Why were people in the 1800s smart about engineering while dumb about medicine?

September 16, 2004 6:44 AM

Why were people in olden days so smart about some things, but so dense about others? (more inside)

Specifically: How is it that people knew enough to build huge ships that could sail thousands of miles, navigating by the stars, and enough to engineer huge, ornate buildings that would outlive them by hundreds of years, but it took until the late 19th century to figure out that splashing a little alcohol in a wound, and on surgical instruments, could reduce infection? How could no one have discovered this? They had alcohol -- wouldn't you think just through blind luck or trial and error, over millions of incidents of wound treatment, they would have uncovered this? Why was "cleaning a wound" such a foreign concept to them? They cleaned clothes, floors, their own bodies, etc. but nobody noticed that a clean surgical environment had a salutory effect?

posted by stupidsexyFlanders to society & culture (35 comments total)

I suspect it has to do a lot with access to clean things in general. Before the 20th Century (and modern plumbing, perhaps?), pretty much everything was dirty all the time, by our standards. Hospitals didn't really exist, and most "medicine" was done in homes. If you "clean" a wound with a rag that you've been carrying around for weeks (and perhaps wiped your hands with a few times), your net gain is probably not much more than cosmetic.
posted by mkultra at 6:50 AM on September 16, 2004

Because they thought they knew how the body worked. It wasn't that there was no theory, they had a competing theory that just wasn't altogether effective in explaining the phenomena they saw. The feedback loop with "is this a good boat?" is much tighter and easier to learn from than "is this a good treatment?" For a much more in-depth explanation than this, read Roy Porter's book Blood and Guts : a short history of medicine [my review] which does a wonderful job explaining just exactly how people learned about infection and how to combat it.
posted by jessamyn at 6:51 AM on September 16, 2004

In a few decades our grandchildren will ask how it could be that we never figured out cancer and Autism.

Technological advancement has occurred so fast over the last two centuries that it is hardly surprising that there were gaps in understanding. It is a world wide phenomenon. Sounds like you would enjoy reading Guns, Germs, and Steel by anthropologist Jared Diamond.
posted by zaelic at 7:02 AM on September 16, 2004

I think one can conceptualize a ship that you can see more easily than infection or microbes which you can not. When Joseph Lister was trying to educate the medical community about microbes and antiseptic conditions he was branded quite the crackpot by many scientists.
posted by caddis at 7:02 AM on September 16, 2004

And if you don't have the time for books this short article describes how Dr. Semmelweis (who beat Lister to it) discovered the link between germs and dissease. And how hard it was for him to convince other doctors about the link.
posted by AwkwardPause at 7:18 AM on September 16, 2004

Every achievement you mention, Flanders, has one thing in common, "huge", while the medical discoveries are the opposite, microscopic.
posted by mischief at 7:22 AM on September 16, 2004

It is funny how, despite the lack of knowledge about infections, knowledge of vaccinations against smallpox preceded Lister and Semmelweis by at least a century. Ben Franklin was a big proponent of smallpox vaccinations, although he failed to vaccinate his son who ended up dying from smallpox.
posted by caddis at 7:33 AM on September 16, 2004

One of the first things said to me in my med school lectures was, "50% of what you're going to learn over the next four years is wrong. Unfortunately, we don't know which 50%."

There were a number of problems with existing doctrine. Pus was viewed as some combination of yellow bile and phlegm, not as an indication of the body's immune response against organisms that could not be seen. Given the doctrine of spontaneous generation (crushing basil between 2 clay bricks could spawn scorpions), why should anyone realize that the wound infection - which typically shows up on day 3-5 - might be related to something that was on the surface of the surgical instrument?

Alcohol is not adequate for sterilization. What you describe is not aseptic technique, it is antiseptic, and that actually doesn't work very well. You can't splash pure alcohol into a wound - it's very toxic and will slow wound healing considerably if left in there long enough to work antiseptically. Also, bear in mind there wasn't really much in the way of anesthesia for most of recorded history. Would you let someone splash alcohol in YOUR wound? I don't think so - it hurts like anything.

