel.

The reason is he changed his name when he became a British citizen. He chose the anglicized version, George Frideric Handel. Note the spelling of his first and middle names, too.

It was Handel himself who chose to change his name, and he used it in letters and other communications, including his signature, and the inscription on his grave's monument at Westminster Abbey, which he commissioned himself [1].

In Britain, his English name is used consistently: The Handel museum (Handel & Hendrix), Handel House, etc.

You can of course call him by his German name, too; both are fine.

[1] https://www.westminster-abbey.org/abbey-commemorations/comme...

Interesting, i didn't know that. Thanks.

I keep wondering what will be written about out current state on medicine a couple of centuries later

Probably in a negative light.

Many doctors now believe if they cannot test for something, it doesn't exist. This has been changing with long covid.

Western medicine is in a weird place. It is based on science but sometimes it takes a very long time for science and information to trickle down to doctors....like decades. Then, there are pharma reps who sway doctors with new treatments, with questionable research.

Looking at my original post, clearly modern medicine didn’t do much for my dyslexia:)

I was amused that the article claimed that loss of eyesight would end an era of music when Beethoven's loss of hearing certainly didn't end his compositional ability.

You're probably already aware, there is evidence that Beethoven was not completely deaf.

According to a leading Beethoven expert, the composer still had hearing in his left ear until shortly before his death in 1827.

“Not only was Beethoven not completely deaf at the premiere of his Ninth Symphony in May 1824, he could hear, although increasingly faintly, for at least two years afterwards, probably through the last premiere that he would supervise, his String Quartet in B-flat, Op 130, in March 1826,” Albrecht said.

https://www.theguardian.com/music/2020/feb/01/beethoven-not-...

Sure yeah. The first part of my comment isn't dependent on Beethoven's full loss of hearing though --- loss of eyesight ending an era of music still sounds a rather hilarious statement to me :)

The writing in this chap’s substack is a joy to read. It has the rare quality of being exactly the right length.

The author also did a great podcast with Tyler Cowen.

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