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Author Topic: Three Centuries of Medicine and Mayhem
Timothy-
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Post Re: Three Centuries of Medicine and Mayhem
on: January 12, 2019, 08:55
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Well, I'd certainly hate to think anyone planned the Five Points or Hell's Kitchen. I'm not sure how much planning goes into any city, good or bad. But a total lack of it could lead to things like roads connecting poorly (if at all). I'm sure someone planned and designed Central Park. (Frederick Olmstead, perhaps; I seem to recall he was a noted designer of city parks in the 19th Century.) And we know how well that's worked out. (In December 1975, having just started at Olivetti, I was in New York to study the program I would be working on. They put in the Mayfair House on Park Avenue, 2 blocks from Central Park. I was tempted to there to see if it was as bad as reported, but sensibly didn't do so in the end.)

Brad-
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Brad Nelson
Post Re: Three Centuries of Medicine and Mayhem
on: January 13, 2019, 10:08
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I'm not sure how much planning goes into any city, good or bad.

There’s probably a good book out there that chronicles the typical development of cities, past and present. One possibility is this book, The City in History: Its Origins, Its Transformations, and Its Prospects. I don’t see a Kindle version of it though. Here's another listing for a hardcover version.

It may be a pretty good book with a broader scope than just cities, per se. One reviewer writes:

Mumford's theses are classic historical analysis and remain pertinent to today. Particularly his view that encroaching bureaucracy poses - as he demonstrates it has for millennia - the most significant threat to the preeminence of dominant cultures.

Mumford wrote another book before this one (which apparently is included in the latter one): The Culture of Cities. One reviewer writes:

The first half of the book is about the history of cities and the second half about how Mumford saw that cities should develop. The history part is superb, although highly focussed on western Europe and the United States. Since the book was published in the 1930s, it was fascinating to read how Mumford saw cities developing and how they actually have. I am not sure that Mumford, if he were alive today, would be entirely thrilled. So even if parts of the book are dated, I still enjoyed it and recommend it as an interesting read.

As far as I can see, as a general principle, cities tended to spread of their own accord, unplanned (speaking of today…not necessarily of walled cities of old which were, by their very nature, planned….at least its boundary was). Fires or various Napoleon-like figures come in from time to time to enforce or facilitate order. Rinse and repeat.

I would guess there was no force greater for facilitating city planning than fires, floods, and earthquakes which allowed people to plan anew. I think cities these days are planned to the point where you could call them remarkably micro-managed. I downloaded the free Kindle sample of this second book. I’ll give that sample a read when I can get to it.

Regarding Central Park, this book seems to stand out as one of the better ones on the subject: The Park and the People: A History of Central Park

Timothy-
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Post Re: Three Centuries of Medicine and Mayhem
on: January 13, 2019, 11:56
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Another book on city planning, though more from the contemporary viewpoint, was The Death and Life of Great American Cities by Jane Jacobs. She was a local activist opposed to the destruction of neighborhoods in the name of urban renewal, and wrote the book to encapsule what she had learned -- based on practical experience, not on theory. The city planners, needless to say, didn't like her.

Brad-
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Brad Nelson
Post Re: Three Centuries of Medicine and Mayhem
on: January 13, 2019, 16:36
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Bonnie Prince Charles at one time criticized the truly horrendous “modernization” what was going on in England. As I understand it, all across Europe (in certain areas) beautiful old buildings have been “planned” over by what you could call Soviet-style ugliness.

If you look at some of the project buildings in and around New York City, they are indistinguishable to the concrete monstrosities that the Soviets built.

I would want Steve Jobs in charge of massing public house, if there had to be such a thing. But the Communists always make things uglier. Perhaps the only thing the Soviets didn’t wreck was their ballet.

Timothy-
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Post Re: Three Centuries of Medicine and Mayhem
on: January 13, 2019, 16:42
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Maybe Ayn Rand was right in The Fountainhead. I also recall Irving Wallace noting the unaesthetic nature of Swedish block housing in The Prize. This seems to be characteristic of bureaucracies. (On the other hand, the Lubyanka started at as the headquarters of an insurance company.)

