Respectful Insolence

NOTE: Because I’ve been (kind of) relaxing over this holiday period, this is not an entirely new post. It is, however, a significantly expanded and reworked version of a post from nearly four years ago. So if you haven’t been reading four years, it’s new to you, and if you have you might or might not remember it.(Who remembers a blog post four years later? I’m not that good—usually.)

Those who know me and/or follow me on various social media know that I’m a big Doctor Who fan. I have been since the 1980s. So the last two big events of the year, the 50th anniversary special in November and the Christmas special on, well, Christmas got me to thinking about time travel, and thinking about time travel. It’s a fun topic to do as the year 2013 fades out, not to mention a way for me to blatantly sneak Doctor Who references into an SBM post.

Being a Doctor Who fan and all, not surprisingly, I’ve often wondered what it would be like to be able to travel through time and visit times and places in history that I’m most interested in. For instance, being a World War II buff, I’d certainly want to be able to check out what every day life was like here in the U.S. during World War II. Given my affinity for psychedelic music and that I was only four years old during most of the Summer of Love, I’d think it cool to check out Haight-Ashbury, although I suspect my reaction to the reality of it would be similar to that of George Harrison when he checked it out for the first time. I guess, if pushed, I’d have to admit that if I were old enough to have been a high school or college student in 1967, I probably would have been one of those straight-laced, short-haired types destined either to go to college to become a doctor or an engineer or to go to Vietnam to fight. Despite loving the music, I never had any interest in experimenting with the drugs. Heck, I never even tried to smoke tobacco. Even as a child I couldn’t stand the smell of cigarette smoke to the point where it was never even rally a temptation.

In any case, what provoked my self-indulgent little bit of end-of-year musing was a post a few years ago by Martin Rundkvist, who wrote about Fear of Time Travel, where he imagines what it would be like for a modern person to be transported back in time:

First, imagine that you’re dropped into a foreign city with only the clothes you wear. No wallet, no hand bag, no money, no cell phone, no identification. Pretty scary, huh? But still, most of us would get out of the situation fairly easily. We would find the embassy of our country of origin, or if it were in another city, contact the local police and ask to use their phone. A few days later we would be home.

That’s not the scary scenario I rehearse. Imagine that you’re dropped into the city you live in with only the clothes you wear. No wallet, no hand bag, no money, no cell phone, no identification. And it’s 500 years ago. (Or for you colonial types, 300 years ago in one of your country’s first cities.)


It’s a fun thought experiment, with Martin pointing out that you would speak the language with what to the natives living at that time would seem a very strange and nearly incomprehensible accent. Think of how hard it is to understand the English spoken in Shakespeare’s plays, which is full of idioms, turns of phrase, and vocabulary peculiar to the time, and then just think about the number of words that we use that would be incomprehensible to, say, an American living in the Midwest, which at the time for where I live would have been ruled by the French as part of New France but mostly populated by indigenous tribes. So for purposes of the thought experiment, I’ll pick New York or Boston. I could also make like The Doctor and claim imagine that the TARDIS (or something else) had given me the ability to speak the native language and appear to be dressed like everyone else. Or I could imagine that I didn’t understand the language and had to learn it. Over time, it wouldn’t really matter. Here’s the part of Martin’s thought experiment that caught my eye:

Some might think that a well educated modern Westerner would soon become one of the sages of the age thanks to their superior technological and scientific knowledge. For one thing, it wouldn’t be hard for most of us to become the best doctor in the world of AD 1509 if knowledge was all it took. But I have a feeling that such knowledge would not be easily applied in a society that is completely unprepared for it, and not easily implemented in an environment where none of today’s infrastructure exists. And say that you’re actually a doctor or an engineer – how much could you achieve without access to any materials or tools invented in the past 500 years? I mean, I know the principles of nuclear fusion, aviation, antibiotics, vaccination and basic biochemistry, but don’t ask me to put them into practice starting from scratch!

Well, I am a physician and surgeon, and I don’t know if I could elevate myself to a sage of the age with my knowledge. The reason is that so much of what I do and have done in medicine relies on the technology and science of the time—this time, as in the decades between 1984 (when I entered medical school) and now. Let’s start with something very, very basic. I’m a surgeon. I try to cure or treat diseases by operating. Operating on a patient, however, is very difficult without reliable anesthesia, and inhalational anesthesia using ethyl ether wasn’t discovered and widely applied until the 1840s. Before that, there were various herbal anesthetics and hypnotics, natural drugs like opium extracts and later morphine, and even alcohol. While these may have sufficed for minor operations (barely), they were not at all sufficient for doing anything major, such as entering a major body cavity like the abdomen or chest.

That’s why, before anesthesia, surgeons had to be fast, and surgery was very bloody. Think of Abigail “Nabby” Adams Smith, the first born of our second President, John Adams. She was diagnosed with a malignant tumor of the breast and underwent a mastectomy without anesthesia, the gruesome details of which were described both in David McCollough’s biography John Adams and in Jim Olson’s Essay on Nabby Adams:

Nabby entered into the room as if dressed for a Sunday service. She was a proper woman and acted the part. The doctors were professionally attired in frock coats, with shirts and ties. Modesty demanded that Nabby unbutton only the top of her dress and slip it off her left shoulder, exposing the diseased breast but little else. She remained fully clothed. Since they knew nothing of bacteria in the early 1800s, there were no gloves or surgical masks, no need for Warren to scrub his hands or disinfect Nabby’s chest before the operation or cover his own hair. Warren had her sit down and lean back in a reclining chair. He belted her waist, legs, feet, and right arm to the chair and had her raise her left arm above her head so that the pectoralis major muscle would push the breast up. A physician took Nabby’s raised arm by the elbow and held it, while another stood behind her, pressing her shoulders and neck to the chair.