It's not so great for sterilizing instruments, either. Carbolic acid was the great innovation - fairly non-toxic, quite lethal to microbes.

Finally, it's hard to 'accidentally' sterilize something. It's much easier to accidentally contaminate something that's sterile. Sterile technique isn't something you run across by accident, especially if you don't understand the principles involved.

Interesting question.
posted by ikkyu2 at 7:51 AM on September 16, 2004

Lister is better remembered because a lot of the people that thought Semmelweis was wrong had begun to either change their minds or die. He also had the advantage of experiments (actually, they were operations on regular patients, but I digress) that showed the efficacy of his carbolic acid "antiseptic". Still, it's amazing to us now how stubbornly wrong people were about things we know now and take for granted.
posted by tommasz at 7:56 AM on September 16, 2004

Besides which the alcohol they had wasn't all that pure. Distillation is a fairly modern invention. Splashing a pint of homebrew in a wound probably won't get you much.
posted by Mitheral at 8:42 AM on September 16, 2004

For a long time, sailing wasn't all it was cracked up to be, either. I read Neal Stephenson's The Confusion recently -- apparently ships in the early 1700s spent a lot of time heading north and south looking for a breeze heading in the right direction, with no idea what longitude they were at because they only knew how to determine latitude. According to Stephenson, anyway, approaching the West Coast of America at the wrong latitude could be dangerous, because you could sail into a becalmed area (a place where wind rarely blows) and you'd die of starvation just a day or two's sail from land. Sure, it's fiction, but I have no reason to believe Stephenson is overplaying the dangers. Being a sailor was incredibly hard work and a good way to live a short life.

It would take the invention of a reliable clock to obtain accurate longitude data, thus massively improving navigation, and this didn't happen until 1759. (I fully expect this will be included in the concluding volume of Stephenson's trilogy, actually.)
posted by kindall at 9:10 AM on September 16, 2004

People are adept at being "stubbornly wrong". Scientists are trainned to be even moreso. Hindsight isn't so good at understanding things like that.

Another issue that seems odd is the failure to understand what we were doing killing off the American bison, or taking more fish than has been sustainable. And now its the oil running out.

Also, its rather clear that about half the American public is stubbornly wrong when it comes to politics.
posted by Goofyy at 9:15 AM on September 16, 2004

You're inviting a long lecture from me, which none of us want.

Speaking as someone with a very strong educational background in the history of science (and philosophy etc.), the most succinct answer I can give you is twofold:

1) The same reason people today are so smart about some things and so dense about others; and,

2) With few exceptions, the things that they didn't know or were wrong about either were much, much less obvious in the historical context and/or they weren't as wrong as people commonly think they were.

My very favorite example is Ptolemaic (geocentric) astronomy. In the Amagest Ptolemy himself acknowledges that a heliocentric system is simpler and makes sense. But in order to accept a heliocentric view, one has to accept the idea of the Earth in motion (which is clearly and obviously deeply intuitively false) and (because of a lack of observed parallax) that the "fixed" stars were an inconceivably, impossibly large distance away from the Earth. Frankly, those two ideas are basically absurd (though true) and I seriously doubt that more than a small portion of the people that today "know" these things are true really comprehend their truth in a significant way. The absurdity of these ideas greatly overmatches the elegance of a heliocentric model.

Today we take for granted the idea that there are living things that are microscopic. But at the time, this discovery was like living underneath cloud cover for one's entire life and being told that there were stars shining above. There was no context for comprehending the idea of sterilizing a wound. There were, on the other hand, folk remedies that worked and folk remedies that made things worse. But those folk remedies existed within a worldview that made sense of how they were expected to work.

The idea of pure empiricism is something of a myth of modern education. We need a model, a worldview, a meaning, a scaffolding, to hang our conceptions of the world upon. That scaffolding is always essentially a lie.

