This is why homeopathy was a good bet in the 19th and early 20th century: their medicines generally were so dilute as to do nothing, which was still better than getting yourself treated by a regular doctor. The history of quicksilver prescription is a good example.
Of course there are those of us who think that in many areas, modern medicine is *still* a bad idea. The problem now is not that there aren't good techniques available, but that the incentives are bad and that over time this corrupts the practice - as with obstetrics and the American c-section rate...

Theodoric of York, Medieval Barber

The Regimen Sanitatis was a popular medieval work translated into numerous languages. It contained an explicit exhortation to wash one's hands, in order to stay healthy. I am not sure if doctors' historic failure to wash their hands was as customary as we believe it was.

This makes me think: there would have been a selection pressure on human beings to be skeptical of materialist claims about the world.

Somewhat related: I'm frequently taken aback by contemporary writers who praise some past author's materialism or materialist reductionism, without asking themselves whether their materialism had any real validity. I don't think that materialist intentions should be honored without real scientific results.

Three examples: 1.) climatic explanations of history which are not based on any climate data to speak of, and which are vague about the mechanisms by which climate controls history (I am thinking of the "Mongol invasions caused by drought" types of theories); 2.) geographical theories of "national character" (people in lowlying places are sluggish and soft, mountain peoples are alert and vigorous); and 3.) nineteenth century explanations of mental states by diet and digestion, for example Nietzsche's, which as far as I can tell are exactly as scientific as back-to-the-land organic food / fasting / purging / herbal regimens (though different in detail -- Nietzsche used synthetic chemical remedies).

You could add astrology and alchemy, but for most these are already identified with superstition, even though they are proto-science and really did discover a lot of fundamental stuff.

Very few religions actually offered faith healing as a norm. Certainly there was no contradiction between religious devotion and relying on physicians in medieval and renaissance Europe.

And no, pre-modern physicians were not merely charlatans. If one had a broken leg, a physician could set it. Physicians could stitch up wounds (after Paré invented suturing). There were successful operations for kidney stones in the 1600s. Paré was also an important contributor to obstetric practice, helping devise or revive procedures which saved many women and babies in cases of breech birth or similar complications.

This is not to deny that there was much iatrogenic illness and death, or that much medical practice was dangerous or harmful. But there were also many real and visible successes of medicine.

i regularly see the 19th or early 20th century as the "turn around" date for the efficacy of the medical profession in increasing, rather than decreasing, lifespan. anyone have a citation from where this comes from?

re: doctors, were there enough of them around before 1700 or so? i don't think that the effect would have been that strong because they weren't rubbing feces on wounds for most people (this was i believe an ancient egyptian medical practice).

Too bad Christian Science, with its emphasis on healthy living, wasn't invented a couple of centuries earlier. It would have done a lot of good.

Too bad Christian Science, with its emphasis on healthy living, wasn't invented a couple of centuries earlier. It would have done a lot of good.

seventh day adventists seem to add around 5 years to life expec.

I read an article about ancient Egypt medicine
some time ago. They actually had quite a lot of
treatments considered beneficial. For example
they put a mixture with honey on open wounds,
which is antiseptic. Or they were rather good
at handling broken bones. The Romans
also had some interesting techniques.
So at least in some cases even ancient doctors
were quite beneficial.

This makes an interesting suggestion - but I suspect that the effect of religion on health would have been swamped by other factors.

And until not much more than 100-150 years ago (varying widely between countries), medicine did not exist as a unified profession or concept. In the UK Physicians were gentlemen with a university education (or equivalent) (physicians were almost pure theoreticians, who typically did not touch the patient, nor look at their problems - they would not ask people to undress - and would often practice by correspondence); while surgeons and apothecaries were craftsmen trained by apprenticeship; and midwifery (obstetrics) was a semi-skilled and self-certified activity based on local reputation.

The professional status of surgery and obstetrics began to rise with the Hunter brothers John and William who became exceedingly rich and famous as a result of the science-based practice of (respectively) surgery and being a 'man-midwife'.

Apothecaries mutated into modern style general/ family practitioners during the nineteenth century - and the separate branches were brought together via university and hospital based education - the relic of which can be seen in most UK medical degrees which have separately- named bachelors of medicine and surgery (e.g. BM BS, MB ChB etc - and in Dublin also obstetrics - BAO).

