Three errors from Wootton’s “Bad Medicine”

Three errors outlined by David Wootton in his very excellent book Bad Medicine:

1. We ignore non-events:

What we need in cases such as these is a history, not of progress, but of delay; not of events, but of non-events; not of inflexible logic but of a sloppy logic, not of overdetermination, but of underdetermination.

Because we have not listened out for the screams, we never hear the eerie silence that fell over operating tables in the 1850s.

Since this book argues that real medicine begins with germ theory, at its heart there is a most puzzling historical non-event: the long delay that took place between the discovery of germs and the triumph of germ theory.

2. Knowledge and therapy are together in hindsight, but separate in reality:

We tend to assume that where there is progress in knowledge there is progress in therapy… but before 1865 progress in knowledge rarely led to improvements in therapy.

Between the sixteenth and the nineteenth centuries, ideas about the body changed fundamentally, but therapies changed very little. Bloodletting was the main medical therapy in 1500, 1800, and 1850. The discovery of the circulation of the blood (1628), of oxygen (1775), of the role of haemoglobin (1862) made no difference; the discoveries were adapted to the therapy rather than vice versa.

Harvey announced that the heart pumped blood through the arteries in 1628; yet the use of the tourniquet in in amputations, which one would have thought was an absolutely elementary application of Harvey’s theory, was first pioneered by Jean Louis Petit (1674-1750), roughly a century later. Leeuwenhoek saw what we would now loosely call germs, or more accurately bacteria, through his microscope in 1677; yet in 1820 microscopes had no place in medical research, and in 1881 the conflict between germ theorists and their opponents was only just entering its final phase. Penicillin was first discovered not in 1941 but in 1872. And so on.

3. Status quo and confirmation errors plagued the progress of medicine:

To think about progress, you must first understand what stands in the way of progress–in this case, the surgeon’s pride in his work, his professional training, his expertise, his sense of who he is… the obstacle was the surgeon’s own image of themselves.

Comments are closed.