Submitted via IRC for Fnord666
[...] After all, who needs a hole in the head? Yet for thousands of years, trepanation -- the act of scraping, cutting, or drilling an opening into the cranium -- was practiced around the world, primarily to treat head trauma, but possibly to quell headaches, seizures and mental illnesses, or even to expel perceived demons.
[...] "In Incan times, the mortality rate was between 17 and 25 percent, and during the Civil War, it was between 46 and 56 percent. That's a big difference. The question is how did the ancient Peruvian surgeons have outcomes that far surpassed those of surgeons during the American Civil War?"
[...] Whatever their methods, ancient Peruvians had plenty of practice. More than 800 prehistoric skulls with evidence of trepanation -- at least one but as many as seven telltale holes -- have been found in the coastal regions and the Andean highlands of Peru, the earliest dating back to about 400 B.C. That's more than the combined total number of prehistoric trepanned skulls found in the rest of the world.
Source: Remarkable skill of ancient Peru's cranial surgeons
(Score: 5, Insightful) by JoeMerchant on Sunday June 10 2018, @08:30PM (16 children)
That's an easy one, Civil War surgeons had less practice, less skill, and less effective resources at their disposal than Incan trepaniers. Metal instruments aren't by themselves a predictor of improved outcomes - just as doctors today, with all the best equipment and training, can and do still screw up for any number of reasons.
I suspect the ancient Peruvian's primary advantage was time allotted to perform the procedure: not rushed on a battlefield or pressured to maximize throughput/profit in an office can be a huge advantage for patient outcome. Also, it takes a really long time to make good stone surgical tools.
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(Score: 2) by JoeMerchant on Sunday June 10 2018, @08:32PM (7 children)
You can reread the post before hitting submit, and still miss a word in the subject.
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(Score: 0) by Anonymous Coward on Sunday June 10 2018, @08:56PM (6 children)
Maybe SN should allow editing (by original author) of subject lines?
Iirc, we've already discussed why allowing the editing of posts is (on balance) not a good idea.
(Score: 2, Informative) by Anonymous Coward on Sunday June 10 2018, @09:40PM (5 children)
They could allow editing of a post for a few minutes or until someone replies. That would prevent edits that were the byproduct of a response.
(Score: 3, Interesting) by JoeMerchant on Sunday June 10 2018, @09:48PM (4 children)
I don't see what harm could come from allowing editing of a post for 2 minutes, or until the first response or mod point is applied?
Other than the bugs this would introduce in the code base....
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(Score: 3, Informative) by lentilla on Monday June 11 2018, @04:36AM (2 children)
No - the rules as they stand are simple, easily understood and consistent. It's like speaking in a public forum - once we have spoken, the words are out. There is always an opportunity to later issue a correction or retraction.
When I reply to a post I am replying on the basis of what I have seen written. I would be most unamused to find that my reply (some minutes later) was invalidated by an edit between the time I hit "reply" and the time I hit "submit". (What are we going to do - lock posts whilst ever there is a reply pending? For how long?) No matter the strategy applied (per above: allow editing for two minutes, until first response or mod point), allowing posters to edit their submission opens the door to a whole lot of grief. (And bugs :-)
(Score: 2) by AthanasiusKircher on Monday June 11 2018, @10:45AM (1 child)
Why would you need to lock posts or do anything so cumbersome? As long as the system tracks which posts have been edited, it should be relatively simple when you hit "submit" for the system to throw up a flag: "The post you are replying to has been edited since you hit 'reply.' Do you still want to submit your comment as written, or do you wish to edit?"
(Yes, if you spent time crafting a long detailed reply, this could be annoying, but how long can your reply be in the two-minute window suggested by GP? Personally, I think if we'd bother with such a feature, editable time should perhaps be five minutes to actually be useful. But whatever.)
Even better (or in addition): the system always maintains a history of all versions of a posted comment which can be accessed via expansion or link or whatever, so no version is ever lost. In the rare occurrence of rapid-fire exchanges here, and someone makes an edit, you can always point out your comment replied to a previous version (or, in fact, the system could actually note that by default).
As opposed to the current system where we have to put up with posts clarifying stupid things like spelling errors or missed words just to correct or clarify a minor error?
No system is perfect. On the other hand, I have no major problems with the current system and agree with your last point that additional complexity has the potential for more bugs.