Anyway, my point is that what we consider 'medicine' was - even in the past 200 years in the most advanced societies - practiced by an incredible diversity of people from family friends and neighbours through local 'wise women' or 'cunning men' up to local priests and aristocrats who sometimes used to practice medicine on their tenants as a hobby.

In this sense our modern idea of 'medicine' did not exist as a distinct subject, just 'what people did when other people were sick' or something equally vague.

RE:
for most of human existence there must have been more than a little difference in fitness between those who eagerly sought out the help of a medicine man / doctor and those who just went to church (or wherever) and prayed to the spirits instead
For most of human pre-history, adhering to religious practices would have meant trusting and respecting the tribe's medicine man or shaman
and following his prescriptions in case of a sickness, so a tendency to adhere to religious practices wouldn't have avoided iatrogenic harm because "medicine" and "religion" were not separate and were administered by the same authority figure.

The history of quicksilver prescription is a good example.

I have a friend whose health was ruined by a mercury treatment for a skin disorder. My friend had some other condition that made her especially susceptible to problems. The doctor was eminent and the malpractice lawsuit went nowhere, but I think that the "best practice" has been changed.

For all the faddism, the rules for healthy living are pretty well know. No tobacco, very little alcohol, a frugal diet (not necessarily completely vegetarian), and the right amount of the right kind of exercise (e.g. not American football). There are various other less common negative factors such as betel nuts, etc.

You can really type all the rules on a single page, but most people find them hard to follow (I don't even try on diet) and look for shortcuts. And people with bad health for non-diet reasons will look for diet cures. And sometimes its a psychic purification trip.

Public health people have very mixed feelings about the healthy living cults, because they teach many of the right things plus a bunch of irrelevancies, and are too friendly to charlatans who advocate deadly organic practices (e.g. the garlic-grape juice treatment for diabetes.)

I had a talk with an old friend of the organic sort a year or so ago, and he explained to me that hypertension and heart attack deaths are skyrocketing, when the fact is that they've been plummeting and were at their peak around 50 years ago. (It's the old "trend" problem: when someone sees a trend, sometimes they marry it for life and talk about it forever, like the skyrocketing crime that would have killed everyone by now if it really had been skyrocketing for the last forty years.

This touches on my explanation for why the National Health Service became the state religion in the UK. Its introduction coincided with doctors suddenly being able to cure people, thanks to penicillin, but the mob attributed the magic to the NHS.

"Medicine is a form of politeness we pay to the aristocracy."

- Erasmus

True, ancient doctors could staunch wounds and fix bones, and 17th Century doctors could remove kidney stones, but it took almost a kind of religious faith to tolerate the agony of removing a kidney stone. It was for all the lesser diseases or miseries that a person was better off avoiding a doctor. And only aristocrats really had the option, either way.

What about China? Acupuncture, as far a I can see, was mostly an ineffective but harmless and inexpensive placebo. A lot better than bleeding, and thus a better form of politeness for the aristocracy. Kept those mandarins alive and skeptical of religion.

The medical profession always had the smartest people around. When the Black Death epidemy hit Italy, the King asked the University of Paris for a report about what it was and what to do. The doctors of philosophy produced very sensible and practical recommendations and the illustrated classes mostly escaped the plague.

AFAICT widespread psycho surgery was a mostly European phenomenon, due to the relative lack of herbs in Europe compared to the abundance of them in the tropics.

Spiritual Shamanism was more common in the New World and Africa, and Chinese herbal medicine has a long history. It's not clear to me that the Europeans are the population group most likely to be attracted to spiritual healing as you might expect if they have undergone a selection process - are there any statistics on this?

There are some obvious implications for recent evolution I can think of due to the Scissorhands approach to European doctoring: the building of the European immune system. Europeans were exposed to a wider range of diseases through intrusive surgery more frequently than they otherwise would have been. Differential survival rates could have lead to specific resistances.

Perhaps contemporary Europeans are also more resistant to stress of surgery and have higher physical pain tolerance, as this could have affected survival rates.

> rubbing feces on wounds

I wonder if this could actually have helped under some circumstances. Bacteria love blowing each to hell with small molecules, hydrolytic enzymes, protein toxins, and toxic peptides. Feces, no doubt, contains lots of such stuff. However it also contains some bacteria that you definitely don't want in your wound (sometimes including very nasty clostridia), which is probably why feces has been used as an arrow poison.

