Table of Contents
Introduction
Herd Immunity
Crude Penicillin: Potential and Limitations
A Night with Venus: STIs and Their Treatment in the 1630s, Part One
Common Childhood Diseases in the 1630s, Part One: Fevers with Rashes
The Progression of Trauma Care and Surgery after the Ring of Fire, Part 1
The Progression of Trauma Care and Surgery after the Ring of Fire, Part 2
The White Plague
The New Royal Touch: Synthesis of Anti-TB Drugs
Medicine and Disease
Vincent Coljee, Kim Mackey, Gus Kiritikos,
Brad Banner and Iver Cooper
Ring of Fire Press
East Chicago, IN
2013
Other RoF Press Titles:
Turn Your Radio On
Essen Steel
Joseph Hanauer
No Ship for Tranquebar
The Danish Scheme
Published by Ring of Fire Press
East Chicago, IN, U.S.A.
http://www.1632.org
Portions have been previously published in the Grantville Gazette.
Copyright © 2013 by Garrett W. Vance
All rights reserved, including the right to reproduce this book or portions thereof in any form.
A Ring of Fire Press Original.
Introduction
This book is an example of a new project we're launching in the 1632 series. We're publishing e-books under the imprint of Ring of Fire Press, consisting of two kinds of materials.
The first are reissues -- sometimes expanded and/or rewritten -- of stories which were originally serialized in the Grantville Gazette. These stories were simply too long to be included in any of the paper anthologies published by Baen Books. At the same time, we felt it would be useful (and hopefully popular) to put them together in unitary volumes so that people who want to re-read them, or read them for the first time, don't have to hunt for them scattered over a number of separate issues of the magazine.
The second type are also reissues taken from the Grantville Gazette; in this case, compilations of fact articles on the same (or similar) subjects. We used to reissue fact articles along with stories in the paper editions published by Baen Books. But beginning with the change in format with Grantville Gazette V, where we switched from a direct one-to-one reprint of magazine issues to anthology-style "best of" collections taken from half a dozen issues, we stopped reissuing fact articles altogether. Again, we felt it would be useful (and hopefully popular) to put together unitary e-book volumes devoted to a single topic or closely related set of topics. That way, people interested in the subject matter don't have to hunt for the separate articles scattered across many issues of the magazine.
This is being done in consultation and with the agreement of Baen Books. As before, Baen will continue to publish the paper editions of the Ring of Fire series, as well as the e-book formats of those volumes. The material we will be publishing as Ring of Fire Press is material that Baen would not be publishing.
For those interested, it will also be possible to purchase paper editions of the Ring of Fire Press volumes on a print-on-demand basis.
Eric Flint
June 2013
Medicine and Disease
including
Herd Immunity by Vincent W. Coljee
Crude Penicillin: Potential and Limitations by Kim Mackey
A Night with Venus: STIs and Their Treatment in the 1630s, Part One by Gus Kritikos.
Common Childhood Diseases in the 1630s, Part One: Fevers with Rashes by Gus Kritikos
The Progression of Trauma Care and Surgery after the Ring of Fire, Part 1 by Gus Kritikos
The Progression of Trauma Care and Surgery after the Ring of Fire, Part 2 by Gus Kritikos
The White Plague by Brad Banner
The New Royal Touch: Synthesis of Anti-TB Drugs by Iver P. Cooper
MEDICINE AND DISEASE
Herd Immunity
by Vincent W. Coljee
Life, disease and death in the 1630s
Imagining life in a small town in Germany in the 1630s is difficult for the average twenty-first century dweller. Picture awaking from an interrupted night's sleep, courtesy of the local swine brawling in the alley below your bedroom window. Extracting yourself carefully from between the siblings sharing the bed with you, you arise and count your bedbug bites.
This may sound crude and uncivilized, but they were the plain facts of awakening in that day and age. Bedbugs, communal sleeping, bedpans, contaminated drinking water and lack of personal hygiene were commonplace, depending on where you lived. This also meant that disease was rife, childhood mortality was through the roof, and overall life expectancy in Germany during the Thirty Years' war was less than that of the Roman era.
In the cities, the death rate usually exceeded the birth rate. It was in the cities that epidemics of plague, typhoid, smallpox and many other diseases ran rampant. For example, the plague hit the city of Amsterdam multiple times in the 1600s. This caused a loss of about twenty percent of the population each time the plague hit in 1624-25, 1635-36, 1655 and 1664.
Nonetheless, the population of Amsterdam had grown from 60,000 in 1600 to double that by 1632 and to 200,000 by 1670. This was in spite of the loss to disease. That many cities grew in this period of history was due to immigration from other cities or from the rural population. Rural communities, while by no means healthy by twenty-first century standards, suffered less from the continued onslaught of disease than the cities did.
Medical treatment
On top of having a far greater chance of coming down with a disease, there were few remedies that were known to be effective for many of the diseases. Many people used folk remedies which were passed down along the generations or adopted from friends or neighbors. Some of these folk remedies survive to this day, such as chamomile tea for soothing the stomach and nerves, or willow bark tea as a pain reliever and to reduce inflammation.