(Score: 2) by JoeMerchant on Monday June 11 2018, @11:08AM
If you're responding to something specific, it's always a good idea to:
it anyway. If we want to go hyper-correct on the whole thing, an edit history could be kept and made available complete with a reason for edit field.
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(Score: 0) by Anonymous Coward on Monday June 11 2018, @12:51PM
Soylentnews can't even get paging right. If you move back to previous, dated pages you'll see they contain posts from neighboring days. How about they fix the tiny things before they try something major like changing how posting works.
(Score: 3, Interesting) by Arik on Sunday June 10 2018, @10:41PM
To the contrary, a skilled knapper with the proper material available can fabricate top-notch stone tools quite quickly, much more quickly than you can realistically produce the metal equivalents. (Yes, today we may pop them out of a machine, but the process that started with mining the ore still takes years to complete.)
That's not the weakness of stone tools, it's more like one of their strengths. The weaknesses include being more fragile, more prone to damage, dulling more quickly, and therefore require more frequent maintenance and replacement. Often stone tools were resharpened repeatedly, growing a little smaller each time, and a piece that started as a large blade might end life as a tiny scraper chip after many resharpenings.
Anyway, it's possible that the Peruvians were measurably 'better' in a real way here, but it's also possible this is not an apples-to-apples comparison. As you say, the later doctors were operating under battlefield conditions, and we really don't know the case with the Peruvians. It seems reasonable to suppose that some were, but maybe many were not. Might have been done primarily to young people in perfect health and ideal conditions, which would certainly help with the survival rate if true.
If laughter is the best medicine, who are the best doctors?
(Score: 2) by RS3 on Sunday June 10 2018, @10:42PM (2 children)
IIRC Europeans brought diseases for which the indigenous Americans had no defense. Could it be possible that there were fewer germs around, fewer infections, better healing, etc.?
(Score: 3, Interesting) by frojack on Sunday June 10 2018, @11:29PM (1 child)
No.
There were just as many unfamiliar germs and diseases in the new world as there were Europe, or the far east. Its just that the locals were pretty much well prepared to fight those diseases off. Sad to say, there was no Garden of Eden. Someone lied to you.
Contrary to popular belief locals did not all die of European imported diseases. While its true that Spanish conquistadors led by Hernando Cortes and Francisco Pizarro, respectively, resulted in large part from epidemics of smallpox and measles virus infection that decimated the native defenders, this decimation took a decade to materialize. Indigenous populations did not drop like flies from disease while on the battle field.
Their own religion was used against them. They believe Cortes was Quetzalcoatl (a god) and for the most part were easily recruited against their leaders.
No, you are mistaken. I've always had this sig.
(Score: 4, Interesting) by JoeMerchant on Sunday June 10 2018, @11:46PM
I mostly agree that there were plenty of germs around the Americas pre-Columbus, and Peruvians, Incas et.al. had their own cities with clusters of humans to breed human specific germs, but... I don't think that the American cities were as dense or well connected as the cess-pool commerce centers of Europe at the time. In other words, I'm hypothesizing that it wasn't so much luck that the Europeans won the disease war, but more that they had trained for it for centuries and came out on top by virtue of having lived in greater squalor for many previous generations.
The Americas, and the tropics in particular, are full of all kinds of nasty diseases, even today, but the really brutal wipe out your whole village stuff like small-pox, plague, etc. seem to have been a European specialty.
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(Score: 2) by HiThere on Sunday June 10 2018, @11:55PM (2 children)
I suspect that the main difference was the theory of "laudable pus". Surgeons used to be proud of not washing their hands between patients. Probably that exact preference wasn't followed on a battlefield, but it inspired a lot of associated customs.
Javascript is what you use to allow unknown third parties to run software you have no idea about on your computer.
(Score: 2) by dry on Monday June 11 2018, @12:47AM (1 child)
Even worse, not washing their hands after performing an autopsy.
It's also interesting the resistance those surgeons showed against the germ theory of disease.
(Score: 4, Informative) by JoeMerchant on Monday June 11 2018, @02:00AM
There are still physicians (and even surgeons) who are resistant to hand washing guidelines. The surgeons are in a minority, but in clinical practice it's reversed. Every single credible study ever published finds positive results for caregivers washing their hands between patients, but when you're in a busy practice, that's a lot of handwashing, and it can be rough on your skin if you do it to the guidelines.