If there's any circumstance that might make feces helpful on balance, it would be a profusion in the environment of some specific, highly aggressive wound-loving bacterium. Perhaps unhygienic animal husbandry could create such a circumstance.

This would also introduce a lot of Toll receptor ligands into the wound and increase immune activity at the site. That too could be good under certain circumstances.

Needless to say it's also very possible this was just a really dumb idea someone had.

I suspect Ni Chi's references to good digestion were partly playful. Their tone of certainty seems calculated to sass those who would reject the entire principle of physiological causes of character. The general principle he did espouse quite earnestly, of course. I think he chose "digestion" partly to obtain this contrast: that to be in a good mood - let alone feel love or experience god - first requires, among so many other requirements, that your shit be advancing commodiously through your guts. This is part of his broad attack on harmful aspects of idealism, romanticism, and religiosity.

I don't read german, though. I admit other readings are possible. And I admit he seemed totally serious about the resorption of semen being responsible, as a sort of quintessential nutrition, for the effects of celibacy - pretty much his most embarrassing gaffe ever. It's also true that he often got into lamarckian ideas.

I think Ni Chi's physiologism was generally very intelligent. I do think subclinical discomfort can alter character in ways that aren't always totally obvious. Do you read Cioran at all? I have only his "Temptation" and don't necessarily recommend it, but he's a funny example of a Nietzschean who sort of missed the first tenet Nietzscheanism - he consistently read his own severe depression into the world itself, rather than making an "interior citidel" where he could increasingly be apart from all things pathological.

Do you know much about Ni Chi's use of drugs/medicines? If there are particular biographic writings in english that you favor (or other secondary lit), I'd be obliged if you could point em out. I've read only Kaufmann's monograph.

I have a related idea that came to me while learning about ancient Greek religious processions, which were often preceded by a ritual (and actual) cleansing of the streets. I thought the city might have actually been healthier in the period afterward (less poo in the street has to be good) and that that would suggest the gods really approved of the cleansing. But rather than providing "proof" of religion's efficacy, it might just be that a high level of religiosity was selected for, because ritual cleansing that is inadvertently real cleansing shows up so often in religions (Judaism, Islam, ancient paganism), and surely had some benefit.

Well, the real claim is about having materialist beliefs vs. supernatural beliefs. If a medicine man is part of religion, then I'm not counting their services under the benefits of religion. I mean the supernatural, non-materialist parts of religion that would have steered you away from treatment based on materialist claims.

And sure, doctors (or whoever) could have done some good -- but just ask the i-bankers what happens when you profit, profit, profit, and then fail. You fail for good. A doctor could have set a bone here, given you a purgative there, but all it takes is that one infection that he gives you, or that one kooky fad that he starts adopting.

And that's the upper-bound of their contribution. It seems hard to escape the idea that those who avoided such people would've done better, all things considered.

"thanks to penicillin, but the mob attributed the magic to the NHS."

Well given that many of them would not have gotten penicillin without the NHS, that made the mob rather smart.

Do you read Cioran at all? I have only his "Temptation" and don't necessarily recommend it, but he's a funny example of a Nietzschean who sort of missed the first tenet Nietzscheanism - he consistently read his own severe depression into the world itself

Nietzsche eperimented with various diets and self-medications. He suffered from insomnia and used all kinds of sleeping potions, including chloral hydrate. He was serious about his physiological reductionism, in considerable part because of philosophical questions about determinism and the mind-body problem.

Alongside the idea that sexual repression causes war, misery, and injustice was a related idea that constipation causes war, misery, and injustice. People were more serious about that stuff than you'd expect. (It was a century of fad diets, extending well into this century.)

I think some people are grossly underestimating the degree to which ancient midwives (etc.) were any good.

Healers have often been pretty good at their job, within the limits of technology and their lack of understanding of, say, germ theory.

It's the relatively modern doctors that suck.

An interesting question. Here's a related one: "Does going along with Authority, even when its prescriptions lack common sense, confer a survival advantage?"