Often, ingredients were picked because of the physical appearance of the source of the ingredient For example, walnuts were thought to have the "signature of the head." Some of these remedies were effective because at least one ingredient contained a suitable active agent (e.g., salicylates in willow bark). The problem then was with dosage control (a particular problem with the digoxin content of digitalis).
If Grandma's home remedy didn't work, you had to consult a medical professional. Regular doctors, trained at university, were often unavailable to most of the population. Cambridge and Oxford universities, for example, graduated on average just one MD per year.
The MDs mostly learned "classical" medicine, based upon the Greek physicians Galen and Hippocrates. These ancient physicians emphasized knowledge of the "humors," which constituted the fluid contents of the body, such as bile, blood and phlegm. Disease was thought to be the result of an imbalance in the humors, which could be detected by studying the patient's bodily functions. Their prescriptions often consisted of purgatories, enemas and/or bleeding their patients, to "purge" the patient of the bad unbalanced humors. It must be admitted that their teachings went beyond this, and many aspects still make sense now, such as advocating a balanced diet.
Unfortunately, even Galen made mistakes. For example, in his time, vivisection or dissection of human bodies was forbidden and he studied his anatomy on pigs. This meant that the Renaissance anatomists ran into a few differences when they started their dissections of real human bodies. Nonetheless Galen's teachings were still adhered to, in spite of being wrong.
Worse, the MDs "cures" were often life-threatening in their own right. Consequently, the general population, even if able to afford access to MDs, might avoid them like the plague.
Consider Dr. Symcott's treatm
ent of the younger son of the Earl of Bridgewater, who suffered an apparent stroke. Symcott describes blowing tobacco and sneezing powder up the patient's nostrils, putting mustard and vinegar in his mouth, administering enemas and suppositories, applying dead pigeons to his feet, holding a hot frying pan close to his head and finally leeches to his rectum. It is no surprise that the patient died.
When Symcott himself came down with gout, his brother, a London merchant, felt free to give him advice on how to treat it, thus exemplifying how much lay people held university trained doctors in contempt.
There were some notable exceptions, however. Graduates of Padua, Leiden and Edinburgh received more practical anatomy lessons than those who attended Paris, Cambridge or Oxford. Also, doctors trained in Arabic medicine tended to have a more rounded and generally more scientific underlying education which included, for example, keeping instruments clean for surgery. Many of these doctors were either Jewish or recent Iberian Jewish "converts" to Christianity. Their superior track record led to them being retained as court physicians, even for the pope.
Aside from regular university trained doctors, MDs, there were numerous lay physicians. This is a catch-all term which includes barber-surgeons, midwives, herbalists (who include "white witches"), and even bath attendants and executioners. The lay physicians by far outnumbered MDs, and were more deeply rooted in the community. Many of these had practical experience which made them more effective than the MDs. Hence, they had plenty of patients.
Since the MDs didn't appreciate this competition, they did everything in their power to exclude the opposition. For example, a century before the Ring of Fire, in the aftermath of Columbus' travel to the New World, there was a syphilis outbreak that hit—among other places—the papal court. Two court physicians, Torrella and Pintor, managed, with a varied degree of success, to treat this disease with metallic mercury, as well as other corrosive and abrasive substances, such as calcium oxide (similar to drain cleaner), ammonia and vitriol (acid).
One of the difficulties with using mercury was that it was a substance known to be used by many lay physicians in treating skin conditions. The MDs didn't want the lay physicians to be able to treat the skin lesions of syphilis. They pointed out to the powers-that-be that mercury has rather severe side effects which could impair the mental health of the patient or even kill him/her. Hence, they contrived that the "professional and safe" use of mercury would be the sole realm of the trained MD.
There were many women among the lay physicians. Treating the sick was one of the few niches a woman could work in, especially when left destitute by widowhood. This, combined with their common practical education in midwifery or in herbology, and the fact that they would charge far less, frequently made these women more successful in treating the sick than the MDs. Consequently, they were denounced by the MDs. In the 1630s, James Primrose, an English MD, published a pamphlet, "Popular Errours," which was very critical of female practitioners.
The tale of Madame Louise Bourgeois shows how much power the MDs had and how willing they were to use it against women practitioners, even when the MDs were in the wrong. Madame Bourgeois had been the royal midwife since 1601 when she attended the delivery of a French princess, the sister-in-law of the king, in 1627. There were six doctors present. When the princess died a week later, the "learned" doctors did an autopsy and laid the blame at the feet of the midwife, so as to exonerate themselves. The midwife, with all her practical experience, wrote a very extensive reply in defense of her reputation. She brought forth an overwhelming amount of evidence showing that the princess was suffering from a massive abdominal infection in her last trimester, but had no sign of that infection in her uterus. She completely refuted the doctor's claims that the princess died from having incompletely passed the placenta at birth. Scientifically and medically she was correct as far as we can evaluate the evidence through the eyes of history. The doctor's responses to her refutation of the autopsy report was little more than "Woman, you don't know your place, shut up or we shall try and get you killed." Such was the influence of the court physicians that the increasing attacks forced her to end her career at the French court.