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(Score: 4, Funny) by realDonaldTrump on Monday June 11 2018, @12:02AM
Believe me, there's nothing monotonic about Dr. Ben Carson, our greatest brain surgeon!!!!
(Score: -1, Troll) by Anonymous Coward on Sunday June 10 2018, @10:07PM (8 children)
Yet the jews would have you believe that the only medical advancements happened in the last 40 years. Hint: no medical advancement happened in the last 40 years. Only painful, economically devastating treatments; no cures.
The world was great before, but with parasites sucking our life out, we are forced to live with less and have more problems. Each has their own issues, and the jews made sure it stays that way. No cures for the poor to get out of poverty. They rig the system to keep the status quo.
(Score: 2) by JoeMerchant on Sunday June 10 2018, @10:17PM (6 children)
We've got great advancements: MRI and CT scan, laparoscopic procedures, some really nifty drugs, and not all are successful at prolonging treatment - some really do cure things. Still, there has also been huge progress in the art of engendering medical dependency... my physicians' assistants look at me in disbelief when I tell them I don't take any drugs on a regular basis.
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(Score: 3, Insightful) by frojack on Sunday June 10 2018, @11:32PM (5 children)
That's because prolonging treatment was never the goal.
(I know, it fits your mantra of dependency, but you need to grow up).
The goal of surgery is to get in, fix stuff, and get out without doing more harm than good.
No surgeon wants you as a permanent patient. (Plastic surgeons excepted).
No, you are mistaken. I've always had this sig.
(Score: 3, Insightful) by HiThere on Sunday June 10 2018, @11:59PM (1 child)
There are different groups of actors involved with different goals. At least some pharmaceutical companies actively refuse to investigate something that would result in a cure for something for which there currently exists a treatment. Other health practitioners look avidly for cures...but many of those can't find funding for the required tests.
It's a complex problem, and I don't see any good solutions, but the current approach gives financial incentives to avoid finding cures. There's got to be some better way.
Javascript is what you use to allow unknown third parties to run software you have no idea about on your computer.
(Score: 2) by JoeMerchant on Monday June 11 2018, @02:07AM
The mantra is "pay for outcome" but that road to progress is going to be long and rocky.
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(Score: 3, Informative) by JoeMerchant on Monday June 11 2018, @01:55AM (2 children)
Last surgery I was in, the surgeon left a bone chip in... clear as anything on the post-op X-ray. After 6 weeks of therapy at his PT clinic (for a wound that should have healed up in 2), osteomyelitis presented to noone's great surprise and I was offered another surgery (after all, you've probably hit your out of pocket max already right?) and a 6 week course of IV antibiotics and of course much more PT and followup treatment. While in the infection control clinic, I got to know several other of my surgeon's patients who had similar stories.
N of 1 isn't worth much, but I have observed it in practice many other times: physicians aren't incentivized to do the best thing for their patients, they are incentivized to generate business for themselves and the many many people they employ. We know a few good doctors, but they seem to be in the minority these days, especially in the specialist fields.
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(Score: 2) by lentilla on Monday June 11 2018, @05:03AM (1 child)
Surely the surgeon would have corrected that as a matter of professional pride? We all make mistakes - that's understandable - but when a professional makes a mistake he corrects it.
I realise a second operation requires a collection of people. I would have thought that was something covered by the surgeon's insurance? Better for the surgeon's insurance to pay for a second procedure up-front than to deal with a claim for negligence further down the track?
I'm sorry you had to go through that.
(Score: 2) by JoeMerchant on Monday June 11 2018, @11:46AM
Apparently not. When I asked him if that chip was going to re-fuse to the bone he (normally confident and clear spoken) kind of grunted and mumbled "no, no it's not." He sent me off to standard PT knowing that the other shoe would drop, eventually. On that day, that may have been the best possible course, the chip might have worked its way out cleanly, but by week 3 when it was apparent that my circulation was compromised, the dissolving stitches weren't dissolving (involving exquisite pain in their removal), and my healing progress was passing 2 and then 3x the normal time... I really would have expected better monitoring of my progress, but why? We hadn't reached the insurance covered PT cap yet. He did suggest a (not covered by insurance or offered in PT) hot wax bath to help with the circulation - which it did...