I would guess affirmatively, if for no other reason than doing the opposite can be dangerous in a despotism (tyranny being the historical norm). Being a maverick if you're not the King can be problematic. Saying that the Priestcraft's teachings are absurdities on their face, saying that Ceasar must be an idiot, saying that Stalin is a psycho, saying that "God" is as realistic as garden faeries...I've long guessed that there is a survival advantage to being an intellectually gullible human, for the same reasons that there is a survival advantage for domestic dogs to go along as they do with any and every perceived human command/desire.

If you doubt I'm correct, ask yourself how the temperament of the Japanese male arose.

Considering variolation, it may be that medical practice "broke even" in its impact a good ways before the 19th. After all, smallpox was the heavyweight champion of the world (unless it was malaria). The practice started in the west early in the 18th and may be a good deal older in India and China; it seems to go back at least to the mid 16th in China.

http://en.wikipedia.org/wiki/Inoculation

Rich Rostrum (by the way, I always make sure to read your comments everywhere),

I would emphasize that the below may be somewhat unrepresentative - after all it seems to have gone on only about "twenty years longer" which is not so much in the grand scheme of things.

But anyways it does show some opposition to medicine on the basis of religion. I found it via the wik article "vaccine controversy."

About the year 1721 Dr. Zabdiel Boylston, a physician in Boston, made an experiment in inoculation, one of his first subjects being his own son. He at once encountered bitter hostility, so that the selectmen of the city forbade him to repeat the experiment. [...] The violence of the opposing party knew no bounds; they insisted that inoculation was "poisoning," and they urged the authorities to try Dr. Boylston for murder. [...] insisting that [...] the smallpox is "a judgment of God on the sins of the people," and that "to avert it is but to provoke him more"; that inoculation is "an encroachment on the prerogatives of Jehovah, whose right it is to wound and smite." Among the mass of scriptural texts most remote from any possible bearing on the subject one was employed which was equally cogent against any use of healing means in any disease--the words of Hosea: "He hath torn, and he will heal us; he hath smitten, and he will bind us up."

So bitter was this opposition that Dr. Boylston's life was in danger; it was considered unsafe for him to be out of his house in the evening; a lighted grenade was even thrown into the house of Cotton Mather, who had favoured the new practice, and had sheltered another clergyman who had submitted himself to it.

To the honour of the Puritan clergy of New England, it should be said that many of them were Boylston's strongest supporters. Increase and Cotton Mather had been among the first to move in favour of inoculation, the latter having called Boylston's attention to it; and at the very crisis of affairs six of the leading clergymen of Boston threw their influence on Boylston's side and shared the obloquy brought upon him.

[...] the facts were too strong; the new practice made its way in the New World as in the Old, though bitter opposition continued, and in no small degree on vague scriptural grounds, for more than twenty years longer [and cropped up a few more times after that].

The same source also describes scripture-based opposition to anaesthesis. It also suggests that the introduction of quinine into England was delayed for 15 years by religious opposition, and its use combated even after its being introduced.

http://abob.libs.uga.edu/bobk/wh...k/ whitem10.html

I might mention that quinine was another quite early success against a very major disease. This source (same as above) dates its introduction to the west, but its possession by the american indians who pointed it out to europeans is perhaps aboriginal, I would guess/assume.

In the early years of the seventeenth century the Jesuit missionaries in South America learned from the natives the value of the so-called Peruvian bark in the treatment of ague [which basically means malaria -EJ]; and in 1638, the Countess of Cinchon, Regent of Peru, having derived great benefit from the new remedy, it was introduced into Europe. Although its alkaloid, quinine, is perhaps the nearest approach to a medical specific, and has diminished the death rate in certain regions to an amazing extent, its introduction was bitterly opposed by many conservative members of the medical profession, and in this opposition large numbers of ultra-Protestants joined, out of hostility to the Roman Church. In the heat of sectarian feeling the new remedy was stigmatized as "an invention of the devil"; and so strong was this opposition that it was not introduced into England until 1653, and even then its use was long held back, owing mainly to anti-Catholic feeling.


I could also note the herbal drug digitalis (not to mention opium, though the latter doesn't really fix anything).

The use of Digitalis purpurea extract containing cardiac glycosides for the treatment of heart conditions was first described in the English speaking medical literature by William Withering, in 1785,[3] which is considered the beginning of modern therapeutics (Silverman)[4][5]


And the treatment of scurvy - "The British civilian medical profession of 1614 knew that it was the acidic principle of citrus fruit which was lacking":

Scurvy was one of the limiting factors of marine travel, often killing large numbers of the passengers and crew on long-distance voyages. It even played a significant role in World War I.

