David Wooton. BAD MEDICINE – Doctors doing harm since Hippocrates. Oxford University Press ISBN 0-19-280355-7 16.99 pounds sterling Pp 304.

Primum non nocere, the Hippocratic dictum, is perhaps the cardinal rule of medicine in general and of medical ethics in particular. This principle has been honoured by most of its practitioners in the long history of medicine. Thus, a book which provides a revisionist history and bunks considerable amounts of accepted or known history needs to be noticed. Medicine has had more error than it has done things right, says the author, David Wooton, Anniversary Professor of History at the University of York, England.

Wooton does not write a conventional history. He chooses, instead, selected – but extremely important – events in medicine to illustrate his theory. For instance, all medical students are taught that James Lind was the physician who showed that scurvy could be prevented in sailors by the regular intake of lime on long sea voyages. Likewise, Ignaz Semmelweis is given credit for showing the aetiologic connection between puerperal fever and the lack of disinfection or washing of hands by medical students and doctors who examined pregnant women after performing autopsies.

Wooten upsets the apple cart by stating that Lind had little to do with the treatment of scurvy; our belief that he did so is purely a misinterpretation of known facts. He shows, also, that Leewenhoek’s microscopes and specimen preparations were far superior to what we’ve always believed – that they were crude and incapable of yielding good information. Wooton shows that there was a delay in microscopic pathology, a delay which is unforgivable and must have cost numerous lives over the decades. In a similar vein, Wooton states that years took place between the discovery of penicillin (long before Fleming rediscovered it) and the realisation of its impact on therapeutics followed by its mass production and use. Indeed, many of our medical heroes seem to have got it all wrong, in this book.

Because physicians refused to accept change and have an open approach to change until 1865, when Lord Lister changed the course of medicine with his seminal introduction of antisepsis in surgery , they have been unscientific, claims Wooton. And an unscientific physician is, it is obvious to us, an unethical one.

And, yet, methinks the man doth protest too much. Is Wooton guilty of evaluating the events of the past with today’s knowledge? I suspect so. There is of course, much truth in what Wooton states. But is it fair, for instance, to say that Semmelweis is given “more credit than he deserves” only because “he did not recognise puerperal fever as an infectious disease or recognise the role of germs”? Opportunities have been lost, mistakes have been made – but that is what research and progress is all about. What he does not seem to realise is that there are very few eureka moments in science. Change, when it does take place, is generally slow. This is probably true not just for medicine, but for other fields as well. Further, making retrospective diagnoses and offering armchair theories are among the easiest things on earth, be it in radiology and pathology, history of medicine or in predicting the stock market. It is all too obvious now that the earth revolves around the sun, but before Copernicus and Galileo changed that belief, millions of people would have scoffed at the idea. Not for nothing is it said that when a new idea is introduced it is initially scoffed at, then looked at with some interest and then accepted as something that was obvious all along.

Wooton himself accepts that psychological and cultural factors worked (and work and will continue working) against innovation. After all, medicine is a science which develops in a social context and its history and interpretation cannot be studied in a vacuum.

It is also useful to keep in mind cases which were immediately accepted by medical science – the use of thalidomide and of frontal lobotomy are only two examples of treatments which created much misery before being discarded. More bad medicine, perhaps?

Although I do not accept Wooton’s thesis – which has been warmly praised by some critics and blasted with equal fervour by others – I recommend that you read the book. Much of his research and interpretation is original and teaches that it is always sensible and often useful to question established theories about known “facts”.