Monday, 18 November 2013

"Hey Doc, How Long Do I Have?: Early Modern Prognostication

A man hasn’t been feeling well for a few weeks, so he goes to his doctor for a testing checkup. After a week or so the doctor asks him to come in to discuss results.
Doctor: “I'm afraid I have some very bad news. You're dying, and you really don't have much time left.”
Patient: “Oh, no!  That’s dreadful news! How long have I got, doc?”
Doctor: “Ten.”
Patient: “Ten what?  Months? Weeks?”
Doctor: “Nine…Eight…Seven…”[1]

Prognostication was a tool that early modern physicians had adopted from the ancient Greek doctors.  While examining the patient, instead of asking the patient for his symptoms, a good doctor would describe the symptoms suffered to display his knowledge of the disease.  He would then predict whether or not the case was mortal and proceed with his treatment accordingly. 

At first glance a common sense approach, prognostication was also allowed the physician “to recognize hopeless cases, so that he could avoid them.”[2]  Unsuccessful cases, especially those ending in a patient death could lead to legal proceedings, would likely hamper further business, and were definitely to be avoided.

In addition, giving the patient a more-dire-than-actually-warranted prognostication was also practiced frequently.  Richard Head, an early modern writer, detailed this technique in his satirical work The English Rogue: Continued Part 2:
“if it were but a prickt finger, he would make a great matter of it, and tell you what danger you had been in if you had staid but a minute longer; instancing how such a one his Patient by only cutting of a Corn, and drawing blood, it turned to a Gangrene, which by had handling of unskilful Chyrurgions growing worse and worse, they were at last inforced to send for him, who in a few days made him perfectly sound, that otherwise (had he not come to him) must inevitably have perisht.”

The purpose was two-fold.  First, by emphasizing the severe nature of the wound the practitioner reassures the patient that he is correct in seeking treatment for a minor ailment.  The tale of the gangrenous corn continues to work in this vein, invoking fear in the patient, ensuring that he will return for further minor wounds, hopefully convince others to do the same.  Second, the technique leaves open the window for further treatment and enhanced cost, thus lining the practitioner’s pockets for very little exertion. 

Hugh Chamberlen, physician to Charles II, wrote about this sort of behaviour, noting that harsh prognostications were used by physicians too:

“Physicians of mighty Prudence  and small Integrity ever gain by Frightful Prognosticks; for, if the Patient dies, their early Prognostick gives them great Reputation for knowing so long before, what must come to pass at last, and if the Patient recovers, the cure is the more Miraculous, because the condition was so Desperate.”

Quick and accurate prognostication was definitely a valued ability.  Numerous quack practitioners, in fact, advertised their ability to prognosticate at a glance.

For the most part, however, practitioners sought to prognosticate accurately in order to treat effectively their patient.  This was a practical process where practitioners would, in fact, discuss the patient’s symptoms and read the signs thereof to determine the disease and how dire the situation.  This took much training and, as the surgeon Peter Lowe, wrote in 1597, practitioners needed to read and educate themselves about diseases and their signs, patient characteristics, and even the weather to prognosticate correctly!

Paul Barbette gives an example of a typical prognostication guide for ruptures or hernias (mid 17th century):

“Prognosticks: In little Children, Ruptures are easily cured; in aged people, slowly or not at all, especially if the Peritonæum be burst. If the Intestines be filled with Wind or Excrements, there follows pain; and if that be not suddenly removed, an Inflamation, Gangrene, and at last Death it self.”

Some methods of prognostication leave us shaking our heads.  I leave you with my favourite plague prognostication method from John Hester’s The pearle of practice:

“Take a quick Frog, and lay it with the bellie next the sore: if the partie will escape, the Frog will burst, in a quarter of an houre.  Then lay on another, and this you shall do, till not more do burst, for they draw forth the venome.  I have beene told that a dried tode will in better sort do the same.  If none of the Frogs do burst, the partie will not escape, this hath bene often prooued.”

Am I the only one with a favourite prognostication practice?  If not, let me know on Twitter @medhistorian

[1] A truly terrible joke about medical prognosis and I apologize for putting you through it. 
[2] Medicine Before Science: The Business of Medicine from the Middle Ages to the Enlightenment.  Cambridge: Cambridge University Press, (2003), 16.  For more on prognostication see also: Stephanie Moss and Kaara L. Peterson, Disease, Diagnosis, and Cure on the Early Modern Stage. Burlington, VA: Ashgate Publishing Company (2004). 


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