Dire prognosis

"Bad Medicine: Doctors Doing Harm Since Hippocrates" by David Wootton, Oxford University Press, 304 pages, $25

What was the prognosis for a person with appendicitis in the days of Hippocrates, in 400 B.C.E.? What was the prognosis for a person with appendicitis 700 years later, in the days of the great Greek physician Galen? And if we jumped another millennium and a half - to 1860, for example - would there be any difference? Not much.

Doctors in those days, any of them, could not offer any real treatment for appendicitis. They knew how to immobilize fractures and open an abscess, although their success rate was not dazzling. They could predict when a patient's days were numbered, when there was nothing that could be done and perhaps the time had come simply to offer a sacrifice or pray.

For the most part, however, they did harm, because those who had the means to pay for the best medical treatment received cures that only hastened the end - like a massive enema, or flushing out the intestinal tract with solutions to which various poisonous substances were added. Or when the patient was already in shock and had lost most of his bodily fluids, the doctor would arrive with a small pointed knife, called a lancet, which he used to pierce a vein and perform bloodletting (the only debate between the doctors was over which arm to draw the blood from, right or left, and how many times to do it).

Why was there no progress in the field of medicine for thousands of years? Why didn't doctors know how to alleviate pain, prevent a wound from getting infected or save women and babies from dying during the lying-in period by performing a Caesarean section (women survived such surgery only from 1876, when doctors began to do hysterectomies, which prevented bleeding and infection)? Why did physicians and scientists, and even patients, believe in the theories of Hippocrates and Galen, which were wrong from start to finish? According to Hippocrates, for example, the arteries carry air. No one made a connection between the pulse, which could be felt in the wrist, and the beating of the heart.

The first microscope was invented in 1575, and a hundred years later, Antony van Leeuwenhoek built hundreds of them. But no one thought of using them to continue studying the tiny particles that Leeuwenhoek saw under his microscope and illustrated. Even William Harvey, who discovered blood circulation, wrote that microscopes were of no value. Only much later did Louis Pasteur disprove the theory of spontaneous generation and show the world the mysterious hidden creatures called bacteria.

The truth is, I never paid attention to the fact that there was such a large time gap between the invention of the microscope and its clinical use, or the fact that patients suffered such intolerable pain during operations performed without anesthesia when the substances that allowed pain relief were already known. Only when the use of ether was demonstrated in 1846, and amazingly, not by surgeons who saw the suffering they caused, but by a quack dentist who thought it was a good way to get rich, did doctors begin to administer ether to dull pain during surgical procedures.

All these facts appear in a slender volume that I found by chance in the basement of a London bookshop. What drew my attention to the book, among all the thick medical texts down there, was the intriguing title "Bad Medicine," embossed in gold on the picture of a old, worn medical satchel, and the subtitle "Doctors Doing Harm Since Hippocrates." How could I not pick up a book like that?

Though it is not fiction, I would definitely include this book in the "airport novel" category. There is nothing like it for passing the time. You completely forget where you are.

"Bad Medicine" is gripping because it offers new insights and presents the history of medicine in a way that I have not seen anywhere else. As par for the course when a historian attempts to write an alternative introduction to history, the book was greeted by a tidal wave of angry criticism when it was published, last summer. But there are others, like me, who have found the book fascinating and are prepared to look anew at history and the mistakes of the past.

Interactive author

Another thing that makes Wootton's book unique is that the author has posted related historical material on an Internet site he refers to in his introduction (www.badmedicine.co.uk). This allows one, among other things, to reach the author directly, with questions or praise. And he answers immediately: In reply to my question, Wooton wrote back to say that he was collecting the responses, complimentary and critical, and would soon be publishing them on his website, followed by comments.

The central issue explored by Wootton is the mental stagnation of medical research, and why, for thousands of years, no one went into the body or searched under the skin. When operating, why were surgeons blind to what was right before their eyes? What kept them from challenging the ancient conventions that reigned supreme until Andreas Vesalius, a Belgian anatomist, began to dissect bodies in the mid-1550s and draw what he saw, disregarding the teachings of Galen.

The story of scurvy, for example, which killed thousands of seamen who ate no fresh produce during their voyages, reveals how little trust doctors had even in their own discoveries. James Lind, a Scottish physician, carried out a daring medical experiment on the crew of his ship in 1758. Out of 800 crewmen, 80 came down with scurvy. Lind divided the sick sailors into groups, giving each a different treatment. One group drank vinegar, another took a popular quack remedy containing no active ingredients, and the third drank fresh lemon juice.

Amazingly, the seamen who drank lemon juice were cured of scurvy within a week. But when more experiments were conducted to establish the efficacy of the treatment, Lind heated the juice (thereby destroying the vitamins that prevented the disease). When nothing happened, he went back to bloodletting....

Has so much changed since then, with all the scientific techniques and strict controls of today? The answer is not so clear. The direct correlation between smoking and cancer has been known for many years, but the implications of this knowledge did not resound loudly enough. (Was it because of economic pressure? Or perhaps because doctors were addicted to smoking?)

Sometimes it happens that a sober-eyed historian with a flair for writing gets up and presents us with a picture of the world that we are not used to seeing. He invites us to think in a fresh, creative way that allows us to learn from the past and move away from the fossilized mentality of the medical profession.

If this book inspires even one reader - be it a doctor, a nurse, a health reporter or just an interested layman - to break out of the mold and engage in creative, productive, original thinking, the author will have accomplished a mission of truly historical proportions.

Prof. Yoel Donchin is the head of the anesthesiology department at the Hadassah University Hospital, Ein Karem.