JOHN SHUFELDT, MD, JD, MBA, FACEP
While treating patients in the emergency department, I occasionally marvel at the changes I have witnessed over my 25 years in medicine. Sometimes I think, “Thank God I did not treat you 25 years ago, because if I had, I would have done (fill in the blank), it would not have worked, and you would have probably hated every second of it.”
I am as old as Moses, so it should come as little surprise that when I started my career, we intubated two or three people in florid congestive heart failure (CHF) every shift; did thoracotomies
in all coding trauma patients, regardless of the etiology and occasionally bare-handed; and performed therapeutic phlebotomy on CHF patients in renal failure. I once used leeches on a nearly necrotic penis. Another time, I drilled an ED burr hole in an unresponsive patient with a blown pupil.
I haven’t intubated a CHF patient in years or performed a thoracotomy in about four years. I, along with the leeches, stopped blood-letting about 10 years ago and, thankfully, have not done a burr hole again (whether it was needed or not).
I was recently visiting my parents and happened to come across a book my sister (an EM physician in Chicago) gave to my father after having the original copy rebound. The book, titled Every Man His Own Doctor, was written in 1816 by William Buchan, MD. The following excerpts are taken verbatim from the book. As you read them, remember: Less than 200 years ago, this was considered the treatise on the prevention and cure of diseases.
Of Children
“One great source of disease of children is the unhealthiness of the parents. It would be as reasonable to expect a rich crop from barren soil, as that strong and healthy children should be born of parents whose constitutions have been worn out with intemperance and disease.”
“A delicate female, brought up within the indoors, an utter stranger to exercise and open air, who lives on tea and other slops, may bring a child into the world, but it will be hardly fit to live.”
“Cleanliness is not only agreeable to the eye, but tends greatly to preserve the health of children. It promotes the perspiration, and, by that means, frees the body from superfluous humours,1 which, if retained, could not fail to occasion diseases.”
Of the Laborious, the Sedentary, and the Studious “Though those who follow laborious employments are in general the most healthy of mankind, yet the nature of their occupations, and the places where they are carried on, expose them more particularly to some diseases. The erysipelas,2 of St. Anthony’s fire, is a disease very incident to the laborious. The iliac passion,3 the cholic, and other complaints of the bowels, are often occasioned by the same causes as erysipelas; but they may likewise proceed from flatulent and indigestible food.”
“A bad figure of body is a very common consequence of close application to sedentary employment. The scrophula, consumption, hysterics and nervous disease, now so common, were very little known in the country before sedentary artificers became so numerous.”
“Intense thinking is so destructive to health, that few instances can be produced of studious persons who are strong and healthy. Hard study always implies a sedentary life; and when intense thinking is joined to the want of exercise, the consequences must be bad.”
Of Aliment4
“Our aliment ought neither be too moist or too dry. Moist aliment relaxes the solids, and renders the body feeble. Fe- males, who live on tea and other watery diets, generally become weak and proceed to hysterics.”
Of Intemperance
“A modern author observes that temperance and exercise are the two best physicians in the world. How quickly does the im- moderate pursuit of carnal pleasures, or the abuse of intoxicating liquors, ruin the best constitution!”
“Nothing tends so much to prevent the propagation, and shorten the lives of children as the intemperance of parents.”
“Every act of intoxication puts nature to the expense of a fever in order to discharge the poisonous draught.”
Of Infection
“Many diseases are infectious. Every person ought therefore, as far as he can, to avoid all communication with the diseased. The common practice of visiting the sick, though often well meant, has many ill consequences.”
Of the Passions
“Many persons of a religious turn of mind behave as if they thought it is a crime to be cheerful. They imagine the whole of religion consists in certain mortifications, or denying them- selves the smallest indulgences, even of the most innocent amusements. It is a great pity that every religion should be so perverted, as to become the cause of those very evils which it was designed to cure.”
“Few persons fall desperately in love all at once. We would therefore advise every one, before he tampers with this passion, to consider well the probability of his being able to obtain the object of his wishes.”
Of Common Evacuations
“Many persons have lost their lives, and others have brought on very tedious, and even incurable disorders by retaining their urine too long from a false delicacy.”
Of Fevers
“As more than one half of mankind is said to perish by fevers, it is of importance to be acquainted with their causes. The most general causes of fevers are: infection, errors in diet, unwholesome air, violent emotions of the mind, excess or suppression of usual evacuations, external or internal injuries, and extremes of heat or cold.”
“Nothing is more desired by a patient in a fever than fresh air. It not only removes anxiety, but cools the blood, revives the spirits and proves every way beneficial.”
Of the Quinsy5
“It prevails in the winter and spring, and is the most fatal to young people of a sanguine temperament.”
An inflammation of the throat is often occasioned by omitting some part of the covering usually worn about the neck, by drinking cold liquor when the body is warm, by riding or walk- ing against a cold northerly wind, or anything that greatly cools the throat and parts adjacent.”
The book dispenses advice on all things related to health for a total of 460 pages printed in very small type. Interestingly, the last third of the book is devoted to the care and treatment of horses and sheep (which mirrors the treatment of humans). It is remarkable that in the 195 years since Every Man His Own Doctor was published we have gone from using Peruvian bark to treat all sorts of things to using embryonic stem cells for spinal cord regeneration and doing transatlantic robotic surgery. To quote the rock group Matchbox 20’s front man, Rob Thomas, “Look how far we’ve come!” Even more amazing is that as dramatic as the pace of change has been over the past two centuries, it is getting exponentially faster.
In The Law of Accelerating Returns, published in 2001, author, inventor, and futurist Dr. Ray Kurzweil opines, “The analysis of the rate of change of technology shows that technological change is exponential, contrary to the common sense ‘intuitive linear’ view. So we won’t experience 100 years of progress in the 21st century, we will experience more like 20,000 years of progress (at today’s rate). The ‘returns,’ such as chip speed and cost effectiveness, also increase exponentially. There is even exponential growth in exponential growth. Within a few decades, machine intelligence will surpass human intelligence leading to The Singularity—technological change so rapid and profound it represents a rupture in the fabric of human history. The im- plications include the merger of biological and non-biological intelligence, immortal software-based humans, and ultra-high levels of intelligence that expand outward in the universe at the speed of light.”
What does all this mean for us living in the urgent care universe? I have to believe that our future will look very different from the present in an incredibly short amount of time. Or, as Dr. Egon Spengler said in the movie Ghostbusters, “Try to imagine all life as you know it stopping instantaneously and every molecule in your body exploding at the speed of light.” n
Notes
1Hippocrates (460-370 BC) believed certain human moods, emotions, and behaviors were caused by body fluids (called “humours”), of which there were four: blood, yellow bile, black bile, and phlegm.
2Erysipelas = cellulitis.
3Iliac passion = a violent vomiting of fecal matter.
4Aliment = nourishment, nutriment.
5Quincy = peritonsillar abscess.