Warren then straddled Nabby’s knees, leaned over her semi-reclined body, and went to work. He took the two-pronged fork and thrust it deep into the breast. With his left hand, he held onto the fork and raised up on it, lifting the breast from the chest wall. He reached over for the large razor and started slicing into the base of the breast, moving from the middle of her chest toward her left side. When the breast was completely severed, Warren lifted it away from Nabby’s chest with the fork. But the tumor was larger and more widespread then he had anticipated. Hard knots of tumor could be felt in the lymph nodes under her left arm. He razored in there as well and pulled out nodes and tumor. Nabby grimaced and groaned, flinching and twisting in the chair, with blood staining her dress and Warren’s shirt and pants. Her hair matted in sweat. Abigail, William, and Caroline turned away from the gruesome struggle. To stop the bleeding, Warren pulled a red-hot spatula from the oven and applied it several times to the wound, cauterizing the worst bleeding points. With each touch, steamy wisps of smoke hissed into the air and filled the room with the distinct smell of burning flesh. Warren then sutured the wounds, bandaged them, stepped back from Nabby, and mercifully told her that it was over. The whole procedure had taken less than twenty-five minutes, but it took more than an hour to dress the wounds. Abigail and Caroline then went to the surgical chair and helped Nabby pull her dress back over her left shoulder as modesty demanded. The four surgeons remained astonished that she had endured pain so stoically.

Without effective anesthesia, I could do no better than these surgeons from 200 years ago or the surgeons from 300 years ago. In fact, I would probably do much worse, because I’m used to operating in a deliberate fashion, cauterizing individual blood vessels as I go. The reason surgery before science-based inhalational anesthesia was discovered was “cut and slash” was because it had to be. To do otherwise was to prolong what was quite literally the torture of the patient. I wasn’t trained to operate that way. I’m not used to operating that way, and there was no such thing as a Bovie electrocautery machine back then. It would all be scalpels, hot irons, and scissors–or, as in Nabby Adams’ case, razor blades and, in essence, a set of tongs to elevate the breast. It’s another reason why surgeons were frequently so fast in doing amputations that their assistants had to be careful not to let their fingers get in the way. As for more extensive operations, even with the anesthesia available in the latter half of the 1800s, a full 150 years after the time period Martin’s thought experiment envisions, there was no way to control respiration. Anesthesia was a delicate balance between not putting the patient so deep that he stopped breathing but putting him deep enough so that he wasn’t reacting overmuch to the surgical stimuli. Mechanical ventilators were an invention of the 20th century.

That’s just one example. There are numerous other tools, disciplines and examples of knowledge that a modern science-based surgeon depends upon in order to do his or her job, such as antibiotics and germ theory, pathology to identify what a patient has based on tissue samples, transfusions, and a wide variety of medications, to name a few. Then there’s diagnostic radiology. There would be no CTs or MRIs; there wouldn’t even be X-rays. Indeed, even something as simple as suture would be a problem. The needles used 300 years ago were huge by today’s standards because of the difficulty making small needles. The technology to do it was not widely available. Throughout history, needles were made of bone or metals such as silver, copper, or bronze, while sutures were made of either cotton, flax, hemp, silk, or even tendons and nerves. There was a reason they called “catgut” suture catgut. Although cat gut suture was not made from the actual gut of cats, it was made from actual gut–connective tissue from intestines. (Actually, cat gut was pretty good suture and was still occasionally used 20 years ago, when I first started my residency, mainly by the older surgeons.)

In any case, I think Martin’s right in that, without the infrastructure and scientific background being there, it would be very, very difficult for a surgeon of 2013 like me to recreate much of anything that I do now in the year 1713, even if I were dropped into Boston among the most learned physicians of the age. No one there would have any idea of germ theory (and thus sterile technique, both of which were at least 150 years away), anesthesia (which was 130 years away), or much of basic physiology. Indeed, at that time, diseases were thought to be caused by imbalances in the four humors or miasmas, for the most part. If I were to try to explain the concepts that underlie the science-based medicine of today to the learned men of the time, assuming I could master the dialect of 300 years ago and find a way to describe the concepts to them, they’d assume I was either mad or a witch. It would be a good thing for me that the wave of witch hunts that swept through New England was pretty much over by the early 18th century.

There is one area that I can think of where a surgeon of 2010 might be able to translate some of his knowledge into 1710 and hope to have some influence. The first, of course, is sterile technique. It would not be that huge of an undertaking to sterilize instruments (although sterilizing sutures would be very problematic), either in flame or in alcohol. It would probably not be that huge a challenge to use alcohol, carbolic acid, or some other compound to clean the operative field, the patient’s skin, and one’s hands. (Given the lack of latex or rubber gloves, I’m not sure if it would be possible not to operate with my bare hands, as surgeons of the time did–and in fact continued to do until the late 1800s and beyond). In other words, I could be Joseph Lister 150 years before Lister showed the benefits of antisepsis, who didn’t publish his seminal paper on the benefits of antisepsis until 1867.

Come to think of it, I could potentially be Louis Pasteur, again 150 years before Pasteur did much of his work. At the very least, I could figure out how to replicate his experiments disproving abiogenesis and to develop Pasteurization. Of course, convincing the world of 1710 of the validity of these ideas would be even harder than it was for Louis Pasteur to convince his contemporaries of germ theory, because far less of the ground work would have been laid. SBM builds on the science of the times incrementally, and if the requisite prior discoveries haven’t been made yet it’s hard for new science-based modalities to take hold. Lister’s discovery, for instance, didn’t take hold in the US until over a decade after it took hold in Germany because of resistance to the germ theory of disease.

In fact, it brings up an issue that should demonstrate just how hard it would be to convince the physicians and surgeons of 1713 of our knowledge. Consider something as simple as blood pressure. Although the ancient Egyptians knew enough to palpate pulses, the very first measurements of blood pressure (more accurately, pulse pressure) were not made until 1733 (twenty years before I’d be dropped into New England) by Stephen Hales, who measured the blood pressure of a horse. It was not until 1855 when the first sphygmomanometer was devised by Vierordt of Tubingen, an instrument called at the time the sphygmograph, which was considerably improved upon by Etienne Jules Marey in 1860. Before this, it was not possible to measure arterial blood pressure other than under surgical conditions using a canula inserted directly into an artery. Finally, the modern version of the sphygmomanometer was invented by Samuel Siegfried Karl Ritter von Basch in 1881, but Italian physician Scipione Riva-Rocci improved upon it by producing a more easily used version in 1896. After that, Harvey Cushing discovered the device during a visit to Italy in 1901 and popularized its use in the U.S. after he returned home. What all this means is that the routine measuring of blood pressure as a “vital sign” in virtually all patients did not become truly routine until 100 years ago. Even more amazing, it was still 20 years before Russian physician Nikolai Korotkov popularized the use of the device to measure diastolic blood pressure as well, meaning that the systolic/diastolic blood pressure ratio that we’re all familiar with didn’t become routine practice until the 1920s.