Well, okay. A minor lecture.
posted by Ethereal Bligh at 9:28 AM on September 16, 2004

Kindall, the issue of clocks and navigation and, well, the amazing pradigm shift that clocks represented in general, is discussed in great detail and very pleasurably in Daniel Boorstin's The Discovers. A book I cannot highly recommend enough.
posted by Ethereal Bligh at 9:33 AM on September 16, 2004

Another good book is "Longitude." A quick read, non-fiction, interesting story. Sadly, I've misplaced my copy.
posted by adamrice at 10:07 AM on September 16, 2004

[This is good] Great question, even better answers.
posted by ssmith at 10:44 AM on September 16, 2004

I'm having a hard time finding online sources, but I know there were also conflicts between midwives, whose folk medicine often included more hygenic practices, and doctors, who saw all that as witchcraft. Women were much less likely to die in childbirth when attended by a midwife, who didn't go around sticking her fingers in various diseased wounds, than when attended by a doctor, who did. So I think you have a split between folk medicines, often practiced by women -- that is, a segment of society held to be personally responsible for the end of paradise -- that worked but couldn't at the time be scientifically proven, and "scientific" medicine as practiced by the more educated segments of society.
posted by occhiblu at 10:49 AM on September 16, 2004

The idea of pure empiricism is something of a myth of modern education. We need a model, a worldview, a meaning, a scaffolding, to hang our conceptions of the world upon. That scaffolding is always essentially a lie.

The fact that some people inherently agree with this idea and some don't I think is probably the largest and most pervasive cognitive divide right now. Some people will read that paragraph and say, "Well, duh," and some people will read that paragraph and say "WTF are you talking about? The heliocentric solar system is a lie, huh? Pomo-spewing idiot. Try jumping out off a 10-story building and see if its a lie."
posted by ChasFile at 11:28 AM on September 16, 2004

Here is one interesting online source, Explorers of the Body by Steven Lehrer, which describes some of the pathways to discovering viruses, bacteria and sterile practice. I do not know who the author is or how accurate is his information, but it makes for fascinating reading.
posted by caddis at 11:39 AM on September 16, 2004

The longitude problem is discussed at some length in Mason & Dixon, as well. Not a quick read, unfortunately.

That scaffolding is always essentially a lie.

And the use of that word (lie) to describe the concept of a scientific model is so much an obfuscating act of meaningless reductionism that it makes your statement essentially a lie.
posted by mr_roboto at 11:49 AM on September 16, 2004

The points about hindsight being much easier than foresight are really true. We wouldn't celebrate discoveries if they were easy. That jump to the obvious is really hard.

There's more to it than that though. The other half of it is that any new idea, good or bad, faces skepticism.

It's very hard to convince someone of something new even when the weight of evidence is against them. Science, in general, tends to attract people who are at least somewhat willing to reevaluate their beliefs with new evidence, but still changing one's mind is usually a career-changing event.

So what seems to happen is not that individuals accept new theories, but that changes are generational. If an idea is compelling enough, like doctors washnig their hands before child birth, or quantum mechanics, or plate techtonics, then it gets picked up by the young innovators and the older objectors slowly fade away. The net effect is that major changes in science tend to take a long time.

This was formalized by Kuhn in his "Structure of Scientific Revolutions". Kuhnic revolutions are semi-predictable: a great new theory will attract immediate controversy, and through a period of intense activity it will get tested and ammended until it's got an enourmous number of exceptions, provisos and special cases attached. At this point interest wanes and people start talking about "the end of science." There are usually only a few "minor" details to solve. Some student will keep picking at it, come up with a brilliant, radical theory, which (if it works), starts the cycle all over again. Particle physics, for example, appears to be "ripe" for a revolution right now to a lot of people.
posted by bonehead at 12:09 PM on September 16, 2004

You're inviting a long lecture from me, which none of us want. Best. EB. Ever. :-)
posted by five fresh fish at 12:14 PM on September 16, 2004

It's very hard to convince someone of something new

This cannot be sufficiently emphasized. A perfect example from Jerome Blum's classic Lord and Peasant in Russia:

The chief barrier that stood in the way of [the potato's] spread in Russia, as in other lands, was the prejudice of the peasants. With an obstinacy and unreasonableness that are supposedly traditional characteristics of their station, they resisted efforts of the government and of improving landlords to introduce potatoes, even when there was famine and the peasants were actually starving.

