Medicine Before It Worked: The Centuries of Getting It Wrong

For most of human history, going to a doctor did not improve your odds. The shift from that to modern medicine happened startlingly recently, and several of its turning points were resisted furiously at the time.

The handwashing scandal

In 1840s Vienna, Ignaz Semmelweis noticed that women giving birth in the ward staffed by doctors died far more often than those in the ward staffed by midwives. The doctors, unlike the midwives, came to deliveries straight from performing autopsies. He instituted handwashing with a chlorine solution and the death rate collapsed.

He was not celebrated. Germ theory did not exist yet, so his result had no mechanism to explain it, and the suggestion that respected physicians were carrying death on their hands was taken as an insult. He was dismissed, and died in an asylum. Within two decades, Pasteur and Lister supplied the missing theory and he was proved right posthumously.

Surgery without anaesthetic

Surgical anaesthesia only entered general use from the 1840s. Before that, operations were conducted on conscious patients, and the leading measure of a surgeon's skill was raw speed — amputations timed in seconds, because every second was endured.

Put on a timeline, this is jarring: the railway locomotive is older than painless surgery. Antiseptic technique, which made surgery survivable rather than merely bearable, came later still, once Joseph Lister applied Pasteur's germ theory to the operating theatre.

The accident that defined a century

Alexander Fleming returned from holiday in 1928 to a messy laboratory and a culture dish contaminated by mould. Around the mould, the bacteria had died. That was penicillin — arguably the single most consequential drug ever found, and found because someone did not tidy up.

The usual telling stops there, which is unfair to everyone else involved. Fleming could not produce the stuff in useful quantities, and the work stalled for a decade until Howard Florey and Ernst Chain developed a way to purify and mass-produce it in time for the Second World War. All three shared the Nobel Prize; only one is a household name.

Two more worth knowing

• Smallpox is the only human disease ever driven to complete eradication, declared gone in 1980. Edward Jenner's vaccine work began from the observation that milkmaids who caught cowpox seemed not to catch smallpox — and "vaccine" comes from vacca, Latin for cow.
• Bloodletting was mainstream practice for well over two thousand years, based on the theory of the four humours. It persisted not because it worked but because there was no framework capable of showing that it did not.

The through-line is uncomfortable. Medicine did not go wrong through stupidity; it went wrong through confident reasoning without a way to test it. The invention that mattered most was not any single cure — it was the habit of checking.