Hmmm. Maybe I could be Harvey Cushing 200 years before Harvey Cushing was in his prime.

In any case, if there’s one thing this little thought experiment has done for me, it’s to make me realize how much of what I do depends on hundreds of years of history and science and any achievements I may have in my career rest squarely on the shoulders of giants. I’ll take another example from my very own specialty, the “god” of modern surgery William Stewart Halsted, who practiced surgery from the late 1870s until his death in 1922. During that time, he pioneered so many surgical advancements that it’s amazing that one person came up with so many ideas and pushed the envelope so much.

In imagining myself 300 years ago trying to replicate such advances more than 150 years sooner than Halsted, I have to think about the sorts of resistance he encountered. For example, when he was working at Bellevue Hospital in New York Halsted saw Joseph Lister present his discoveries. Inspired by Lister, Halsted tried to convince hospital administrators to construct a sterile operating room. The hospital refused, because it would have been very expensive and was considered at the time to be “wildly innovative.” (The administrators, I suspect, didn’t mean that in a good way.) So Halsted used $10,000 of his own funds to erect a tent on hospital grounds. He equipped it with maple floors, gas lights, and sterilization facilities. Basically, it was the first planned sterile operating environment in the US, possibly in medical history. Ironically, Halsted had also pioneered the use of sterile latex operating gloves because his fiancee’s hands (she was his nurse at the time) complained that complained that the antiseptic mercuric bichloride had caused dermatitis on her hands. Given how much difficulty physicians and scientists like Halsted and, before him, Ignaz Semmelweis and Louis Pasteur had convincing a scientific world that was primed for their discoveries, imagine how much difficulty I would have convincing the physicians and scientists of 1713 of my discoveries. I can’t help but think that if I were to be dropped in Europe in 1513 (Martin’s original idea of traveling 500 years back in time), I might be introduced to the Tribunal of the Holy Office of the Inquisition, depending upon where in Europe I ended up.

Of course, Halsted was also often rather adventurous (some might say overly so) in his achievements, for example:

In 1881, while visiting the family home in Albany, New York, he performed the first emergency blood transfusion, drawing his own blood and injecting it into his sister’s bloodstream when he found her passed out from a postpartum hemorrhage. The next year he performed emergency gall bladder surgery on his mother, performing the operation on her kitchen table — administering ether to knock her out, sanitizing his hands and equipment by dipping them in carbolic acid, then slicing into her abdomen and gall bladder, draining vast amounts of pus and removing seven stones — the first recorded surgery to remove gallstones.

Obviously, both of these emergencies could have ended disastrously. Halsted’s sister could easily have died from a transfusion reaction, given that virtually nothing was known at the time about immunology or blood typing, and his mother could easily have died due to her home surgery, although given the lack of antibiotics she would almost certainly have died without treatment. No doubt Halsted knew that.

How I treat breast cancer also depends upon hundreds of years of painfully gained advances in scientific knowledge and is (usually) the best that can be achieved at the time. This inevitably brings me back to the example of Halsted. Halsted performed the first radical mastectomy in 1882. It was a long, extensive, and bloody operation for the time. In talks on the history of breast cancer surgery that I have given, I like to point out that, early on, Halsted’s surgery was viewed as butchery. However, as his survival data matured and it turned out that he produced survival rates better than other surgeons operating at the time, his method became the standard of care for the next 80 years. Yes, it was brutal surgery, but it made sense at the time. When Halsted operated, there was no chemotherapy. Even though Emil Grubbe had demonstrated the first use of radiation to treat cancer in 1896, radiation therapy was crude and the concept of adjuvant radiation therapy was decades away. If breast cancer was going to be cured, surgery alone would have to do it, and, given the scientific understanding of cancer at the time, it made sense to perform a radical resection of the breast and all lymph nodes to which the cancer might drain. Later scientific discoveries and developments rendered such radical surgery unnecessary, but, although it can be argued that such surgery persisted as the standard of care too long after other, less disfiguring, surgery became possible, it makes no sense to criticize the surgery as barbaric when at the time it was the best available and was consistent with the science of the time.

Finally, this fun little thought experiment brings me back to the present through the lens of history. Critics of SBM, in particular those who advocate what we like to call unscientific medicine or pseudomedicine, often make the claim that today’s treatments of cancer will, 50 or 100 years from now, be considered barbaric and unscientific. This sort of idea is sometimes expressed in pop culture as well. Indeed, one is reminded of a scene in Star Trek IV: The Voyage Home (whose plot, not coincidentally, involves the crew of the Enterprise time traveling back to San Francisco in 1986). In that scene, some of the crew finds itself in a hospital of 1986, and Dr. Leonard “Bones” McCoy is horrified at dialysis, which he likens to the Dark Ages:

Later in the scene, he likens a debate between two residents about radical chemotherapy to the “goddamned Spanish Inquisition.”

Did I ever mention, by the way, that Dr. McCoy was one of my inspirations for becoming a doctor?

Of course, this movie scene is a perfect way to end this post. In STIV, the time difference is 300 years, the crew of the Enterprise having traveled back from Star Date 8390, which corresponds to the year 2286, back to the year 1986. Perfect! This is pretty much the same as my traveling 300 years back in time to 1713, at least enough for my purposes. I’ve tried to give you a flavor of how different that world was in terms of medicine and how out of place my skills would be there. All that I know about medicine and all of my skills as a surgeon and scientist, rest on the advancements of anatomy, chemistry, physiology, and science that have been painstakingly discovered, mostly over the last 300 years—actually, mostly over the last 150 years. So it’s not at all unreasonable to guess that to a fictional doctor from nearly 300 years from now our medicine would seem as primitive as the medicine of 1713 does to a physician like me from today. However, disparaging such medicine as primitive and brutal is misguided. The medicine of 1713 was brutal and primitive because the science didn’t yet exist to make it otherwise. A physician traveling back to that time would discover just how true that is and how difficult it would be to convince his peers of the time of how much better his science and treatments are.

