Bad Medicine: Doctors Doing Harm Since Hippocrates

David Wootton writes in his introduction to Bad Medicine: Doctors Doing Harm Since Hippocrates (Oxford) that he set out to write “a history of different ways of conceiving the human body” (the medieval, the mechanical, the chemical, the genetic) but came to understand that throughout history there has been a fundamental difference between ideas about the body and medical therapies applied to the body: in particular that as ideas changed, therapies did not. For centuries, for example, doctors continued bloodletting as a (useless) therapy despite the discovery of circulation in the seventeenth century, oxygen in the eighteenth century and hemoglobin in the nineteenth century: bloodletting and purging were still primary treatments at the beginning of the twentieth century. In fact, Wotton discovered that no progress in therapy occurred in the two thousand years before 1865, when Lister invented antiseptic surgery. But even Lister’s work was a matter of long delay. As Wootton points out, the intellectual principles of antiseptic surgery had been widely known for thirty years before Lister or anyone grasped their application. The story of Bad Medicine is a story of discontinuities, of knowledge gained and forgotten—or ignored, of delay and obfuscation. The cure for scurvy is another example: lemon juice had been clearly identified as the effective remedy by 1601, and British, Spanish and Portuguese sailors all used it. The problem of scurvy, Wootton writes, had been solved by the early seventeenth century. But doctors and ships’ surgeons gradually convinced ship captains otherwise, and a hundred years later scurvy was killing at least 50 percent of ships’ crews on long voyages. During the Seven Years’ War, which ended in 1763, only 1,512 British sailors were killed in action, but a further 133,708 died of disease, mostly scurvy. James Lind rediscovered the role of lemon juice as a preventative for scurvy in 1747 and waited six years to publish his findings. By 1773, when his book appeared in a 3rd edition, he had reversed his conclusion and renounced his “discovery.” Nevertheless, Lind is considered in standard histories to be the father of scientific medicine and the discoverer of the cure for scurvy. Bad Medicine is itself a refinding of history, and a new way of thinking about “progress.” Stephen R. Bown’s Scurvy: How a Surgeon, a Mariner, and a Gentleman Solved the Greatest Medical Mystery of the Age of Sail (Thomas Allen) is an excellent account of life and lingering death on the high seas during the age of empires and oceanic voyaging. Bown acknowledges some of the discontinuities in the history of medical science that Wootton scrutinizes more closely, and his book will make you glad that you never went to sea in the eighteenth century.