After a busy holiday season, activity has resumed in Melioria. A recent open house was well attended, and this last Saturday, the coffee house salons started once more.
You may find them a bit dry, or perhaps historically implausible. That's ok, if you do--I tend to loathe things that other people enjoy, like shopping or watching sports. But I do love these discussions.
Aldo usually provides us with intriguing period readings to look at beforehand, and we all seem to do some preparation in advance. We assemble at the coffee house at a given time and then we engage in the amusing mental exercise of having a discussion while taking on the perspectives of relatively informed and enlightened people of the 1780s. Are we discussing things from the perspective of a typical 18th century person? No, not really. But it's fun, and we keep learning things. For example, most of my adult life I knew who Rousseau and Diderot were, but I never actually read any of their stuff. Now I have, and it's pretty cool.
I look on this is as an excellent example of what I think is the most common and dynamic form of educational process that takes place in virtual worlds: "cooperative self-directed learning." A group of interested, interesting people develops a collective reason (or excuse, if you will) for doing individual reading and study, then they get together to share what they have learned. They encourage each other, and they motivate each other, but ultimately, what they get out of is pretty much equivalent to what they put into it.
In the end it is about amusing ourselves and being entertained. But it is entertainment in which we actively participate.
The following is a Melioria Salon partial Transcript:
“In Sickness and In Health”
January 7, 2012
Attending: Aldo Stern, Diogeneia Kuhr, Joseph-Hyacinthe de Rigaud, Oona Riaxik, JJ Drinkwater, Serenek Timeless
[13:13] Aldo Stern: The subject matter is, of course a question of science, but one that affects us all...
[13:14] Aldo Stern: matters of disease, theories of how it spreads...modern treatments for it...and if we have time...the responsibilities of us all to foster good health among the public
[13:15] Diogeneia: if I may begin with a comment...
[13:15] Diogeneia: you know I mentioned my brother...
[13:15] Diogeneia: and being wounded...
[13:16] Diogeneia: you know what the doctors wished to do for him, once thy bandaged his leg...was of course to bleed him
[13:16] Diogeneia: it is for many still the standard, to try to adjust the humors within the body...
[13:16] Diogeneia: but he said it made him feel weaker...
[13:17] Diogeneia: and so he subsequently avoided the surgeon whene'er he saw the poor man coming...
[13:17] Diogeneia: and he healed quite nicely without the benefit of bleeding...
[13:17] Oona Riaxik: To my mind, he had already been bled by the wound. Perhaps leeches should be reserved to internal maladies
[13:17] Diogeneia: better perhaps, he thinks
[13:17] Diogeneia: what may I ask do you my friends think of the practice?
[13:18] JJ Drinkwater: Of bleeding?
[13:18] Diogeneia: ja,Fraulein Oona, she has a good point, he already did the bleeding with the wounding
[13:19] Aldo Stern: yet the surgeon wished to take more, no?
[13:19] Joseph-Hyacinthe de Rigaud: I've always been skeptical about this practice
[13:19] Aldo Stern: indeed Signor Conte?
[13:19] Sere Timeless: It is my understanding that the medicine of Galen, the balance of the humors, and the value of bleeding is much out of favor with those who do the most healing ...the battlefield surgeons.
[13:19] Oona Riaxik: was this a local physician or one acquainted with war hospitals?
[13:20] Oona Riaxik: Precisely, this is what I hear of war surgeons as well. Which makes me wonder if they brought in a local doctor to care for your brother
[13:20] Oona Riaxik: or news reaches the colonies too slowly
[13:20] Diogeneia: the surgeon of the regiment died of a fever some time ago
[13:21] Diogeneia: so the doctor my brother was seeing was a civilian ... an American
[13:21] Oona Riaxik: well then he simply wanted to effect your brothers end!
[13:21] Oona Riaxik: by bleeding him to death
[13:21] Diogeneia: Ach, no, it was a loyalist ...