[...]

Herbal cures for scurvy have been known in many native cultures since prehistory. In 1536, the French explorer Jacques Cartier, exploring the St. Lawrence River, used the local natives' knowledge to save his men who were dying of scurvy. He boiled the needles of the arbor vitae tree (Eastern White Cedar) to make a tea that was later shown to contain 50 mg of vitamin C per 100 grams

[...]

The British civilian medical profession of 1614 knew that it was the acidic principle of citrus fruit which was lacking, although they [dead wrongly -EJ] considered any acid acceptable when ascorbic acid (Vitamin C) was unavailable. In 1614 John Woodall (Surgeon General of the East India Company) published "The Surgion's Mate" as a handbook for apprentice surgeons aboard the company's ships. In it he described scurvy as resulting from a dietary deficiency. His recommendation for its cure was fresh food or, if not available, oranges, lemons, limes and tamarinds, or as a last resort, Oil of Vitriol (sulfuric acid).[6]

A 1707 handwritten book by Mrs Ebot Mitchell discovered in a house in Hasfield, Gloucestershire contains a "Recp.t for the Scurvy" that consisted of extracts from various plants mixed with a plentiful supply of orange juice, white wine or beer.[7]

Chis Anton, looks like your post got mangled

razib:
i regularly see the 19th or early 20th century as the "turn around" date for the efficacy of the medical profession in increasing, rather than decreasing, lifespan. anyone have a citation from where this comes from?

This is not the hard data you probably want, but Lewis Thomas's memoir "The Youngest Science: notes of a medicine-watcher" begins with the transition in the early 20th century. He talks about how his physician father knew that there was practically nothing positive he could do to help the patients, but that his colleagues did intervene, to negative net result. here is a summary of these first few chapters (with titles like "1911 Medicine,""1933 Medicine," "1937 Internship")

I second Fabian and Caledonian, among others on this thread. Vassar has proposed almost exactly the opposite theory, that people are evolved to respect priests and that doctors are priests. The evolved part is awfully specific; I can accept the second part while rejecting the first. There are some great parallels, like compliance: people acknowledge the authority of priests, but don't actually obey all that much.

Although he does not get into the relative merits of "prayer-based" healing vs. pre-antibiotic Western medicine, Lawrence Keeley, in his War Before Civilization, does note that "military medicine during the nineteenth century was worse than ineffective: it was positvely harmful" (95). Indeed, he contrasts the largely harmful techniques of nineteenth century Western medicine with the considerably less life endangering methods of "primitive healers," and finds that nineteenth century doctors were superior in only one area over their primitive counterparts: namely, WEstern surgeons'"ability to stop massive bleeding from major arteries and veins (96).

Here are a couple of predictions of the hypothesis. People would vary in the magnitude of harm suffered if the doctor (medicine man, etc.) screwed up. So even if the probability of a screw-up were the same across patients, the risk (= probability of harm * harm done) would vary a lot. For example, if he gave you a new infection, it would wallop your fitness a lot more if you were elderly than adolescent.

So, the groups who had greater expected risk should be more inclined toward the supernatural than those whose risk was lower.

The elderly, with their weaker immune systems and general greater frailty, should be more religious than the young -- yep.

Women, who could die from an infection during childbirth, should be more religious than men -- yep. (I think this effect is much smaller than the age one because men are also more likely to need battle wounds tended to than women, so this will reduce the male-female gap compared to the young-old gap.)

Others maybe?

I think Fabian is probably right.

If I assume no god exists, then I suspect religion has primarily been a way to ameliorate various different fitness-reducing effects of reason and self-awareness. Consider the Yanomamo. Their spirit world often provides casus belli, and this may be their spirituality's biggest effect on fitness. Reason might suggest that they extend their sympathy for their relatives also to these enemies, who appear awfully similar to themselves. Their delusion that those people have perpetrated fatal witchcraft lets them go to war without guilt.