In other words, even if it is true that the science-based medicine of 2313 would be as far ahead of the science-based medicine of 2013 as the SBM of 2013 is compared to the best of 1713 (or the fictional SBM of 2286 is compared to that of 1986), that’s beside the point. We don’t know the science that will inform the medical advancements of the next 300 years any more than physicians of 1713 had a glimmer of an idea of the advances and discoveries that would be made over the next 300 years from them. SBM is always changing and adapting in response to new scientific discoveries. The process is often slower and messier than we would like, but it does continue. The SBM of today will give way as new discoveries are made, and it is not at all shameful if medicine in even 50 years is very different than it is now. After all, medicine now is much different in so many ways than it was in 1963, and that doesn’t make the physicians of 1963 incompetent. Like us, they were products of their time.

Finally, it occurs to me that the way medicine was practiced 300 years ago here in the colonies bears a lot of resemblance to many “alternative” therapies. Medicines back then were virtually all derived from herbs or animal products, often the herbs or animal products themselves, unpurified. Germ theory was at least 150 years in the future, and disease was thought to be due to things that very much resemble alt-med’s concepts of disturbances in the flow of qi. While I might be very much a fish out of water in 1710 as far as trying to practice medicine and surgery, I suspect many “alternative” medicine practitioners would not be, and that’s the difference. SBM changes substantively as science advances. In “complementary and alternative medicine,” (CAM), the ideas remain the same, and only the names change.

Comments

  1. #1 Carolyn
    December 30, 2013

    Make sure to watch The Five(ish) Doctors Reboot, Peter Davison’s video about how he and Colin and Sylvester DID make it into the 50th Anniversary Special. Lot of real laugh out loud moments.

    http://tinyurl.com/nuck9t9

  2. #2 Lowell Gilbert
    December 30, 2013

    Even Pasteurization is harder than it appears. The concept is easy enough, and heating milk is not complicated to do in anything that might be called a “kitchen.” But even if you practiced it on milk in 1713, it would be less effective than we expect, for a number of reasons: heating the milk evenly would be difficult (a particular problem since overheating it will damage both taste and nutrients); the storage and transport would be using less-than-sterile containers; and, of course, higher storage temperatures would limit the amount of time you could stay ahead of the bacteria.

  3. #3 Sarah A
    December 30, 2013

    I’ve sometimes tried to explain a very similar idea to people who think that the auto companies are sitting on a design for a 300 mpg car, or that Big Bad Pharma has the technology to cure various chronic diseases but won’t because they make more money from long-term treatments. Such conspiracy theories fail to take into account the fact that new inventions and ideas don’t occur in a vacuum – they are enabled (sometimes, it seems, almost necessitated) by the knowledge and technology that already exists at the time. That’s why patent disputes can be so fierce, and why researchers worry about getting “scooped.”

    On a lighter note, if a complete noob wanted to get into Dr. Who and see what all the fuss is about, where would be a good place to start?

  4. #4 Mark Thorson
    December 30, 2013

    If you introduced homeopathy and Dianetics in 1710, you could definitely become a sage of the age. Then, you could use the profits to build a large clinic and laboratory to pursue your weird hobbies, like the so-called germ theory.

    Cholera was common in those days, so I suppose introducing oral rehydration therapy would have had the biggest impact in real medicine using only stuff available in those days.

  5. #5 Mephistopheles O'Brien
    December 30, 2013

    @Sarah A – It all depends on how far back you want to go, your interest in history, and tolerance for varying production values.

    If you’d like to begin at the real beginning, you need to start with the episode “An Unearthly Child”, which introduced (but did not significantly explain) the Doctor.

    If you’d like to skip ahead a bit and get just as good an introduction to the modern Doctor Who, you should start with the “Series 1″ episodes starring Christopher Eccleston. These are substantially higher budget episodes than the early ones, and since it had been off the air for many years there’s a re-introduction of many of the concepts and characters. If you choose to continue watching, this series also brings up a number of continuing questions, issues, and concepts that will be further explored in the later series.

    My first Doctor Who episodes were back in the 70s with Tom Baker.

    You should be able to find these on DVD at many libraries, or streaming through Netflix or iTunes.

  6. #6 jane
    December 30, 2013

    I’ve always found it strange to bash traditional medicine for never changing and then turn around and bash it for changing (e.g., claiming wrongly that acupuncture didn’t exist before Chairman Mao). There have been several significant surgical traditions before ours (e.g., that described in the Sushruta Samhita), though certainly none anywhere near as skilled or elaborate as ours. All developed some means of trying to ensure cleanliness, though this must have been done by trial and error as there was no germ theory, and no reason there should have been without microscopes.

  7. #7 Erp
    December 30, 2013

    I suspect the most accessible ways of improving health without the later infrastructure would be
    (1) Vaccination using cowpox against smallpox
    (2) Clean drinking water (cholera wasn’t to hit Europe/America for another 100 years but there are other water borne diseases) and proper washing.
    (3) Possibly dealing with mosquitos though I’m not sure how cheap and how good the netting one could make at that time would be.

  8. #8 Orac
    December 30, 2013

    I’d recommend starting with “An Unearthly Child.” The first episode, at least, is surprisingly good, even by today’s standards, although the three episodes that follow about the trip back in time to the caveman era are less than stellar. I’d also watch “The Daleks,” which is the next Doctor Who story and introduces the series’ most famous villains. They remain surprisingly consistent right from the beginning. I’d also check out the next two episodes, a two-part story called “The Edge of Destruction.” It’s the first Who story in which the TARDIS is portrayed as being alive and at least somewhat self-aware.

    Next I’d skip ahead to a couple of Patrick Troughton (Second Doctor) stories, such as “The Tomb of the Cybermen,” which is a classic example of a story type that dominated the Second Doctor’s tenure, namely the “base under siege” story. I also recommend “The War Games,” which, although too long by at least a couple of episodes, first introduces the Time Lords.

    From the Third Doctor’s (Jon Pertwee’s) era, I’d check out his first story, “Spearhead from Space,” as well as “Terror of the Autons” (a great combined Master-Autons story) and maybe “The Green Death” (nice environmental preaching, typifying early 1970s TV).

    It’s hard to go wrong with the Fourth Doctor (Tom Baker), but I’d start with his first two seasons. Not a bad story in the lot, although “The Brain of Morbius” was a bit over-the-top, even for me. Heck, I’d watch all of his episodes, although the story quality became rather uneven towards the latter half of his tenure before rebounding in his final season.