(My emphasis.)
posted by languagehat at 12:57 PM on September 16, 2004

in shipbuilding v. medecine, you're really comparing apples and oranges, for a variety of reasons.

obviously medecine was much much slower in freeing itself from religion/philosophy than engineering & navigation was. there are excellent reasons for this lag that you can guess at for yourself: all we can do really is make reasonable conjectures about the relative importance of such retarding factors as "medecine as a practice had much less economic pressure to get things right", "medecine dealt with the body and was therefore more susceptible to superstitions", "medecine dealt with human lives and that made experimentation more difficult", etc.

once the scientific method started to win out over these various forms of resistance, the situation very rapidly began to improve.

[as far as astronomy goes, i imagine that a couple hundred years from now, people will have a conception of how "moderns" [1700-2000] viewed celestial mechanics that is as disdainful as our view of the ptolemaic system. we are still, i think, unable to fully conceptualize the modern views of physics on the subject of the interactions of large bodies in space; we still consider gravity to be a sort of force field that's maybe also a particle/wave. however close an enlightened individual today is to being able to parrot the proper terminology of curved space and all that, it's largely faddish cant...

and then, it's reasonable to assume that there will be further major levels of complexity/simplicity beyond einstein's [et al] refinements of newton. just my 2 cents into the fountain]
posted by mitchel at 1:20 PM on September 16, 2004

The fact that some people inherently agree with this idea and some don't I think is probably the largest and most pervasive cognitive divide right now. Some people will read that paragraph and say, "Well, duh," and some people will read that paragraph and say "WTF are you talking about? The heliocentric solar system is a lie, huh? Pomo-spewing idiot. Try jumping out off a 10-story building and see if its a lie."

If you're reading, say, Gombrich on how there is no "innocent eye", or Goodman, or the like, it's not hard to be convinced that facts are theory-laden and vice versa. It's rather harder to see how that, even if you think it's true, really applies to ten-story buildings.

I refute it thus!
posted by kenko at 1:36 PM on September 16, 2004

Well, I have little patience with the people that feel the need to argue philosophical relativism versus absolutism. There is no real tension there at all. "Hard" versions of either one—basically what I think most people believe themselves to be thinking of when they take one strong position or the other—are meaningless assertions to me, at best tautologies, at worst pure nonsense.

I find it very disconcerting and sort of amusing to called a Kuhnian or, worse, pomo. Sure, I probably can be correctly called a "Kuhnian"; but certainly not postmodern. But I find that ChasFile is quite right (as Mr. Roboto demonstrates) that there is a great intellectual cultural divide. Basically, there's contemporary scientists (and, um, "Objectivists") who are alarmingly naive—simpleminded really—realists on the one side, and the pomos who are naive (the sort of naivete that cloaks itself in sophistication) relativists on the other side. And the gap between them is huge.

I once heard Murray Gel-Mann lecture at the Santa Fe Institute on "creativity" and scientific discoveries. He utilized one very memorable metaphor. It was of ideas as particle energy states—that they will find the locally lowest stable "well" to settle in. But that local low may not be the regional or global low, of course, and it takes an increase of energy to move the idea up out of the local low in order for it to find its way to something deeper. Here the idea was the deeper the well, the "truer" the idea. And Gel-Mann's point was that it's a contrary thing to go up that well...that an essential characteristic of creativity (and intellectual discovery) is to do the unlikely, the counter-intuitive. Not always be contrary and go uphill, of course, that's worse than useless (something the cranks don't understand). But just enough at the right times to open up new vistas that were previously unimagined.