At 6 weeks when the green pus started coming out, the PT office finally opened the back door and sent me to see the doctor again. He suggested a second surgery "I can get you in at the end of the day tomorrow" - just like he did for the first surgery, adding my case to the end of a full day. When I declined the additional surgery (which would have involved the whole team including my family to drive me home after anaesthesia which I didn't want in the first place...) he then offered to take care of it then-there in a supply closet with a nurse, and did, and we had a good outcome from that. In reality, that's how the first operation could and probably should have been handled too, but instead we waited 24 hours to assemble the big team, had the big jovial production and managed to screw it up anyway.
Similarly, my wife's last major medical episode involved pre-eclampsia and a practice of 4 OBs who completely overbook themselves on a regular basis. They almost caught it - saw a high blood pressure reading at a regularly scheduled visit and wrote the correct orders for a followup, but then totally screwed up the followup and the final weeks of regularly scheduled visits - directly traceable to overbooking of the practice and lack of access to the doctors. On the first occasion after 2 days of phone calls with no response we presented at the office in person and I had to push past the receptionist and find the doctors back in their private lounge, physically collapsed on the sofas after a long hard day, to get any kind of followup for the high BP reading - one sprang back to life, did a 2 minute exam and declared "everything's great! Go home and reschedule your next visit for later since you've already come in today." That rescheduling was completely screwed up due to the way their office runs, and the recommended 7 day intervals turned to 10, on day 9 we had to present as an emergency case in the morning with blindness due to high BP - this time not even talking to the receptionist just pushing past to grab the first available MD and get the admission rolling. After 2 weeks in ICU and >$30K in bills Mrs. "everything's great!" came out with her other nugget: "At least we had a good outcome." 2 weeks in ICU is a good outcome? If I wore a body-cam (like Russians' dash cams) for that episode, we would have had a slam-dunk case: receptionists painting their nails, picking up the phone and hanging it up without even talking to the patients who are calling... an average of 2 hours wait past scheduled appointment times, many times stretching to 4 hours and occasionally cancelling. Staff terrified to call the on-duty MD to handle followup orders. We could have spent the next years of our lives in court pressing that case and maybe winning, but it would have all been based on personal testimony and a sketchy paper trail sourced mostly from their offices. The situation also involved good friends of my employer and pressing such a case could also have cost us our sole source of income.
Those are the low-points, but they happen, and our acquaintances who spend more time in the medical care system seem to have more of them.
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(Score: -1, Troll) by Anonymous Coward on Sunday June 10 2018, @10:30PM
You forgot to say "Khazar."
(Score: 4, Insightful) by Gaaark on Sunday June 10 2018, @10:36PM (12 children)
How do they know the mortality rate of the surgical procedures?
17-25%
They don't for sure know how the pyramids were built, but they know the mortality rate in the Incan empire?
They must SURELY know who Jack the Ripper was, then...that time is much nearer the Incan times.
"This kids about to die and we wouldn't want our good mortality rate to rise, so SACRIFICE AWAY! If she becomes a statistic of the ritual sacrifice, she can't become a statistic against the surgeon.
There.... yes....that fixes the whole thing. We'll show those modern people....muahahahaha!"
--- Please remind me if I haven't been civil to you: I'm channeling MDC. ---Gaaark 2.0 ---
(Score: 4, Insightful) by frojack on Sunday June 10 2018, @11:41PM (6 children)
I see you've finally started to grow a healthy skepticism bone.
Good On Ya.
Their head surgeries were performed mostly on crazy people, for which they could find no other cure, but who were otherwise healthy.
Civil War surgeries were to remove bullets.
Not the same thing.
Their statistics came from modern grave robbers, and such. We can't even find all the graves in the Jungle.
We measure their success by the degree of healing. We don't have a clue about their rate of curing crazy.
Civil War statistics came from medical records. We know pretty much where those graves are, but we resist digging them up.`If the survivors went home drooling, it was still a success.
No, you are mistaken. I've always had this sig.
(Score: 2) by Gaaark on Sunday June 10 2018, @11:54PM (1 child)
I'm also wondering: did they know "wash your hands" worked better than "Next! No...the blood and gore on my hands will be just fine inside this next body"
--- Please remind me if I haven't been civil to you: I'm channeling MDC. ---Gaaark 2.0 ---
(Score: 2, Interesting) by pTamok on Monday June 11 2018, @08:48AM
It took a while.