    The Fifth Doctor (Peter Davison) is good, too. I’d recommend checking out “Earthshock” and his final story, “The Caves of Androzani,” the latter of which regularly appears at or near the top of lists of the best Who stories of all time, and deservedly so.

    You can pretty much skip the Sixth Doctor (Colin Baker), although if you’re curious “Vengeance on Varos” and “Revelation of the Daleks” aren’t too bad. This era wasn’t bad so much because of Colin Baker (whose Doctor I rather liked), but because the scripts were almost uniformly awful, and the 1980s cheese took center stage in everything.

    I have a particular fondness for the Seventh Doctor (Sylvester McCoy, who these days is playing Radagast in the “Hobbit” movies), although his start was rough. (His first story was awful.) Of his stories, I rather like “The Happiness Patrol,” “Remembrance of the Daleks,” and “The Curse of Fenric” (the last of which shows The Doctor at his most scheming).

    Finally, we get to the reboot, which is sometimes called “Nu-Who.” I concur with Mephistopheles; this one is good to start at the beginning, with the Ninth Doctor (Christopher Eccleston). He was great; too bad his tenure only lasted one season. Best episodes from the Nu-Who Doctors:

    Christopher Eccleston: “The Empty Child”/”The Doctor Dances.” (But, then, I’m a sucker for a WWII story, and Captain Jack Harkness is introduced in this story.)

    David Tennant: Lots to choose from. Some that come to mind are: “School Reunion”; “Human Nature”/”The Family of Blood”; “Silence in the Library”/”Forest of the Dead”; and “The Waters of Mars.” Heck, just go straight through the David Tennant era. Only a small handful of crappy stories (“Fear Her” and “Love and Monsters,” the latter of which was a good idea poorly executed with a truly disgusting ending).

    Matt Smith. Also lots to choose from, but the plots get harder to follow because of Steve Moffatt’s love of “timey-wimey” stuff. Personally, I’d just follow these through, too. Standouts, however, include “The Eleventh Hour”; “The Time of Angels”/”Flesh and Stone”; “The Impossible Astronaut”/”Day of the Moon”; and “The Girl Who Waited.”

  9. #9 Mephistopheles O'Brien
    December 30, 2013

    jane – I believe you’ve chosen to misunderstand the nature of that particular critique. Traditional medicine isn’t bashed because of its ability to change; it’s bashed because it is not proven safe and effective. The particular example you cite is a counter to the appeal to antiquity – how can one really argue that acupuncture must work because it was used for thousands of years if what was used for thousands of years was substantially different from what is done today?

    If the various traditions did discover that cleanliness and sanitation improved the results of surgery – good for them.

  10. #10 Mark Thorson
    December 30, 2013

    Erp, Jenner thought the virus he used was cowpox, but the Vaccinia we have today which is descendent from his strain is clearly not cowpox, nor is it smallpox, though it’s closely related to both. It’s a great mystery what it is and where it came from. It may still exist in the wild, undiscovered, in some mammal. It may be extinct in the wild. Genetic studies indicate its closest known relative is horsepox, but Vaccinia is distinct from horsepox.

  11. #11 Mrs Woo
    December 30, 2013

    My first Doctor Who episodes were with Tom Baker, too. We even wrote in and had my stepmother made “Whovian of the day” for her birthday one year. :)

    Fascinating thoughts.

  12. #12 AstroLad
    December 30, 2013

    Poul Anderson explored the idea in “The Man Who Came Early” (http://en.wikipedia.org/wiki/The_Man_Who_Came_Early). A 20th-century GI dropped into 10th-century Iceland. A Connectiuct Yankee it’s not.

  13. #13 Denice Walter
    December 30, 2013

    Because I survey woo, I often feel like a time traveller myself.

    Amongst the many blasts from the past are;
    life energy
    spiritual healings
    typing people via concepts that resemble the 4 humours
    naturalism
    taboo foods
    healing with vibrations, gems, herbs, minerals, catharsis
    fear of technology
    magic foods
    reliance upon testimonials
    lectures that resemble religious revivals
    belief that novices can overturn scientific consensus
    belief in ‘changelings’
    mistrust in the media
    belief in a just world
    reliance upon persuasion and other tricks
    and much more.

    HOWEVER there is one constant:
    the prediction that *soon* they will prevail as the much-vaunted paradigm shift transpires and they’ll be elevated to their rightful position.

    - sigh-

  14. #14 Johanna
    December 30, 2013

    @SarahA

    I usually hook my new-to-Classic Who chums with the Tom Baker story “City of Death”. It was written by Douglas Adams (under a pen name*) and has everything a great DW eps of the time must have: a nifty time-travel mystery, rubbery monsters, humour and a cast that was clearly having a great time (bonus: Julian Glover is among the supporting cast).

    That’s where I’d suggest you start. I’d say more but I’m typing this on my phone!

    * as he was series script editor at the time and apparently there were rules about wearing more than one hat at the and had

  15. #15 Johanna
    December 30, 2013

    Gah! Strike my last two words, obviously!

  16. #16 Krebiozen
    December 30, 2013

    Orac,

    I have a particular fondness for the Seventh Doctor (Sylvester McCoy,

    I’m so glad. I thought it was only me.

  17. #17 Krebiozen
    December 30, 2013

    jane,

    I’ve always found it strange to bash traditional medicine for never changing

    The point is CAM doesn’t change even when clinical trials show that something they do doesn’t work. There are still people using laetrile, and Gerson therapy is thriving, despite clinical trials that show they are worse than useless. Even toxic herbs like aristolochia, radium treatments and electrical remedies are still used.

    What homeopathic remedy has ever been abandoned because it has been found not to work? Or any other CAM treatment for that matter?

    and then turn around and bash it for changing

    It’s making up an entirely new kind of acupuncture in the 1930s and claiming it is an age-hallowed technique developed by trial and error over thousands of years that I object to.

    (e.g., claiming wrongly that acupuncture didn’t exist before Chairman Mao).

    I don’t think that is a wrong claim. Why are the meridians in use before 1930 different to those used now? Before 1930 they were positioned over blood vessels and were clearly intended to be used for bloodletting. Even the pulses still used for diagnosis make it clear that the vascular system was the original target of acupuncture, not some imaginary meridians. The needles in use in ancient times were very similar to European lancets, and there is no evidence (correct me if I’m wrong) of the use of fine needles before the 20th century. Do you have evidence of any use of acupuncture in ancient times that unequivocally didn’t involve bloodletting or draining pus, or blood from a hematoma?

