| In this important book the author is essentially propounding two
theses. The first, not exactly novel, is that until recently therapeutics
was
a sham — a confidence trick practised by doctors who lacked effective
medicines and who, with their obsession with bleeding and purging, did
more harm than good. The second and more original argument is that throughout
history the medical profession ignored or opposed advances rather than
welcomed them.
Wootton cites many instances where discoveries were ignored for considerable
periods, an example being the anaesthetic properties of nitrous oxide
being overlooked for half a century. In one case the discoverer himself
ignored the advance.
The medical histories now credit James Lind with conducting the first
clinical trial resulting in the discovery that oranges and lemons were
a cure for scurvy. As Wootton points out, the reality is not so simple.
James Lind, as a surgeon and not yet medically qualified, on board HMS
Salisbury in 1747 found that 80 of the 800 crew were suffering from scurvy.
He selected 12 of the scurvy sufferers, put them all on the same diet
and divided them into six pairs. Five of the pairs were given ineffective
remedies such as vinegar and elixir of vitriol, and the sixth pair, who
were cured within a week, were given oranges and lemons. Unfortunately,
there were no more oranges and lemons to give to the other sufferers
and Lind made no use of his finding until he had qualified as a doctor
six years’ later, when he published ‘A treatise of the scurvy’.
It was 400 pages long and only four of these were devoted to his trial
showing the curative powers of oranges and lemons. Lind obscured his
finding with 396 pages of humoral theorising and it made no impact. Even
worse, after Lind was appointed chief medical officer of the Royal Naval
Hospital, Haslar, near Portsmouth, he treated his scurvy patients with
lemon juice concentrated by heating, a process that destroyed most of
the vitamin C. Lind gradually lost his faith in citrus fruits as a cure
for scurvy and, sadly, ended up recommending blood-letting as the main
treatment.
The author, somewhat arbitrarily, dates scientific medicine from 1865,
when Joseph Lister adopted antiseptic surgery, but the book nevertheless
convincingly shows how doctors for two millennia resisted, rather than
welcomed, advances in medicine. Anyone interested in the history of medicine
will want to read this book.
Ray Sturgess (a contributor to The Pharmaceutical Journal, mostly on the
history
of medicine and surgery)
|
The
Pharmaceutical Journal