Our accumulation of what we consider knowledge is such a journey and where we are at any given moment usually seems the most likely, the most stable, the most "true" place to be. And, you know, it is. There's something perverse in what's happening every time we roll uphill. The Earth in motion? Nonsense. Invisible living creatures that cause disease? Nonsense. In every case there's a sense in which we've rolled uphill into an insanity...an insanity that becomes palatable over time. Almost always because it's useful.

Working through the history of western science, particularly actually doing much of it, is deeply instructive in a way that I think few people realize. Most working scientists have (rightly) little use for any strong sense of the history of science; and by far the largest proportion of those philosophically or similarly engaged with the subject don't actually do very much science and are usually ideologically bound to a critique of the enterprise of western science. I've been recently convinced that many or most historians of science have pretty strong science expertise, but when the sorts of philosophical issues we're discussing here are involved, I frankly see little evidence of anyone between the two camps I mention above. But if one does what few do nowadays and work through the history of western science from a deliberately naive point of view, one aquires a deep appreciation for both how right everything seemed at each step of the way, and how much we've learned that we once didn't know. There is an obvious and easy middle-ground, at least, here in the restricted realm of "the progression of western science". That is, the people before us weren't as stupid or ignorant as they seem to us, we are not as smart and wise as we seem to ourselves, yet it's undeniable that we "know" things today that we didn't know before.

I am honestly unsure of what I think of modern science education. On the one hand, the enterprise is now so vast, and each part of it so focused, that it is absurd to think that anyone trained in it today should be deeply versed with the breadth and history of it or its philosophy. In the ideal, perhaps. In practice, of course not. On the other hand, though, the shift in science education to being very technical, very "of the moment", and very hubristic about what's known at present is, I think, too recent, only a couple or three generations, for its effect on the overall enterprise to be yet fully apparent. I worry that we may lose something essential without even noticing it. But, probably not. I mostly think that the scientists for whom that way of thinking (the kind I rue the loss of) could be important as a practical matter will think that way, regarldess, and do that sort of work, regarldess. I hope.
posted by Ethereal Bligh at 2:40 PM on September 16, 2004

EB, you're on a roll. Those are some thought-provoking comments, and I love the Gell-Mann image.
Minor correction: it's the Almagest, not "Amagest"; I mention it in case anyone wants to try googling it.
posted by languagehat at 3:05 PM on September 16, 2004

That scaffolding is always essentially a lie.

hm - not sure i agree with the "always" in that sentence. i think because science has sped up so much, there is much more awareness now that the dominant paradigm of the moment is transitory [and surely that's a workable enough definition of pomo]. if in the past that scaffolding was a lie because it was a rickety card-house of metaphors, and metaphors are by definition lies, nowadays that scaffolding is a rickety card-house of similes, and similes are by definition free of truth value [opinions], so the scaffolding isn't a lie so much as a work of art stripped of its former propagandistic purpose.

the shift in science education to being very technical, very "of the moment", and very hubristic about what's known at present is, I think, too recent, only a couple or three generations, for its effect on the overall enterprise to be yet fully apparent.

seems to me the universities still provide havens for all sorts of dissenters, cranks, visionaries and quiet toilers of strange backwaters.

you've got so many more scientists now, famously more than have ever lived. it wasn't until the 20th cent. that the industrial revolution really reached the lab, and mass production of precision instruments became affordable. you've got computers, you've got quick communication between far-flung researchers, you've got greater freedom than ever for professors to leave their home town and teach whereever they may feel most accomodated.
posted by mitchel at 3:39 PM on September 16, 2004

Before we soar off into the philosophical stratosphere, may I try and answer supersexyFlanders's original question?

It is wrong to say that "it took until the late 19th century to figure out that splashing a little alcohol in a wound .. could reduce infection". Here is the French surgeon Ambrose Pare describing his treatment of the wounded after the Battle of St Quentin in 1557: "to correct and stop the corruption, and kill the worms in their wounds, I washed them with Aegyptiacum dissolved in wine and eau-de-vie, and did all I could for them". ('Aegyptiacum' is hyssop; 'eau-de-vie' is a distilled wine, whose antiseptic properties had been recognised since the Middle Ages.) Not the ideal treatment (and Pare goes on to say that "in spite of all my care, many of them died"), but better than nothing.