Similarly, a male may need to perform dangerous feats to prove genetic quality. His self-awareness, however the hell such a monstrosity evolved (it doesn't really seem necessary), now has its own ideas which are sometimes fitness reducing. It likes existing and may want to avoid, sometimes, certain existential risks that are fitness-enhancing. If consciousness emerged gradually from a dim beginning, this problem (like the problem of the justice of war) would probably get accordingly worse as that process unfolded. Religion, promising immortality, assuages this rational anxiety and so smooths over one more specific threat posed to fitness by reason.

Similarly, a male may need to perform dangerous feats to prove genetic quality. His self-awareness, however the hell such a monstrosity evolved (it doesn't really seem necessary), now has its own ideas which are sometimes fitness reducing.

interesting in light of the fact that males seem to exhibit a robust pattern of being less likely to be supernaturalistically inclined than females.

"Does going along with Authority, even when its prescriptions lack common sense, confer a survival advantage?"

The best strategy is to go along without getting too serious or volunteering for the front lines, and to desert or betray the authority when it seems to be crumbling.

On smallpox vaccination, what I've read tells me that before Jenner "discovered" a kind of vaccination, it had been a deliberate folk remedy. He didn't just notice empirically that milkmaids seemed resistant to smallpox; milkmaids had noticed it themselves, and were deliberately infecting themselves with cowpox. To all intents and purposes, Jenner developed an old wives tale that had a degree of reality behind it.

The discovery of penicillin was purely empirical too -- Fleming didn't clean his glassware properly and noticed that something was killing his bacteria cultures.

Perhaps those were times when discoveries were lying on the ground to be picked up for nothing. Alternatively, maybe discovery depends more on luck and alertness than people realize, and not so much on powerful scientific methods. (For example, economists are all smarter than me, and their methods are powerful, but a lot of them have made fools of themselves in the last ten years or so.)

Because before roughly 50 to 100 years ago, going to the doctor was worse than doing nothing. He bled you, gave your wife a disease by not washing his hands while delivering her baby, etc.


This seems to be referring to the Christian and Western perspective. I'm not aware of widespread religious aversion to doctors in Islam, Buddhism, Hinduism (even within the West it seems limited in sect and time.) Galen's approach to medicine lined up quite well with the Koran and so Islamic civilization made much use of his work in the middle ages.

I was always under the impression that medieval peasants had little access to doctors. So whether they would reject their services or not was of little importance.

If a woman died due to doctor assisted childbirth in which she delivered a healthy baby, how much would that affect natural selection? Isn't it more important that genes passed to the next generation than that the mother had a longer life expectancy?


Doctors of the Incan Empire, for example, were able to do more good than harm with surgeries for head trauma. Some skulls indicate men that had more than one such surgery during their lifetimes. This did not present a conflict for their religion.

Touche.

What about religion allaying anxiety and melancholy over other peoples' death (and one's own eventual doom). Even despite religion we still see many people experiencing clearly fitness reducing grief. This one fits the gender difference in religiosity, since women are more anxious and more sentimental in their interpersonal attachments, men a little more callously and rationally self-interested. Even atheists are typically driven to explore stoic-like philosophical thoughts, if not something much /less/ austere than stoicism.

I also think a special class of group-selective models is appealing: namely those in which the phenotype has trivial cost to the individual, and so group selection won't be swamped by individual selection. Consider, say, the potential role of the supernatural in inter-group alliances (I don't know enough ethnography to take this beyond the hypothesization.)

Sure, proclivity for inter-group alliance could be increased in other ways. You could just evolve a brain that, well, simply /is/ disposed toward inter-group alliances. There's no absolute need for any sort of ideas or rationales to be involved in producing a behavior: we all want to kiss sexually attractive people in a stereotyped way, etc, but certainly not because there is some rationale or explanation for doing it.

And yet, if a faculty for supernatural rationale simply happens to be the /fastest/ way to get to the pinnacle of a new fitness peak (or very close), then that's the way it will happen. Pre-adaptation, as they say. Humans were probably already having lots of thoughts by the time they needed to further sophisticate their inter-group politics, so thoughts might as well be recruited into the "effort" to evolve new behavior. Whereas the more ancient hominids that developed amorous kissing may not have been able to think in the rather unlimited way that we can think today.

I think this is a fair way to analyze "ideas," "rationales," and "consciousness," even though we don't really know why awareness would evolve in the first place instead of a dumb computer-brain that produces all the exact same behaviors.

> Isn't it more important that genes passed to the next generation than that the mother had a longer life expectancy?