    There have been several significant surgical traditions before ours [snip]

    There we can agree. Even a Roman surgical kit is quite impressive, and contains many instruments that have barely changed.

  18. #18 AnObservingParty
    December 30, 2013

    Kreb, the best part of that Roman link is this line,
    One of the most spectacular, if fearsome looking, Roman medical instruments is the vaginal dilator or speculum (dioptra).

    Because they haven’t changed much. Or really at all.

  19. #19 Rich Scopie
    December 30, 2013

    Re: The Doctor: Start with Tom Baker to get the feel of the great older stuff, then probably go backwards. The William Hartnell stuff in particular is difficult to watch if you’re used to modern TV CGI. (Oh, and if you can watch the effects in The Green Death – which is a great story – without laughing, then you’re a better man (or woman) than I)

    Ignore most of the Davidson, McCoy and Colin Baker – they’re generally rubbish – then make a fresh start with the Eccleston stuff. As Orac says, the “reboot”. Modern effects for the modern viewer. (Can I TM that?)

    Some of the Matt Smith stories are a bit incomprehensible, but they’re great fun.

    Best Tom Baker? Genesis of the Daleks, Pyramids of Mars, Revenge of the Cybermen.

    Also, if you can get hold of any of the Target paperback books of the older series, do so – they’ll explain a load of stuff you might miss in the TV series, as a lot of them were written by the script editors of the time. Aimed at kids, but a fun read.

    Anyway, happy new year from the Scopie household!

  20. #20 Rich Scopie
    December 30, 2013

    Denise – I’m going to print that off on a little card, and whenever I meet an alt-meddler I’ll just fish it out of my pocket and start ticking points off.

  21. #21 Narad
    December 30, 2013

    I’ve always found it strange to bash traditional medicine for never changing and then turn around and bash it for changing (e.g., claiming wrongly that acupuncture didn’t exist before Chairman Mao).

    Youo’re conflating two statements. The acupuncture one is that it was on the scrap heap before Cheng Dan’an got word of neurology from Europe and rejiggered the meridians away from bloodletting points and swapped out lancets for filiform needles.

  22. #22 Narad
    December 30, 2013

    ^ Around 1932.

  23. #23 Denice Walter
    December 30, 2013

    @ Rich Scopie:

    I thank you for the kind words. Glad I learned young to only cast my pearls before smart people.

    Although pearls aren’t quite as rare as they used to be which I observed earlier today at Mrs Chan’s Grand Pearl Emporium.

  24. #24 Denice Walter
    December 30, 2013

    @ Krebiozen:

    There are a few places where woo ‘keeps up’:

    they attempt to incorporate NEW magical foods ( acai, goji )
    they use all the modern-est forms of advertisement ( e.g. e-mail, internet radio, facebook)
    they try to scare people in new and timely ways- e.g. radiation is big now because of Fukushima, cell phone tower radiation, HFCS, new diseases they make up etc.

  25. #25 Chris HIckie
    December 30, 2013

    If you want to go waaaaaay back in time to see how miserable it would be as the only human on the planet, I highly recommend “The Dechronization of Sam Magruder (http://www.amazon.com/The-Dechronization-Sam-Magruder-Novel/dp/031215514X). By George Gaylord Simpson. Brutally realistic in its nature.

  26. #26 Doug Johnson
    December 30, 2013

    Orac — don’t know if you have seen this White House petition yet about allowing a patient to get the Burzynski woo.

    https://petitions.whitehouse.gov/petition/authorize-fda-grant-compassionate-use-exemption-refael-elisha-cohen-antineoplaston-therapy/BVSP1ZkW

    Ridiculous.

    Happy New Year.

  27. #27 Peebs
    A few light years from Gallifrey
    December 30, 2013

    I don’t often comment here very often. Orac’s posse make my comments irrelevant (not in a bad way!). But I’ll bring up a couple of points re. Suturing;

    I used catgut very rarely and remember when the packet was opened, the suture and needle were in isopropyl alcohol and were a pain in the arse to actually sew a wound.
    My favourite sutures were 4.0 or 5.0 silk and I sewed hundreds of patients with never much of a problem.
    After 15-20 years of using ‘Mersilk’ I got a bollocking and was told never to use the stuff again.
    On the subject of the time travel thing, does anyone remember an episode of Fantasy Island where this subject was directly covered?
    If memory serves a modern physician goes back in time to apply his modern medicine. Unfortunately they ‘send’ him back to Salem to very much the wrong time in history.

  28. #28 Infuriatingly Moderate
    Looking forward to more daylight
    December 30, 2013

    @Peebs: I remembered that episode as well, though my recollection was that it was a nurse who wanted to go back to a “simpler time” and got in trouble for giving aspirin to reduce a fever, until Mr. Roarke bailed her out.

    So, I looked it up. Can’t find an official synopsis but there is a user review in the link below that sounds familiar. In essence, the witchcraft accusation was a ploy to get rid of the socially disruptive newcomers. Right up DW’s alley, methinks:

    http://www.imdb.com/title/tt0577793/

  29. #29 Denice Walter
    December 30, 2013

    @ Peebs:

    You are never irrelevant: you are fabulous.

    @ Infuriatingly Moderate:

    Which DW?
    Oh. *Him*.

    At any rate, re time warps and witches.
    Ever see the film: City of the Dead a/k/a Horror Hotel?

  30. #30 Peebs
    December 30, 2013

    Denise, I love you and want to have your babies!
    In a different time of course.

  31. #31 Denice Walter
    December 30, 2013

    @ Peebs:

    Better you than me.

  32. #32 Sarah A
    December 30, 2013

    Wow, thanks for all the advice everybody. Netflix has the re-boot on watch instantly, so I’ve already started watching that while I wait for the DVDs of the older seasons.

    BTW, Dr. McCoy was one of my inspirations for wanting to be a doctor as well, although in my case it didn’t work out so well (a lot more comfortable in the lab than around people, especially people who have been rendered even less rational than usual by illness or injury.) In retrospect, maybe the reason I liked Dr. McCoy is because he was meant to be a foil to Mr. Spock, with whom I had so much in common that when I was a kid I believed that I was actually a Vulcan who’d been abandoned on Earth as a baby.