[13:21] Sere Timeless: I wonder where this American doctor was trained. Or if he was trained.
[13:22] JJ Drinkwater: Surely the latest medical thinking does not reach the Americas quickly
[13:22] Oona Riaxik: they have not seen enough of war *sigh* to make this observation
[13:23] Aldo Stern: perhaps...although they do have great scientists such as Dr. Franklin...but I do not know if any of their most forward looking thinkers do so in the field of medicine
[13:24] Sere Timeless: The difficulty, I think, in discontinuing ineffective medical practice is that we know so little of the mechanisms of disease we cannot invent more effective practices.
[13:25] Diogeneia: Well the King of Prussia when he was wounded in the 7 years war, I know they bled him...but for my brothers sake, I am glad the thinking changes...I have never felt very good after bleeding, and so I avoid it
[13:26] JJ Drinkwater: We have begun to understand that health is a sign that the mechanism of the body is functioning correctly, but what that mechanism comprises is still largely a mystery, is it not?
[13:26] Aldo Stern: to a great extent yes...but we have made great strides beyond merely saying, "here is what the ancients thought, so it must be correct"
[13:27] Oona Riaxik: the mechanisms are but we still have so much information about the course of the disease
[13:27] Oona Riaxik: that we can study it progression and learn form this
[13:27] JJ Drinkwater bows "You are quite correct, signorina"
[13:27] Aldo Stern: there is some very interesting thinking I have seen, for example in Diderot's encyclopedia...
[13:28] Aldo Stern: and I note that often conclusions .. or theories at any rate, are based upon actually examination and autopsies
[13:28] Oona Riaxik: well, sickness occurs in living bodies! yet another practice that needs revision
[13:29] Joseph-Hyacinthe de Rigaud: but recognizing an effective remedy, doesn’t necessarily mean we comprehend the mechanism behind, a lot is intuition, trial and error
[13:30] JJ Drinkwater: So we have begun by casting off old certainties, and admitting our need of knowledge drawn from examples
[13:30] Oona Riaxik: We cannot wait to treat until we understand the mechanism, we have only trial and error - and critically, observation to aid us.
[13:30] Aldo Stern: so are you arguing, Signore Conte and Lord Twilight, that the body is not unlike a machine...with predictable mechanisms at work?
[13:31] JJ Drinkwater: That is the most modern medical thinking, as I understand it
[13:31] Joseph-Hyacinthe de Rigaud: some could be predictable, provided we had proper insight
[13:31] Sere Timeless: We have known for over a century from the work of Dr. William Harvey that blood flow, for example is a very mechanistic process.
[13:31] Oona Riaxik: and the spread of disease is also looking predictable
[13:31] Joseph-Hyacinthe de Rigaud: oh yes
[13:32] Aldo Stern: *smiles* then we may rule out such factors as demons and curses
[13:32] Sere Timeless: Which would lead one to suspect that other mechanical and causal principles are at work in our bodies.
[13:32] JJ Drinkwater: Are we not, after all, composed of matter? And does matter not behave according to certain laws?
[13:33] Joseph-Hyacinthe de Rigaud: so true, but these laws seem so intricate
[13:33] Diogeneia: ja, even the madness....or melancholia, it may seem to the uneducated that there is no mechanistic cause, but if you do enough observation, eventually one would surely find there is some rational reason for irrationality...
[13:34] Diogeneia: too much bile, a fever in the brain, not enough of something, rather than a supernatural cause
[13:35] Aldo Stern: *nods*
[13:35] Oona Riaxik: well the church will not like to hear this thinking!
[13:35] Aldo Stern: even the ancients did not simply say, "oh well the gods are ill favored today and so they make us sick"
[13:36] Aldo Stern: they made observations such as the influences of swampy areas on the health of their people...they noticed a connection to fetid water and decaying matter, and so either did not build near swampy ground, or they built their great drains to carry off the dampness
[13:37] Aldo Stern: *smiles* something that we can learn from, especially for those who believe in the miasmatic theories of disease
[13:38] Sere Timeless: And so is it the nature of human thought to be able to infer that there must be a causal connection even if we cannot explain the mechanism?