Read about the sad story of Ignaz Semmelweis [wikipedia.org], the Austrian physician who determined that if the attending physician washed his hands before attending to a women in childbirth, the woman was significantly less likely to die of puerperal fever. He was ignored. Oliver Wendell Holmes (Senior) [wikipedia.org] had observed the connection between contact with the physician and puerperal fever, but offered rather impractical advice "...he insisted that a physician in whose practice even one case of puerperal fever had occurred, had a moral obligation to purify his instruments, burn the clothing he had worn while assisting in the fatal delivery, and cease obstetric practice for a period of at least six months."
Preventing sepsis in wounds only really became accepted practice after Joseph Lister's work [wikipedia.org]. There's a readable, more in-depth history written in 1964 (hyperbaric oxygen therapy hasn't fulfilled what appeared to be its early promise) here: The Lister Lecture,1964: Wound Sepsis - From Carbolic Acid to Hyperbaric Oxygen [nih.gov] and here: Listerism, its Decline and its Persistence: the Introduction of aseptic surgical Techniques in three British Teaching Hospitals, 1890-99 [nih.gov]
(Score: 2) by requerdanos on Monday June 11 2018, @01:51AM (3 children)
I am sure someone will correct me if I'm wrong, but isn't the mortality rate of those patients recovered by grave robbers closer to 100%?
(Score: 2) by lentilla on Monday June 11 2018, @05:07AM
Sometimes more - especially when the graves were protected by fancy booby traps!
(Score: 0) by Anonymous Coward on Monday June 11 2018, @02:35PM (1 child)
They probably look for signs of healing of the skull. If there is significant healing, the patient probably survived the trepanation, if not, the patient died shortly after the trepanation (not sure whether they can infer that cause of death was the procedure itself).
(Score: 2) by requerdanos on Monday June 11 2018, @02:52PM
Well, thinking on this, even if 50% of those found with fresh skull ventilation died from an unrelated cause such as being sacrificed in a religious ritual or from an ASW/PDT (arrow shot wound/poison dart targeting), that would mean that the mortality rate from the cranial breezeway fitting procedures was only half what it appears (~8 to 13 percent).
I don't, however, think that it's such a bad inference upon finding a body with nice sharp entrance wounds to the head to conclude a high likelihood that they were involved in some way with the demise of the departed.
(Score: 5, Informative) by HiThere on Monday June 11 2018, @12:01AM (2 children)
This is usually determined in archaeological finds by whether the bones started to heal. I haven't read this particular article, but I'd assume that was the practice in this study.
Javascript is what you use to allow unknown third parties to run software you have no idea about on your computer.
(Score: 2) by Gaaark on Monday June 11 2018, @12:42AM
Ay, makes sense. Thanks!
--- Please remind me if I haven't been civil to you: I'm channeling MDC. ---Gaaark 2.0 ---
(Score: 2) by qzm on Monday June 11 2018, @05:53AM
Perhaps you can also comment on why the study is comparing what are almost certainly severe trauma patients (civil war cases) with that are most likely religious/psychological patients (peru) who were most likely in otherwise good health?
My assumption is that they wanted to push some preconception about 'wow look at those amazing ancients!'
(Score: 2) by sjames on Monday June 11 2018, @09:19AM
Bone heals and remodels at a reasonably well quantified rate as long as the person is alive. By examining the edges of the hole it is possible to come up with a reasonable estimate of how long the person lived after the hole was made.
(Score: 1) by Muad'Dave on Monday June 11 2018, @12:12PM
I didn't RTFA, but I assume you could at least get a decent idea of the mortality rate by comparing skulls with trepanation holes with no bone regrowth at the margins (died) vs those that did (survived some amount of time).
(Score: 2) by looorg on Sunday June 10 2018, @11:50PM (2 children)
Could it just be that they had a lot more "volunteers" (or victims) to practice their trepanation on? Lots of human sacrifice -- willing and unwilling, prisoners of war and all kinds of unseemly people that probably didn't mind terribly to die for their Gods (or had a choice). I guess they could have also just practiced the old scientific method of erasing all their failures from history. The once where it succeeded and the patient survived was left alone as successes, those are the skulls found. The not so lucky patients went on the refuse pile somewhere -- or since they where clearly possessed by demons met some other untimely skull crushing fate.
(Score: 2) by JoeMerchant on Monday June 11 2018, @02:14AM (1 child)
I think Civil War surgeons got all the practice they could handle...
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(Score: 2) by looorg on Monday June 11 2018, @11:46AM
As someone else already noticed, drilling a hole in their skull during or just after battle when you have a pile of patients isn't really the same as being able to take your time. So conditions probably do matter.