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Brad Nelson
Post Re: Three Centuries of Medicine and Mayhem
on: January 14, 2019, 09:00
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I’m getting into the section of this book now where the Germ Theory is being discussed. The reckless, selfish, and ego-based resistance to even considering it by many (especially American doctors) we’ve discussed before regarding another book. (I forget which one.)

Still, it’s astounding to read how callous doctors were back then. (Hope things have gotten better.) You’d think that when your surgery patients are dying left and right from infection that you’d at least entertain looking at better methods.

One of the truisms illustrated in this is that it often isn’t until the old guard retires or dies that new and better ideas are adopted. And regardless of whatever theory held the day, it was Florence Nightingale, the Crimean War, and the enlistment of women as professional nurses that made progress in hospitals possible by cleaning things up and bringing order.

And, of course, there was resistance to women having anything to do with having any kind of authority over patients or doctors. Nightingale placated most of the wounded egos with a strict rule that nurses never hand out any medical advice and to tell patients who have questions, “Do whatever the doctor advises.”

Some critics (rightly so) say this led to nurses being looked at as mere grunt workers even though in years to come their training was immense. Initial recruits into the new profession of nursing were carefully filtered. Let’s just say that particularly good-looking women were not wanted. And specifically virtuous women (not a bad idea at all) were required.

But hospitals were so dirty and horrible in those days it wasn’t necessarily a foolish opinion to suppose that women (as full-time professional nurses…there had always been part-time or short-term mostly unskilled help) couldn’t cut it. The nearly robotic hard-working and incorruptible Catholic Sisters of Charity were instrumental in paving the way for women in the nursing corps. These Sisters had impressed a great many.

And although these attributes listed below are still likely true to some extent of the fairer sex, it’s clear that men have their attributes they must battle as well, such as being pompous asses:

The greatest fear, however, was that trained female nurses might challenge the doctor’s authority—or worse, try to become doctors themselves. The American Medical Association spoke directly to this problem when it described nursing as “an art and science” in the hands of properly trained women, while also listing the deficiencies that prevented them from ever becoming good physicians: “uncertainty of rational judgment, capriciousness of sentiment, fickleness of purpose, and indecision of action.”

Pasteur’s and Lister’s work (and bona fide tangible results from that work) had been known for decades. But the “rational,” “non-fickle,” unsentimental doctors and others had let thousands of patients die horribly because of their massive oversized egos.

At about this point in the book (43%) it talks about cocaine being discovered as a useful local anesthetic. Some doctors, not wishing to subject their patients to something without trying it out on themselves, got hooked on the stuff. One famous fellow who eventually followed his friend, William Welch, to the new Johns Hopkins — William Halsted – battled the drug for the rest of his life. He would go into and out of periods of heavy use. Rather than firing him, they put up with him. The author writes that “It was the price that Johns Hopkins silently paid to have the brilliant Halsted around.”

Giving a major boost to germ theory was the botched job the leading doctors of the day did on treating President Garfield for a bullet that was lodged in him. Present-day opinion is that if they’d have simply disinfected the entry wound and left him alone, he’d have been fine. But these leading “experts” almost certainly doomed Garfield by poking and prodding dirty fingers and instruments into him to find the bullet (which they never did). Thomas Edison was enlisted to invent a device that would find it. But he wasn’t successful.

Kung Fu Zu
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Post Re: Three Centuries of Medicine and Mayhem
on: January 14, 2019, 09:43
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Present-day opinion is that if they’d have simply disinfected the entry wound and left him alone, he’d have been fine. But these leading “experts” almost certainly doomed Garfield by poking and prodding dirty fingers and instruments into him to find the bullet (which they never did).

As I recall, the head doctor who treated Garfield in this case was an arrogant asshole who even banned Garfield's family from the sick room and kept Garfield's wife from having any input in Garfield's treatment.

I believe Edison's device did not work because it was based on finding metal and the bedframe on which Garfield was lying had steel mesh in it, which interfered with Edison's machine.

Timothy-
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Post Re: Three Centuries of Medicine and Mayhem
on: January 14, 2019, 09:50
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I thought it was Bell who invented the metal detector used (unsuccessfully) to locate the bullet in Garfield. Paul Harvey once noted that Charles Guiteau's defense was based on the idea that the doctors killed Garfield, not him. Of course, if he hadn't shot Garfield, they wouldn't have operated on him, so it's no surprise that the defense failed.