[13:39] JJ Drinkwater: The causes, as M. le Comte has observed, are intricate
[13:39] Aldo Stern: I think that was part of the Conte's point ... that even if we cannot be sure of the exact mechanism at work, we should act as best we can, based on our best understanding and observations
[13:40] Oona Riaxik: agreed. So again,
[13:41] Oona Riaxik: why does the practice of bleeding persist - is so accepted even when many in the field
[13:41] Oona Riaxik: know of its deleterious effects - is this to make the patients feel that they are getting care in spite of our lack of knowledge?
[13:41] Aldo Stern: well going back to how doctors are trained
[13:41] Aldo Stern: most after all do not attend a school of any sort, they study with an experienced doctor
[13:42] Aldo Stern: and follow him as an assistant until they feel they know enough to practice
[13:42] Aldo Stern: consequently, old habits and ideas will be passed on, no?
[13:42] JJ Drinkwater: A valuable opportunity for observation, if they will use it
[13:42] Oona Riaxik: surely however if ones sees patients grow faint after bleeding, why recommend it? to collect coin?
[13:42] Joseph-Hyacinthe de Rigaud: but some convictions are so difficult to eradicate, even if they have been proven to be wrong. We like continuity, and not be in uncertainty
[13:43] Joseph-Hyacinthe de Rigaud: ...and so maintain our old beliefs
[13:43] Joseph-Hyacinthe de Rigaud: but that's not the way forward
[13:43] Diogeneia: maybe they don't like to admit how little they know, and fear business will diminish if they do too much experimenting and observation
[13:43] Oona Riaxik: it would be considered a poor doctor to be called to treat and not treat with something... rather than say, "bleeding will not help you, I do not know the cause, so just rest."[13:43] Aldo Stern: so may I ask...you all here are very forward thinking and enlightened people...what sorts of treatments for various maladies do you think are of value?
[13:43] Aldo Stern: I myself, have observed how much better I feel after imbibing several cups of this excellent coffee...I may conclude from that that the chemicals in the mixture have some beneficial effect upon my internal mechanisms
[13:44] Aldo Stern: *smiles* so I shall continue my experiments with great enthusiasm
[13:44] Joseph-Hyacinthe de Rigaud: mmmm, nicotine, where are you? I have some experience on that
[13:44] Sere Timeless: And certainly liquor produces the same feeling of well-being, at least for awhile.
[13:44] Diogeneia: ah, there you go...the tabac as a potent medical herb...
[13:44] Joseph-Hyacinthe de Rigaud: oooh, tell me, smiles
[13:45] Diogeneia: my other brother ... the one who is a trader among the Indians of northern America...he has written me about how the natives use tabac as a medicinal
[13:45] Sere Timeless: And yet, do we truly believe that tobacco and liquor are good for the body?
[13:45] Oona Riaxik: yes, funny how readily we adopt new cures and yet loathe to be rid of the old... We see how effective these medicines are, tobacco and coffee.
[13:45] Diogeneia: they inhale the fumes for lung troubles, they make poultices of the leaves to put on wounds
[13:45] Diogeneia: I myself am happy just to smoke it...
[13:46] Oona Riaxik: We see that they are good but to a point
[13:46] Joseph-Hyacinthe de Rigaud: I feel so lucid after actually inhaling
[13:46] Oona Riaxik: the Conte's intricacies come into play here - a fine balance is necessary with these drugs
[13:46] Aldo Stern: ah a good observation signorina Oona...
[13:47] Aldo Stern: there is perhaps a balance of the chemicals that must be maintained...
[13:47] Aldo Stern: and that even a good substance in too much quantity can be bad for the body
[13:47] JJ Drinkwater: Indeed, it stimulates the mechanism....but how much stimulation will the mechanism bear?