It is fascinating to read Pare's treatise on The Method of Treating Gunshot Wounds (1545) and to see how much he got right. He observed that sepsis was as common among noblemen as among common soldiers, even though the former had their wounds dressed every day whereas the latter were left untreated. He also observed that wounds turned septic faster in hot weather -- from which he concluded that sepsis was not caused by poison in the bullet or the gunpowder, but by something in the surrounding environment. ('Corruption in the air', he thought.)

So, having observed so much, why couldn't he make the conceptual leap into a germ theory of disease? Two reasons, one theoretical, the other practical:

1. Theoretically: he explained his observations in terms of traditional (Galenic) ideas about the four humours (hot, cold, wet, dry). Much of his treatment involved 'heating up' the body if it became too cold, or 'cooling it down' if it became too hot. So, for example, when he found that wine was effective in treating wounds, he assumed that this must be because it was a 'hot' substance that counteracted the cold and phlegmatic humours in the body.

2. Practically: his methods were a good deal better than anything else available at the time. Before Pare came along, the standard method of treating gunshot wounds was to cauterise them with a hot iron. Pare found that he could achieve a higher success rate by washing and dressing wounds and leaving them to suppurate. He didn't see that this introduced new risks of infection; all he saw was that more of his patients were surviving.

Several contributors to this thread have commented that "people are adept at being stubbornly wrong" and that "it's very hard to convince someone of something new". This reminds me of E.P. Thompson's remark about "the enormous condescension of posterity". Ambrose Pare was wrong about many things, but he was not "stubbornly wrong". He did the best he could with the knowledge available to him.
posted by verstegan at 3:51 PM on September 16, 2004

Allow me, since I partially raised it, to defend being stubborn. Conservatism is natural because there are so many bad ideas out there. It's a defense.

Einstein is reputed to have said that he wasn't particularly smarter than anyone else, but that he had a thousand ideas before lunchtime. If he had one good one, he considered it a good day.

Most of the time, skepticism is healthy, but history shows us that it's been too often used as a weapon (for reasons often unrelated to the truth of the claim). Semmelweis is one example, but so was Wegener. Planck and even Darwin had to fight for years before their views became widely accepted. as Planck himself remarked in his autobiography: "A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it."
posted by bonehead at 5:45 PM on September 16, 2004

When Paré ran out of Aegypticum and hyssop in eau-de-vie, he took to ladling boiling oil into the wounds. This actually did sterilize and cauterize them, and many of these soldiers escaped sepsis. Paré observes this but fails to draw any conclusions from it, if I recall correctly.

It's been years since I read that, and most of what I recall was an overwhelming feeling of tragedy and frustration. Had I only a time machine, I could have set him straight in a 2 minute conversation!
posted by ikkyu2 at 7:07 PM on September 16, 2004

EB, have you read much by Ernst Cassirer? I haven't read his works on science (I believe he specifically was interested in physics) but from what I have read (Essay on Man and Philosophy of Symbolic Forms volume two) it seems like he would be a candidate for bridging the camps. And really there are many philosophers who've acknowledged the "scaffolding" (one of my favorite professors was in the habit of referring to this as eyeglasses) without retreating into a simpleminded relativism.

(Wasn't Robert Musil trained as a physicist or engineer? I know he was a relativist but I don't know how extreme he was. I may be confusing him with the main character of the Man without Qualities.)
posted by kenko at 7:19 PM on September 16, 2004

Kenko, I haven't read anything by Cassirer. I'll add him to my Ever Increasing List. Thanks.
posted by Ethereal Bligh at 10:23 PM on September 16, 2004

ikkyu2, thanks for replying. I think you've got the Pare anecdote the wrong way round. According to his own account, he started off by cauterising wounds with boiling oil, following the accepted medical practice of the time. Then, on one occasion, he ran out of boiling oil and had to do the best he could by washing the wounds and treating them with an improvised dressing of egg yolk and turpentine. 'That night', he writes. 'I could hardly sleep, fearing that for want of cauterising, I would find my patients dead in the morning'. To his astonishment, he found that they were resting well and that their wounds soon started to heal.

