In his interesting book The Great Influenza (2004) on the 1918 Flu epidemic, John M. Barry begins by giving the background and context of 19th century medicine. He says that medicine during this time lagged behind other sciences, especially because doctors were slow to embrace the quantitative methods and tools that helped other sciences like chemistry and physics make great advances. For example — amazingly — although thermometers were invented 200 years earlier, it wasn’t until the 1820’s that they were first used by medical people to measure body temperature in Europe (The US was even slower to change, and thermometers were still rarely used in the Civil War.) In the 1840’s and 1850’s John Snow was the first to use numeric methods for populations of patients, in his pioneering epidemiologic study of cholera in England. As Barry makes these fascinating observations about 19th century medicine, he adds this footnote, lest we think we’ve completely escaped the innumerate medicine of the 1800’s:
The effort to correlate treatments and results has not yet triumphed. A “new” movement called “evidence-based medicine” [boldface added] has emerged recently, which continues to try to determine the best treatments and communicate them to physicians. No good physician today would discard the value of statistics, of evidence accumulated systematically in careful studies. But individual doctors, convinced either by anecdotal evidence from their own personal experience or by tradition, still criticize the use of statistics and probabilities to determine treatments and accept conclusions only reluctantly. Despite convincing studies, for example, it took years before cancer surgeons stopped doing radical mastectomies for all breast cancers.*
From my college training in History of Science & Medicine, I learned the subversive nature of the discipline — Subversive because it forces us to realize that sometimes we’re not as far beyond ancient methods and ideas as we think we are. How much is there in contemporary medicine that’s still a vestige of the relatively recent past that Barry describes?
*Radical mastectomies for breast cancers: The definitive study that disproved the value of this is here.
Eric Rumsey is on Twitter @ericrumsey