The disability-adjusted life year (DALY) is a measure of overall disease burden – the number of years lost. I’m wondering just much harm premodern medicine did, per doctor. How many healthy years of life did a typical doctor destroy (net) in past times?
Consider Semmelweis. Between 1839 and 1847, the First Clinic at the Vienna General Hospital had 20,204 births and 1,989 maternal deaths. The Second Clinic, attended by midwives, had 17,791 birth and 691 maternal deaths. An MD’s care conferred an extra 6% chance of death. Births at home were even safer, with maternal mortality averaging about 0.5%
In that period, MDs caused about 1200 extra deaths. Today ob-gyns deliver about 12-15 babies per month; assuming that caseloads were similar back then, there would have been something like 14 doctors working there ( a very rough guess: 2500 births a year, 180 births per doctor). So each MD was responsible for something like 85 extra deaths over that period. Since some were students, who surely didn’t spend the whole 8 years there, probably the per-doctor fatality rate was less that that. Maybe only 50 deaths per doc. Of course a doctor’s career was longer than 8 years…
Assuming 30 years of life lost per mom, 1500 DALYs per Victorian ob-gyn sounds like a minimum.
Ob-Gyn was especially bad, but most doctors, over most of history, must have had significantly negative effects. We know that wounded men in the Civil War had a better chance of surviving when they managed to hide from Army surgeons. Think how many people succumbed to bloodletting, over the centuries.
It looks as if the average doctor (in Western medicine) killed a bunch of people over his career ( when contrasted with doing nothing). In the Charles Manson class.
Eventually the market saw through this illusion. Only took a couple of thousand years.