One child is good, but ten children is ten times better. So it won't do to die in your first or second childbirth.

I think there's something to be said, at least in theory, for the efficiency of bundling all fitness-enhancing irrationalities into one comprehensive system which protects them against reason. One stick is weak; the bundle is strong - and can more easily and efficiently evolve to be stronger yet.

Man got kind of sucked onto reason like a person who touched a live wire. Evolution could not "anticipate" that logic would turn out to have backbone, a substance of its own, because of its systematicness and connectedness. It doesn't want to play by the rules of fitness; it has a life of its own. It has a certain resistance to being tinkered with and fitness-optimized. In fitness terms this was a tremendous "waste" and misfortune at the very heart of a thing which was so good. It would be hard, and unwieldy, to use a silly example, to evolve to rationally believe in euclidean geometry in the springs and riemannian geometry in the autumns, even if that were fitness enhancing. It would be hard to retain the feeling that you must do everything to save your life, yet also feel that death is nothing to worry about. That you should sympathize with your relatives and allies, but not sympathize a la Socrates with enemies who objectively speaking seem awfully similar to yourself and your allies.

What's needed is a citidel of unreason that can organize all these different irrational behaviors and feelings into something that can actually overrule logic.

"Well given that many of them would not have gotten penicillin without the NHS, that made the mob rather smart." What? So Americans couldn't get penicillin, for example?

Another observation from Keeley, in his WAR BEDORE CIVILIZATION, concerns the expanded role of women in 19th century health care:
...I am convinced that one of the most effective innovations in nineteenth- century military medicine was the begrudging acceptance of women nurses. Victorian sexism focused women's intelligence and practical curiosity on precisely those subjects that were eventually recognized as primary medical concerns-cleanliness (antisepsis), nutrition, convalescent care, and patient morale.

Although Keeley holds that nurture accounts for women's critical role in improving health care, I wonder if nature might not also play a role. Perhaps women, along with being more religious than men, are also innately more "health-conscious" (at least in the areas that Keeley lists)than men are? Indeed, one might even note that such health topics as cleanliness, nutrition, convalescent care, and patient morale are exactly the areas where religiously prescribed health care regimes and scientific medicine converge.

One additional point: a lot of comments here point out some effective intervention or other, whether it's bonesetting or stopping blood loss or Incan trepanning. But being effective in one specific area is not sufficient, unless

- no one expects you to do anything else (say, you're a midwife)
- you have a good enough grasp of your own limitations to do nothing in cases where you can't help, *and* you can either convince people to accept this or have a handy placebo treatment for these cases (seems implausible)
- your medical tradition includes a lot of placebos, but you yourself don't know this (I think homeopathy is like this)

More usually, though, the pressure to do something (even in cases where the medical professional / witch doctor had no effective treatment) would encourage damaging interventions. And doctors who overstated their capabilities (whether from self-delusion or deliberate fraud) would displace those who presented their abilities accurately, assuming they had the same actual competencies.
So having a few effective treatments may not result in a net positive contribution if you're forced to act in too many other areas.

I've seen the statement attributed to Abraham Flexner that it was only around 1900 that the average patient with the average disease seeing the average physician had a better than 50% chance of being helped. There are a number of imprecise terms in that formulation, but Flexner was probably as qualified to make the estimate as anyone.

Liesel:

Trepanning wasn't a therapeutic practice among the Incas. It was intended as precautionary punishment typically inflicted on two different classes of malefactors: 1.) those who negligently dispensed ruinous investment advice; and, 2.) those who, repeatedly, told either long-winded or unfunny after-dinner jokes.

No record survives of whether they ever convicted the guy who told them "Never trust a Spaniard. Kill 'em all." Seems they couldn't decide whether the guy meant it as advice or was simply joking.

bbartlog wrote you have a good enough grasp of your own limitations to do nothing in cases where you can't help, *and* you can either convince people to accept this or have a handy placebo treatment for these cases (seems implausible)

A good point, indeed. I would expand this to society as a whole accepting that even modern medicine has a window of application. OBs, in particular, are expected to act as gods and anticipate any and every possible situation then sued when the fall short.

Realistic expectations in the minds of doctors, patients and jurors regarding what a physicisian can actually accomplish would likely reduce the multi-million dollar settlements based on raw emotion.