I'm struck by your remark that "if I only had a time machine, I could have set him straight in a two-minute conversation". This is an interesting thought-experiement, and worth pursuing further. Let's suppose we could go back in a time machine to the battlefields of sixteenth-century Europe. What could we do to improve medical treatment and reduce mortality?

1. First, we could explain to Pare that there were tiny organisms on his hands, too small to be seen by the naked eye, which were passing into his patients' wounds and causing them to become infected. Not such a difficult concept to grasp. But of course we would have no experimental means of proving it -- remember, microscopes haven't been invented yet. Pare might well have been interested in our theory, but might reasonably have regarded it as a mere speculation, impossible either to prove or falsify.

2. Secondly, we could try introducing more hygienic conditions into the field hospitals. But it would be an almost impossible task. Pare gives a graphic account of conditions on the battlefield: the dead bodies, the stench, the flies .. Unless we brought some modern antiseptics with us in our time machine, there probably wouldn't be much we could do to make a difference.

Pare's clinical observations are excellent; his understanding of disease was very limited. But it's important to realise that there was no obvious mismatch between the two. Everything that Pare observed -- the symptoms of fever; patients complaing of burning sensations in their wounds; infections spreading faster in hot weather -- could be fitted, without undue difficulty, into a Galenic theory of hot and cold humours. It simply wasn't the case that Pare was making observations and then failing to draw the obvious conclusions. Nor was he stubbornly clinging to a theory that didn't fit the observed facts. There was nothing wrong with his reasoning; he just had no way of knowing that the Galenic theory was mistaken. As far as he was concerned, it worked.

Sorry to go on at such length, but I think there is an important point here which is worth drawing out. It is commonly assumed that the doctors of the pre-modern era were mostly quacks or charlatans who were more likely to kill their patients than to cure them. I don't agree -- and I would like to defend the people of the past against the (as I take it) patronising assumption that they were idiots who failed to see the obvious truths that were staring them in the face. (For the same reason, I disagree with the heroic theory of scientific progress which assumes that most people are timid and resistant to change, and that only a few Master Minds can rise above the common herd. But that's a discussion for another time ..)

Roy Porter has argued that medicine is essentially about 'what works'. If doctors find that a particular drug, or a particular surgical technique, seems to work, then they will adopt it (and patients will demand it). If Western medicine has conquered the world, it is because Western medicine works better than any alternative. (Note that this is a different matter from saying that Western medicine is 'true'. 'Does this work?' and 'is this true?' are different questions.) What the example of Pare teaches us is that it's possible to get an awfully long way simply on the basis of 'what works', even if your explanation of why it works is profoundly mistaken.
posted by verstegan at 3:43 AM on September 17, 2004

kenko:

> I refute it thus!

Ah, a Johnsonian. Dr. J. doesn't get nearly enough credit for his refutation--because he didn't spell it out in words for dim old Boswell, and verbal-gerbil philosophers since then have gotten away with assuming he was just being stubbornly naive-realist. Here it is in words:

1. Either there is an Independent, Non-Mental Reality out there, or

2. there is not such an INMR, but things appear to us exactly the same as if there were.

There was a faith-healer of Deal
Who said, Although pain isn’t real,
If I sit on a pin
And it punctures my skin,
I dislike what I fancy I feel

3. There is no conceivable evidence to help us choose between 1. and 2. The choice of 1. or 2. makes no difference to the way we must live our lives (Johnson kicks stone, hurts toe exactly the same whether stone is independently real or just a mental construct),

4. hence Occam's Razor entitles us to pick the simpler possibility. There is an Independent, Non-Mental Reality, QED.
posted by jfuller at 5:04 AM on September 17, 2004