[13:47] Joseph-Hyacinthe de Rigaud: that's a good point, the doses, can be decisive also
[13:47] Diogeneia: but that is true with any medicinal, ja? you take too little and it does no good...
[13:48] Diogeneia: but too much, and maybe you get sicker
[13:48] Joseph-Hyacinthe de Rigaud: if I drink much more coffee, I get all shaky
[13:48] Aldo Stern: an excellent point
[13:48] Joseph-Hyacinthe de Rigaud: and I have to vomit, if I inhale too much nicotine in whatever way
[13:48] Joseph-Hyacinthe de Rigaud: so we're back to balance
[13:48] Oona Riaxik: and we all know the ill effects of too much wine
[13:49] Oona Riaxik: so we can establish this balance - a measure of how much is beneficial and how much becomes toxic
[13:49] Aldo Stern: but might not that vary from individual to individual?
[13:50] Oona Riaxik: this could be easily determined by a little experimentation
[13:50] Joseph-Hyacinthe de Rigaud: yes, it made a whole empire vanish, too much wine, lead in the vases
[13:50] Oona Riaxik: we could do it now!
[13:50] Joseph-Hyacinthe de Rigaud: *grins*
[13:50] Aldo Stern: obviously there are things that are poisons...
[13:51] Oona Riaxik: perhaps the poison comes form the dose and not the drug?
[13:51] Aldo Stern: there are poisons that must be kept out of the water the people drink ... even the air they breath
[13:51] Oona Riaxik: as we see with coffee nicotine and alcohol as with belladonna
[13:51] Joseph-Hyacinthe de Rigaud: I like that idea, of the dose/balance
[13:51] Oona Riaxik: and arsenic
[13:51] Aldo Stern: going back to miasmas...what is in the air ... does that need balance as well?
[13:51] Oona Riaxik: ahhh you bring up a difficult one!
[13:52] Aldo Stern: obviously there are always certain "particulates" in the air: the effluvia that is given off by stale, standing water...
[13:52] Joseph-Hyacinthe de Rigaud: indeed, I find that concept so hard to comprehend
[13:52] Oona Riaxik: it would seem to hold true - the cure, so to speak, may be to change or improve environment rather than dose[13:52] Aldo Stern: well. it seems obvious that decaying plants and animals
[13:52] Aldo Stern: the wastes of men and beasts...
[13:53] Aldo Stern: as they decay, they give off impurities...
[13:53] Aldo Stern: obviously such things cannot always be avoided
[13:53] Aldo Stern: they are part of the cycles of life
[13:53] Aldo Stern: but it is when there is an imbalance that disease may result it seems...
[13:53] Oona Riaxik: they can be managed like a dose - the ancients managed these things very well
[13:53] JJ Drinkwater: But how are we to examine these particulates, when they are so subtle? How are we to gain knowledge of them?
[13:53] Oona Riaxik: how have we lost this knowledge?
[13:53] Aldo Stern: Again, is it not enough to start with the genereral observation, that when a city sits on a swampy field with rotting plant life...
[13:53] Oona Riaxik: *sigh*
[13:54] Aldo Stern: or one is on a battlefield, the many dead decaying...
[13:54] Aldo Stern: there is then too much of the effluvia and disease results?
[13:55] Diogeneia: Lord Twilight has a good point...if you cannot see such things as the noxious gases given off by decaying matter...how can we capture and study them?
[13:55] Oona Riaxik: this seems apparent - but many more soldiers die of sickness than the injuries of war -
[13:55] Aldo Stern: yes, and we observe that a city that wallows in its own wastes and has dirty water about ... and the people get sick often and in large numbers
[13:55] Oona Riaxik: so what mechanism is at play?
[13:55] JJ Drinkwater: il Professore has partly answered me: we may know them by their effects
[13:57] Joseph-Hyacinthe de Rigaud: identifying and quantifying gets us halfway already, could that be?