This battle would continue until the MDs finally managed to achieve a virtual monopoly on "healing" during the Victorian era. Whether or not they were more successful at curing people by that time is debatable, but they certainly won the propaganda war.
How would the Ring of Fire change medicine?
One seemingly small, but in fact huge, contribution Grantville would bring is a concept in modern science that is called the "Scientific Method." Originally, Descartes outlined the main tenets of this method in his 1637 book, Discourse on Method. One basic principle that is requested of anyone asking a question scientifically is to be objective. This is very difficult because virtually everyone makes assumptions of some kind and some of these assumptions inevitably end up being wrong. The scientific method further declares that any theory or hypothesis, a suggested explanation of a phenomenon, should be testable. The method involves a number of other principles, such as: "cause and effect" have to follow one another and plausible alternatives have to be eliminated.
For example, whether the active ingredient in willow bark extract, aspirin, does not relieve pain is a testable hypothesis. The experimenter would think about what factors, other than the aspirin, could affect the outcome. This would probably result in an experimental design in which one group of people (the treatment group) gets the aspirin and another group (the control group) gets a sugar pill.
All of the groups must be of people who are already in pain and are suffering of similar levels of pain. An example could be to test the relief of acute pain, such as after receiving an injection or chronic pain, such as from arthritis or migraines. The groups must be sufficiently large so that if there is a difference in outcome (pain relief or not) between the groups, the experimenter can fairly infer that this is attributable to the difference in exposure (aspirin versus sugar pill).
Ideally, the experiment is what is called double-blind. That is, the subjects don't know if they are getting the treatment or the control, and the experimenter who records the outcomes doesn't know which subjects get what, either.
If the treatment group exhibits more pain relief, and the difference is significant, then you can infer that the hypothesis that aspirin does not relieve pain is incorrect. That doesn't mean it is proven that aspirin relieved pain in the sense that a mathematical theorem is proven. Rather, it means that the probability that the difference was the result of chance variation in pain subsidence is very small.
Likewise, if there isn't a statistically significant difference between the two groups, that doesn't absolutely prove the hypothesis. Chance variation could have swamped the positive effect of aspirin if the sample groups were too small. For example, a study might only include four people. Two of these people get a sugar pill but still claim to have a degree of pain relief, as do the two people who had aspirin. This means there was no difference in the result. However, if one does these kinds of studies with hundreds or thousands of people, clear differences in the effectiveness of a drug as compared to a placebo can be shown.
Thus, when plausible alternatives have been disproved (in the practical, not the absolute, sense) and the cause and effect relationship seems reasonable, a theory can be accepted in principle. However, it remains a theory, so it is still possible to do more experiments to try to disprove it. That is why people speak of the "theory of gravity" and the "theory of natural selection" while for almost all scientists these are accepted as "scientific fact."
This leads to a natural confusion between what scientists and the public consider to be "facts." Since theories are formulated in a manner which could theoretically be disproved, they cannot actually be "facts" as the concept is defined in the English language. Unlike mathematics, where one can prove that two plus two equals four, nothing ever gets "proved" in science. So there are no facts, as such, in science. That makes sci
ence an awkward tool, especially when countering critics who ask for proof. Even when providing overwhelming evidence, nothing is proved conclusively, the likelihood of finding evidence to the contrary merely diminishes.
While scientists are often good at their jobs of posing scientific hypotheses and testing them, they are not trained in communicating those results to the general public. Science, even in this modern era is often misunderstood and wrongly portrayed by the media, thus people in general have little idea of what science can and cannot do. This leads to the peculiar headlines of "Tomatoes Can Kill You," or "Broccoli Cures Cancer" and subsequent rushes to toss tomatoes out or buy broccoli supplies, to the despair of children everywhere.
So what can science do, if it cannot come up with absolute proof? Science does experiments which can be described in numbers and probabilities. For example, a number derived from studies into the effects of smoking is that men who smoke are twenty-three times more likely to get lung cancer. Another number is that the average life expectancy of smokers is about seven years less than that of non-smokers. These numbers are based on very large sets of data, including studies of literally millions of people, so the theory that smoking is bad for your health is considered to be very reliable.
The statements that you get to hear in the media that broccoli and carrots are good for you and to stay away from red meat do not usually provide the numbers that underlie them. In order to understand the numbers and methodology, one needs to understand statistics.
Statistics is the mathematical study of the collection, organization and interpretation of numerical data. Statistics can be arranged in many different ways depending on how one quantifies things and then separates the numbers (do you include or exclude people who have an allergy to aspirin, and such). Since most people find these kinds of numbers extremely boring and can never stay awake long enough to read or listen to what it is all about even when they have to, it makes for a confusing world. Even so, one isn't usually provided with the data itself by the general media, just a blanket statement of "fact." Thus, most people don't have the means to understand it. It doesn't stop people from drawing conclusions based on media hearsay, however, which will be discussed further in the section on vaccine scares.