  33. #33 Narad
    December 30, 2013

    From the Third Doctor’s (Jon Pertwee’s) era, I’d check out his first story, “Spearhead from Space,” as well as “Terror of the Autons” (a great combined Master-Autons story) and maybe “The Green Death” (nice environmental preaching, typifying early 1970s TV).

    It is certainly in no small part because this was the first episode I ever saw, in the summer of 1980, serialized in the afternoons on WTTW, but “Day of the Daleks” seems like indispensible Pertwee, “Venusian karate” aside.

  34. #34 Scared Momma
    Cold.Dark.Midwest.
    December 30, 2013

    I love this blog. And all of you wonderful characters that Orac has brought together. I can honestly say my life has been greatly enriched because of it. Happy New Year all.

  35. #35 Shay
    sitting and knitting
    December 30, 2013
  36. #36 DLC
    December 31, 2013

    I love the early Doctor Who episodes. They have rather cheesy special effects but then they don’t let the SFX get in the way of the excellent stories and acting.

  37. #37 Lawrence
    December 31, 2013

    Tom Baker may have been (and is) a little crazy, but it played extremely well as part of the character traits of his Doctor…..I received a few of the old episodes for Christmas & plan to spend some time watching them.

  38. #38 Todd W.
    http://www.harpocratesspeaks.com
    December 31, 2013

    My first exposure to Who was Baker, as well. In my mind, he is the Doctor, but the others do a fine job, too. Daleks scared the crap out of me when I was a kid.

    As for the other topic of the post, there’s something to be said about studying low(er)-tech stuff and how to get what you need when what you want is unavailable.

  39. #39 Jesse
    December 31, 2013

    @AstroLad — I remember the Poul Anderson story, and it illustrates neatly some of the linguistic issues as well — the guy who is sent back speaks Icelandic, and the only reason anyone around can understand him is that Icelandic hasn’t changed much in 1000 years. This is actually true; if you can read and pronounce Beowulf fluently, you’ll notice a striking similarity to Icelandic, even though the writers of Beowulf were from a different region of the Germanic-language world. More to the point, Iceland was isolated enough that the language didn’t change much — they can still read their sagas from the time with less difficulty than we read Shakespeare. Again, look at Beowulf or Chaucer and read those in the original, and imagine trying to speak with anyone who spoke English. English (the modern variety) is a mash-up of Norman, Saxon, Breton, Latin, and German. Or as I like to say, what happens when a bunch of Germans try to sound educated and speak French like the nobles. (Fun fact: Henry V was the first English king to use English in government business. HE might have been the first to use it extensively at home as well, odds are his grandparents spoke some variant of old French, as did much of the court).

    Interestingly, if you are a really, really good speaker of French, Spanish or German you might be able to decipher some medieval versions of those languages better than you could with English because scholars in those regions standardized stuff earlier, though in the German case you’d probably be limited to, I dunno, the stretch around where Hamburg is now(?). (I am less sure of which regional variant of German became “High” German, anybody know?) If you know Latin well enough to speak it you could certainly pas as an educated person 500 years ago, even a scholar. I mean, I can read older versions of Spanish without too much trouble, though I’ve zero idea how the pronunciation might sound and deciphering the orthography is a slog.

    As to scientific knowledge, while many of us might know the use of gunpowder (for instance) how many of us know how to make it? I suppose I could impress the locals of 1714 or 1514 with thermite, if I could get my hands on aluminum.

    And if I knew engineering better I suppose I could actually convince people in 1714 or thereabouts of quite a bit — at least by then that kind of stuff wasn’t considered witchery.

    Another interesting point: many of the engineering / technological feats we imagine ourselves impressing the locals with could work, but the prime time, as it were, would be the late 18th century, at least in the US and Europe. That is, people were doing all kinds of experiments and such — think of Ben Franklin — so if you were to time travel back to say, 1760 and meet up with him, or a Tom Jefferson, I could see them being less hard to convince about some stuff, like for example, a real steam engine (which was invented around the IIRC). Or a submarine, which was technically feasible, or even a hot-air-baloon-based dirigible. Heck, there was even in the late 1800s an early version of a fax machine, and the technical basis for it existed a long time before that. (It was to send engravings. It never got traction because there was no use for it at the time).

    I wonder if the knowledge of future events would not be more useful than anything else. If I were zoomed back to 1714 in the current US, I’d might let the Natives in on some things. Maybe try to convince the Cherokees and Choctaws to make their own guns and powder, or at least start buying from Spanish dealers. Maybe tell the Haudenosaunee the same thing.

  40. #40 Jeff S. M.
    December 31, 2013

    As a teenager living in the burbs of SF in the 70′s, I used to hang out in and around the Haight from time to time. Trust me, you didn’t miss anything.

  41. #41 herr doktor bimler
    December 31, 2013

    I suppose I could impress the locals of 1714 or 1514 with thermite, if I could get my hands on aluminum

    Not available until the 1800s, alas.

  42. #42 Scilicet
    Lab rat maze
    December 31, 2013

    Can you imagine trying to explain modern medicine to the people of 1713 when you are hoplessly inept at thier modern day living skills? I’m thinking things like riding a horse, hunting, sewing, and swordsmanship. ” I can’t provide for myself one iota, but believe me! We gotta do something about these germs! You can’t see them, but they are there, trust me!”

    Yep, straight to the witch burning fire you would go…

  43. #43 ChrisL
    December 31, 2013

    Dara O’Briain’s bit on going back in time and trying to explain technological advances is an excellent take on modern ineptness:

    http://www.youtube.com/watch?v=BVxOb8-d7Ic

  44. #44 Shay
    December 31, 2013

    “I’m thinking things like riding a horse, hunting, sewing, and swordsmanship.”

    I can do three of those four but I’m still not sure that would help me survive back then.

  45. #45 Narad
    January 1, 2014

    Ether had been around since the 17th century, so that could be understandably referred to in certain circles. Nitrous oxide was only 50 years away from 1713 at the latest. Microscopes were already “around.” Production and sterilization of glass plates with some sort of sealable lids seems to lie within the realm of the feasible. Agar appears to have been another 17th-century item, so, doable. The next trick is concentrating penicillin.