[13:57] Oona Riaxik: we compare healthy tissue and unhealthy tissue to see what differences lie therein
[13:57] Oona Riaxik: or to use Herr Sterns example, we compare water in healthy cities and unhealthy ones
[13:57] Diogeneia: or at least gives us a strategy to follow until we do understand better
[13:57] Oona Riaxik: Si, one must know what to treat in order to treat it
[13:58] Diogeneia: like in the days of the plague, when the nobles left the cities and went to their country estates...they were getting away from the contagion as best they could
[13:59] Sere Timeless: Is there anything to be gained from studying those who remain healthy even in the midst of unclean situations and rampant disease and contagion?
[13:59] Oona Riaxik: Signora brings an excellent question
[13:59] Aldo Stern: an interesting idea Signorina Sere....how might one approach such a task?
[13:59] JJ Drinkwater: Signorina Timeless, what would we study about them?
[14:00] Sere Timeless: That is precisely my question, Signore.
[14:00] Sere Timeless: Presumably there is something about them that renders them immune to disease.
[14:00] Aldo Stern: or if we are looking at this purely as a mechanistic issue
[14:01] Sere Timeless: What I have noticed is that those who have survived a disease such as the pox, do not seem to contract the same disease again.
[14:01] Aldo Stern: there is something they do, something about how they live, what they eat, or something that keeps them from giving into the contagion
[14:02] Aldo Stern: and...yes..there...having had the disease ... or something similar
[14:02] Aldo Stern: renders a person less likely to get it again...
[14:02] JJ Drinkwater: Perhaps Herr Van Leeuwenhoek wonderful device would tell us more, if we examined their tissues....although it is a grisly thought
[14:02] Aldo Stern: a rational explanation, even we do not precisely understand the mechanism that makes it work so
[14:03] Oona Riaxik: Yes van Leeuwenhoek's work is very compelling
[14:04] Oona Riaxik: allowing us to see those differences between healthy and non healthy tissues
[14:04] Oona Riaxik: theses cells as he calls them
[14:04] Oona Riaxik: seem to undergo many changes
[14:05] Diogeneia: there is much o be said for understanding the exact mechanisms of why something works as a treatment...or why an organ or healthy tissue becomes diseased...
[14:05] Diogeneia: but for the most part I think the higher priority is to share information on what works, based on experience and observation...
[14:06] Diogeneia: if we see that a poultice of tabac helps a wound to heal, then use it and worry later about why
[14:06] Oona Riaxik: on this we agree
[14:06] JJ Drinkwater: But what if it seems to help in some cases and harm in others?
[14:07] Oona Riaxik: the colleges should come together with government to set some standards
[14:07] Aldo Stern: that is why I think it is important for there to be publications like the encyclopedia of Diderot...to share the information about what helps and what causes harm
[14:08] Sere Timeless: It would be well enough if the medical colleges would simply systematize the knowledge they already had about the efficacy of various cures.
[14:08] Oona Riaxik: It does seem to help in some and not in others - with open community of physicians, these experiences should be shared to
[14:08] Oona Riaxik: determine better treatments
[14:08] Oona Riaxik: and be implemented more universally
[14:08] Oona Riaxik: Very true Ms. Timeless
[14:09] Aldo Stern: then let us do some sharing...what do each of you think is one of the most important ideas in health and medicine to be discovered ... or agreed upon...in recent years?
[14:09] JJ Drinkwater: Assuredly the circulation of the blood
[14:10] JJ Drinkwater: For if blood circulates, may not other essential fluids, at whose existence we now only guess?
[14:11] Aldo Stern: ah...now that is interesting
[14:12] Sere Timeless: I regret to say, my friends, that I need to attend to some other matters at present. It grieves me to have to leave such an interesting discussion.
[14:12] Joseph-Hyacinthe de Rigaud: au revoir Madame
[14:12] Aldo Stern: thank you for joining us Signorina