We've discussed Ignatz Semmelweiss quite a bit here previously. I'm sure he came up again in that section on sepsis (in his case, puerpural fever aka childbed fever).

Not only cocaine, but morphine, which was available in Army first aid kits, I believe, as late as World War II. For that matter, Paul Harvey once noted that heroin got started as a cold remedy, getting its name because it fought the ailment so "heroically".

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Brad Nelson
Post Re: Three Centuries of Medicine and Mayhem
on: January 14, 2019, 10:27
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the head doctor who treated Garfield in this case was an arrogant asshole

That's the guy (or guys). I don't remember if it mentioned him banning the family. But the weird thing was that even as Garfield's condition deteriorated, this same doctor (or group of doctors) put out rosy reports to the press.

The lead physician (a family friend) was Doctor Willard Bliss. Bliss was an arrogant asshole, for sure. The author writes, “Though Bliss spoke boldly of his ability to handle the case, Secretary of State James G. Blaine, Garfield’s political confidant, was less certain . . . he summoned two of the nations’s top surgeons to the White House—David Hayes Agnew, sixty-three, a professor at the University of Pennsylvania Medical School, and Bellevue’s Frank H. Hamilton, now sixty-eight.”

Had they been giving out titles at the time, Hamilton was lead asshole.

He [Hamilton] and Agnew examined Garfield the following day—July 4—without pausing to wash their hands or clean their instruments. The problem, Hamilton told reporters, was that “the ball seems to have entered the liver and remains in the abdominal cavity beyond the reach of detection.” Actually, Hamilton had no idea where the bullet lay, and wouldn’t find out until the autopsy was performed. Worse yet, he threw caution to the wind. “The President is getting better,” he assured the nation. “The chances are all in his favor.”

Hamilton furthered his fantasy by returning to Bellevue. With Garfield’s condition now “stable,” a full recovery was predicted . . . But when Garfield didn’t recover—he got progressively worse—Hamilton was summon back to Washington.

Still clinging to the “miasma” theory, and with the President’s condition getting worse:

Some blamed the presidential mansion, then in awful disrepair. The pipes leaked, the floors were rotted, and rodents had the run of the place. Surrounded by swampland, it often stank of sewage. In one of the more bizarre episodes of the assassination drama, Garfield’s doctors, suspecting dangerous, “miasmas” to be the cause of his troubles, brought in a sanitary engineer to inspect the plumbing, cesspools, and local marshes for dangerous odors. His report, never made public, confirmed the worst: the White House was a deadly mess. “The President,” said one alarmed physician, “is now in much greater danger from the pestilential vapors of the Potomac flats than from Guiteau’s bullet.”

The president was moved but his condition didn’t improve. At the end of this, Garfield’s assassin put things into perspective:

At his murder trial that fall, Garfield’s soon-t0-be-hanged assassin refused to accept blame for the president’s death, shouting: “Nothing could be more absurd….Garfield died from malpractice.” Sadly there was truth to what he said.

One could point out that these doctors were simply following the theory they had been taught, that of “miasma.” The author makes it pretty clear in this book though that it was wanton negligence on their part. One of the early promoters of the Germ Theory at Bellevue was ridiculed often and openly throughout the halls of the hospital. He’d hear things like “There’s another of those germs” with people grabbing handfuls of empty air.

This same lead asshole, Hamilton, ridiculed the idea. He basically said, “You want me to believe in something that you can’t see?” These were not doctors in any scientific sense, boldly fighting for truth and knowledge and the advancement of their profession. They were small-minded gits.

Kung Fu Zu
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Kung Fu Zu
Post Re: Three Centuries of Medicine and Mayhem
on: January 14, 2019, 10:41
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You might be interested to know that many doctors are still arrogant assholes.

I once dealt with a hospital administrator in Singapore who saw that there was a cross-infection problem in the hospital. He went around his hospital with a sheet of sterile gel on to which he would have a random doctor press his or her hands. He would then let the gel sit for a few days after which time he would take it back to said doctor and show said doctor how many germ colonies had taken root from the germs on the doctor's unclean hands.

I am not sure how much this helped.

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