  46. #46 Narad
    January 1, 2014

    I suppose time-traveling with copious notes prepared in advance is the main problem.

    [In 1940,] Heatley devised a new technique to measure the activity of a sample of penicillin and came up with a method called back-extraction to isolate the penicillin. He managed to automate this procedure using a set up consisting of bottles, milk churns, yards of glass and rubber tubing.

  47. #47 Art
    January 1, 2014

    Some of your answers come from so called ‘ditch medicine’, medicine as practiced in wilderness, primitive, battlefield conditions, and often with far less than ideal equipment and conditions.

    Anesthesia is possible under those conditions. On limbs draining the limb of blood through the use of pressure bandages and operating behind a tourniquet renders the area senseless. You might want to brush up on regional blocking. Conventionally you would use one of the cocaine derivatives and deliver a dose next to the appropriate nerves but you can get most of the same effect, albeit with more toxicity, using ethyl alcohol. Granted syringes and needles were larger and seldom cleaned but injections were pretty common.

    Sterile technique, or at least a hell of a lot closer to sterile than any other surgeon or clinic should be possible. Laundry at the time was commonly boiled and lye soap is strong stuff. Iodine and chlorine bleach were known.

    Rubber gloves, quite thick and hard to work in, were available but strong soap, possible applications of alcohol or iodine, and diligent scrubbing should be almost as effective.

    Depending on the time you are talking about ether, morphine, cocaine may or may not be available. I used to know how to produce small quantities of ether using alcohol and something else …

    Your more accurate medical understanding would be an asset but you would soon come up against a well entrenched medical/technological/religious establishment that would be sure to see you as a irritant, is not an actual threat.

    Speaking of invisible disease causing agents could get you accused of being a witch. Doctors of the day were familiar with the language of fluxes and humors. You might couch your actions in those terms even if they are inaccurate.

    ie:The Chinese had a mystical/cultural rational for only drinking water in the form of tea. The explanation was BS, nonetheless boiling the water for tea was quite effective in keeping the Chinese workers free of water born diseases.

    Of course, you are going to have to be lucky. Get mistaken for a peasant while they are collecting the peasant levees, sacrificial troops, for a great battle and you are destine to die by arrow or sword. Show off too much too soon and you get burned as a heretic or witch. Fail to come to the attention of someone with wealth and you are going to be too busy grubbing for food and fulfilling your religious/legal duties to worry about advancing anyone tech level. And while you are doing that you are going to be more vulnerable to disease than most of your fellow peasants. Most people in earlier ages either died young or developed some immunity to things like giardia and common infections.

    The US army sees this when troops go on missions in Afghanistan and other primitive areas. The locals can drink the water untreated. When US troops try they end up doubled up for most of two weeks. In time they can adapt to the local food and water but it takes time.

    And being sick is going to testify against you. Hard to explain the advantages of your world view while doubled over with cramps. Popular belief in most places and times was that sickness was a punishment from God and that allowing sick people to stay around threaten angering God and sickness being imposed upon the community. The only people likely to try to help would be your relatives, relatives you don’t have.

  48. #48 Shay
    January 1, 2014

    @Art – and yet, to some people (and I am not referring just to libertarians, although they certainly are included), this was a Paradise — no income tax, no regulation of business or industry, no Big Gummint interfering with your life…

  49. #49 Old Rockin' Dave
    On the threshold of a dream...
    January 2, 2014

    Orac, you sell yourself short.
    One area where you would definitely shine in the 18th Century that I haven’t seen mentioned: physical diagnosis. You would be equipped with the not only the skills, but also the understanding of the signs. Your history-taking would seem arcane to your new ancient colleagues, but you would produce impressive results there too. Let’s not forget your knowledge of psychiatry, even what you retain as a surgeon, which would permit you to get the occasional positive result. You probably know enough to get a maker of musical instruments to make you a horn-style stethoscope a century early. Even with the primitive optics of the time, you might be able to do some blood and urine microscopy, maybe even some pathology; if you know how to make some of the more common stains you could go even farther. You understand the roles of diet, exercise, oral hygiene, and nutrition in health. You might even be John Snow at the public pump a century before time. There are more things you might manage – obsidian scalpels, effective casting and splinting, basic life support and first aid.
    You know more than you think you do.

  50. #50 Narad
    January 2, 2014

    Speaking of invisible disease causing agents could get you accused of being a witch. Doctors of the day were familiar with the language of fluxes and humors. You might couch your actions in those terms even if they are inaccurate.

    Or by analogy with yeast, which had been observed by microscopy in 1680, and food spoilage. It would be necessary to demonstrate the Pasteur effect to drive it home.

    Fail to come to the attention of someone with wealth and you are going to be too busy grubbing for food and fulfilling your religious/legal duties to worry about advancing anyone tech level.

    Well, yah, depending on where one landed. Then again, the title (if not the premise) does say “like the The Doctor.”

  51. #51 DLC
    Somewhere theoretically south of some other point on the globe.
    January 2, 2014

    A clever person might sell knowledge of germ theory by claiming to be divinely inspired. But I personally couldn’t pull it off. All in all, The Good Old Days weren’t.

  52. #52 Joseph Hertzlinger
    Planet Earth (for now)
    January 4, 2014

    Vitamin C might be the most understandable and usable secret from the future. It’s helpful if you know what foods contain Vitamin C.

  53. #53 Chris,
    January 4, 2014

    I just read the book Glorious Misadventures. It is about the failure of Russia to establish a hold on the Americas.

    Sometimes their outposts in Sitka had no vegetation during winter, and by spring the rough and tumble residents had scurvy. It was an interesting read, especially on the effects of diet, the fickle winds of politics, how the fur trade caused almost the extinction of both animals and native peoples.

  54. #54 Denice Walter
    January 4, 2014

    @ Chris:

    North of SF, the Russians built a fort, hunted sea otters and tried to grow food for their Alaskan ventures. There are quite a few place names like the Russian River, Russian Gulch and perhaps Fort Ross ( Rossiya?) and Russian Hill.

  55. #55 Narad
    January 5, 2014

    And, hell, belt and suspenders.

  56. #56 Sofia
    http://toptights.tumblr.com/
    January 14, 2014

    The best areas where you can utilize sky lanterns

The site is currently under maintenance and will be back shortly. New comments have been disabled during this time, please check back soon.