Author: David Wootton
This book is an exploration of Medicine’s murky past. The author, a history professor, shines a light at a time when medical practice was ‘a fantasy of science’ (page 11) that ‘…killed when it claimed to cure’ (page 8). Medicine’s preoccupation with prognosis at the time was an indication of ‘…the limits of the doctor’s capacity to intervene’ (page 35). The author justified revealing this ugly but factual picture of pre-modern medicine because ‘…we need to begin with bad medicine if we are to understand better medicine’ (page 13).
The author addressed the untested and ineffectual practices of Hippocratic and Galenic medicine in detail. He said ‘…medicine, until the 1820s, was rather like a religion, in that its claims were not subject to practical testing’ (page 144). The medical principles then were of the four humours– blood, phlegm, yellow and black bile (page 36). The gory therapies were of bloodletting, emesis, purgatives, cautery, and bloody amputations (page 17). This state of affairs was sustained for an inexplicably long time by the illusion of success, the placebo effect, and a pressure to conform (page 146). Conformity was ruthlessly enforced; Horace Wells, the pioneer of painless dentistry, for example ‘…was driven to suicide by the hostility of the medical profession’ (page 22).
The author was particularly scathing of the countless opportunities Medicine missed to advance clinical practice. He said ‘…something very strange happened in late seventeenth century science: an intellectual revolution that should have taken place failed to occur’ (page 110). The medical profession negligently ignored important inventions like the microscope, and overlooked significant discoveries like William Harvey’s circulatory system. The author argued that, with Leeuwenhoek‘s discovery of infusoria, ‘…there was no need to wait more than a hundred and fifty years for Lister…’ (page 129). The ‘limits of imagination’ and the ‘conservatism of institutions’ hampered medical scientific progress in subjects such as infection and reproduction (page 22). ‘Science and medicine had parted company’ he said ‘above all because the doctors were determined that no scientific discovery would alter their traditional therapies…’ (page 136).
In the latter part of the book, the author turned his attention to modern medical achievements. This period started from 1861, the year Louis Pasteur published his germ theory of disease. This theory, in the author’s view, was the key accomplishment that marked the beginning of modern medicine. The book chronicled the pioneering use of statistics and randomised trials by Ambroise Pare and Johannes Baptista van Helmont. He praised the work of William Withering on foxglove and John Haygarth on the placebo effect (page 166). He extolled the works of Paul Ehrlich and Gerhard Domagk in chemotherapy, John Snow on cholera, and Alexander Gordon and Ignaz Semelweiss on puerperal fever. He commended the roles played by great doctors such as Oliver Wendell Holmes, Claude Barnard, Charles Bell, François Magendie, Robert Koch, and Alexandre Yersin. He was however critical of several key figures, particularly James Lind, the discoverer of scurvy, who he said ‘… had no clear understanding of exactly what it was that he had discovered,…and no grasp of the importance of the clinical trial as a procedure’ (page 163). He also rebuked Thomas Sydenham for rejecting the microscope (page 24), and Alexander Fleming for not recognising the significance of his discovery of Penicillin.
This critical review highlights significant historical shortcomings and how they limited Medicine’s progress. The historical detail is impressive and the chronology easy to follow. The writing style is conversational and this occasionally drifts too far suggesting some poor editing. I enjoyed the storytelling although falls short of the standard set by The Rise and Fall of Modern Medicine. The author is very passionate about the subject and this keeps the reader engaged. He was very critical of individual historical personalities, James Lind and Alexander Fleming particularly. Much of the criticism is quite severe, almost as if he has an axe to grind, and I thought the hindsight bias and perhaps the historian’s fallacy contributed to this.
Although the author’s arguments were mostly counterfactual, they were reasonable. He makes a strong case for doctors to be vigilant against the narrow-mindedness that impeded medicine’s advancement, and still threaten it. For this reason I recommend it.
- Publisher, place, date: Oxford University Press, Oxford, 2006
- Number of chapters: 16
- Pages: 304
- ISBN: 0-19-280355-7
- Price: £11.19
- Star rating: 4 stars