Two Views : Bad Medicine: Doctors Doing Harm Since Hippocrates

1.

An ancient theme in the history of medicine is the story of the enlightened physician overcoming ignorant and stubborn colleagues. In the mid 20th century a few scholars began to use history of medicine to understand broader social and political issues, and today most professional historians eschew simple tales of progress. David Wootton, a professor of history, seeks to revive the progress narrative but focus on physicians' mistakes in order to improve today's medical practice. He fails on all counts.

Wootton argues that modern medicine began in 1865 when English surgeon Joseph Lister used antisepsis to improve outcomes. By applying germ theory to medical practice, Lister finally fused science and practice to prolong life. Wootton frequently reminds us that the microscope and germ theories were available for 200 years before Lister, so generations of physicians and scientists deserve our scorn: "the whole of medicine before 1865 was caught up in a fantasy world" (12).

There's trouble with this approach from the beginning, as Wootton doesn't keep his pledge to judge doctors based on therapeutic effectiveness. Hippocrates may have been able to set bones and lance boils, but his fantastic theory of humors apparently cancels out credit for any effective manual interventions. Similarly, battling wounds with an alcohol-containing substance was merely good luck, given ancient physicians' ignorance of bacterial causes of infection. Later heroes in the usual histories of medicine similarly deserve no praise. Supporters of William Jenner's smallpox vaccine did not publicize the risks of vaccination, and scholars discovering scurvy took too long to understand their results and disseminate their work.

What accounts for the longevity of the "fantasy world" that enveloped medi- cine before 1865? Wootton tells us that it was culture, which he explains this way: "the medical profession had set its face against the new research" (135). Wootton never defines "culture" more precisely, except to say that the "best doctors and best scientists failed to acknowledge the importance of the microscope" (240). In the closest Wootton comes to providing evidence for this explanation, we learn that medical authorities finally accepted John Snow's ideas about contagion because "intellectual fashions had changed against miasmatic theories" (210).

Later in the book Wootton suggests that "germ theory succeeded... because it demonstrated a capacity to prolong life" (255-56). He offers no proof other than Lister's case series of surgical successes in the 1860s. But Lister's work did not include a randomized, controlled clinical trial, the standard which Wootton applies throughout the book. (At one point Wootton tells us that "Homeopathy, we can be sure, would have outperformed Hippocratic medicine in a trial" p.68-69.) The Lister thesis has other problems as well. It turns out that Lister himself operated in a frock coat that carried infection, and that he probably didn't have "the slightest idea as to how to implement" a policy of asepsis (227). Wootton further suggests that English doctors didn't generally act on Lister's work until after 1935, and the French were completely lost: "without the discovery of diphtheria serum [in 1894] it is perfectly possible to imagine germ theory continuing to develop in opposition to French medicine, not within it" (255). So why does Lister get credit for something he didn't prove and many didn't follow? If merely putting germ theory together with a change in therapeutics gets the palm, then Wootton should instead highlight the Italian physicians who stopped blood-letting in the late 1600s based on their ideas of contagion. But Wootton apparently prefers slander to logic. Wootton alleges that "millions of lives could have been saved" if only Alexander Fleming had followed through on the implications of penicillin in 1929 (246-47). Two paragraphs later we learn that Lister himself apparently saved the life of his nurse with a penicillin-like substance in 1884 but decided not to pursue the therapy. Wootton doesn't seem to recognize that Lister is...