You can’t help seeing it as a kind of back-handed compliment. No sooner had his daughter announced that she intended to train to be a doctor than David Wootton decided to start work on Bad Medicine, a book that comes with the catchy subtitle Doctors Doing Harm Since Hippocrates. Wootton smiles, unfazed by the association. “It’s true that my daughter’s career choice did spark my interest in the history of medicine,” he says, “but the title is somewhat misleading. My working title was Death Deferred and the main thesis is that it’s only in the past 150 years that doctors have started to do any good.”
Just as the title got lost somewhere in translation, so too did the book. What Wootton, anniversary professor of history at York University, originally intended to write was a rather esoteric Foucaultian exploration of the ways we inhabit the body, but he rapidly became diverted into the 2 000-year Hippocratic tradition of Western medicine and how it has failed to progress. True, there had always been a few quacks, but then — as now — doctors were, for the most part, well-paid, highly educated practitioners who were respected within the community, even when they were killing more patients than they were curing by practising therapies such as blood-letting, which we now know had worse results than allowing the illness to take its natural course.
“You can see it only as some kind of mass professional delusion,” Wootton says. “Even in the late 17th century, when doctors no longer believed that the body was made up of the four humours, they continued to practise the same therapies. They managed to convince themselves that the treatments they had always practised were effective and it was their belief systems about why they worked that needed to change. And patients colluded because they were desperate; doing something was perceived as better than doing nothing.”
So far Bad Medicine has received what publicists refer to as a “mixed reaction”. Doctors in the United Kingdom, with an interest in how medicine became effective, have largely given the book the thumbs-up, while those in the United States — where evidence-based medicine still plays second fiddle to clinical judgement — have been lukewarm. But it is from the medical historians that Wootton has copped the heaviest flak. His crime? Writing a history in terms of progression.
“It is almost an article of faith for historians that notions of progress are relative and illusory,” says Wootton. “And it makes perfect sense when you are studying something like 18th-century politics, because notions of taking sides between good guys and bad guys are to some extent meaningless, because people are a product of a particular social and cultural construct. But it doesn’t make so much sense when you are talking about science, because progress is something than can be clearly measured and quantified.”
This is more than some slightly recherché academic squabble over postmodernism. For in writing Bad Medicine Wootton has completely redrawn the received version of medical history, which states that it was only with the building of large hospitals in the 19th century — and the accompanying increased mortality rate due to the proximity of patients to one another — that doctors began to grasp germ theory. Rather than trading in the standard “what if?” counterfactuals that have become the staple diet for many historians, Wootton trawled through the archives to create a parallel, virtual history of medicine that raises serious questions about how the actual one evolved.
“There were physicians in the 17th-century who had come up with relatively sophisticated ideas of germ theory,” says Wootton. “They understood there were little things that were buzzing around and that some people must develop resistance to them. They could even see them in microscopes. I’d always previously assumed that their microscopes weren’t powerful enough, but that was incorrect. They could see microbes, but the medical establishment did nothing. It was Pasteur who got the credit for germ theory, but he was really only running experiments other scientists had run 30 years before.
“It may sound as if I’m using hindsight to condemn doctors for failing to break free from the prevailing belief systems, but that’s not true. Contemporaries were asking themselves the same kind of questions; when anaesthetics were first introduced, countless doctors asked themselves why on earth they hadn’t started using them earlier, as the science was already well understood. Medical history is littered with these anomalies … So it makes sense to think of medicine as a series of progressive breakthroughs and it is legitimate to ask why progress has often been so slow when the necessary evidence is available. Even now we’re making the same mistakes. It’s only in the past 25 years that we’ve finally accepted that ulcers are caused by bacteria rather than stress.”
Wootton is a curious mix of the radical and the old school. He might have cut his teeth on Foucault and Levi-Strauss several years ago, when he came across their work piled up in a sleepy bookshop in Poitiers where he was studying on a pre-Cambridge scholarship. But, not far beneath the surface, there is a committed rationalist whose beliefs are firmly rooted in the Enlightenment. And it’s a rationalism he values, all the more for the fight it took to get it.
His parents were missionaries and he spent his early life near Lahore in Pakistan. It was a peculiar, alienated existence. He was home-schooled and the only English speakers he came across were Americans, so when he returned to England, he found it to be just as strange a land.
These days he chooses his words carefully when describing his relationship with his father, but he does concede it wasn’t easy. “My father was an extremely religious man,” he says, “and it upset him greatly that I did not share his beliefs.” Wootton wanted to become a mathematician — “it was soon made clear to me I didn’t have the talent for it” — so he ended up going to Cambridge to read history. And hating it.
“It was as if the new intellectual world I’d discovered in France just didn’t exist. History was reduced to the stultifying empiricism of the establishment of facts.” Things started to look up in his third year when the first English translations of Foucault started to appear and Wootton found himself in the vanguard of the student radicals. “It was a heady, exciting time,” he says.
Pessimism — or realism — has long since blunted some of his idealism, yet even in his student days he did not allow his enthusiasm for the new-isms of postmodernism and structuralism to destroy completely his faith in the old-ism of empiricism. For, just as Bad Medicine is grounded in evidence, so too was his doctoral thesis on Paolo Sarpi, a minor Venetian theologian and contemporary of Galileo. And, just as with Bad Medicine, his work on Sarpi caught him on the wrong side of the historical thought police.
“I came across a notebook that no one had read since Lord Acton in the 19th century,” Wootton says. “And it clearly showed that, contrary to what everyone had hitherto believed, Sarpi believed religion to be completely false and merely a means for the inculcation of social order. I presented my findings to my supervisor, Hugh Trevor-Roper, and he told me to forget them, as the examiners would reject them because no one would accept that atheism existed in the 17th century. He didn’t say I was wrong; just that it wouldn’t be accepted.”
Wootton resolved the situation by resorting to a peculiarly quaint Oxbridge tradition. “I discovered that if a Cambridge graduate could persuade the University Press to publish their book, it would count as a Phd. So I got a contract from CUP, sacked Trevor Roper as my supervisor and wrote the book. Twenty years or so on my work on Sarpi’s atheism is now accepted in historical circles. But it’s been a battle.”– Â