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Lessons from 18th Century Medical History


Yglesias has been reading Middlekauf and tries to learn lessons on modern health care from the disastrous medicine of the time:

I think discussions of health care economics pay far too little attention to the question of pre-modern health care. People have been earning a living as medical professionals for a long time. And yet everybody knows that the invention of actually useful medical treatments is pretty recent development. Surely this tells us something about the nature of the health care consumer’s ability to find and purchase cost effective treatments.

I don’t know. I certainly respect the goal to take lessons from the past for the present–I am essentially a presentist in my work. I also don’t really agree (regardless of the reality of modern America) with Yglesias’ general philosophy of finding ways to make neoliberal free market capitalism work more efficiently and with somewhat more generosity and somewhat more equitable dispersal of resources (if any of you see this as a mischaracterization of his overarching line of thought, including Matt himself, let me know). I see the current system of extremist capitalism as a complete disaster that is leading our nation back to the Gilded Age. But let’s leave that aside for the time being.

I’m just having trouble finding any real lessons for modern health care out of 18th century medicine except to say that bleeding is a really freaking bad idea. I don’t think the desire for more efficient markets really drove the 19th century medical reforms that created modern medicine. It had a lot more to do with the fact that a) most of the patients were dying, b) there were lots of opportunities to experiment thanks to Civil War casualties, c) improved drugs, and d) evolving technologies. My sense is that consumer choice really didn’t drive any of this–although I should read up on the debates over bleeding when it went out of fashion. In any case, with the development of the smallpox vaccination in the 18th century, I’ve always thought it was more or less forced upon a suspicious and superstitious population from on high until it was proven far more effective than not getting it at all, even with the very real chance of death.

That said, it’s a bit out of my time period, so I’d be curious to see a) what others think and b) if others believe that these changes had anything do with patient preference.

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