Essays in Idleness

Atul Gawande, MD, made what I consider a devastating point, though in passing, during some recent podcast (here), called to my attention by an article in Crisis (here). It was a tale of two nineteenth-century inventions that changed the practice of medicine, unquestionably for the better: anaesthesia and antisepsis.

The first demonstration of the ether gas was performed at Massachusetts General Hospital in October, 1846, by a Boston dentist, William T. G. Morton. For the first time, surgical operations could be performed painlessly. Within two months, the invention was known and being applied in every capital of Europe, and in little more time it became commonplace internationally. The number of surgical operations vastly increased, as it was no longer necessary to hold patients down, and act very quickly.

Joseph Lister first used carbolic acid (phenol) to perform sterile surgery at the Glasgow Royal Infirmary, in August, 1865. This would have the effect of vastly increasing the survival rate from these now commonplace surgical operations. But the news took years to circulate, and by the twentieth century surgeons were still working with infected equipment in filthy environments. Indeed, I have read accounts of the horrors of battlefield medicine in the First World War: men with survivable injuries, lost by the hundred thousands from ignorant, unnecessarily unhygienic medical procedures.

As Dr Gawande points out — in passing — both advances made life easier on patients. But the second saved lives on a — vastly — greater scale. The first was unique, in making life easier for doctors, who no longer had to operate on screaming, writhing customers. This also, incidentally, hugely increased their trade, and thus their income. Washing up, effectively, only added nuisance.

I already knew this history — my mommy was a ward matron, after all — but until the comparison was spelt out, the full significance was lost on me. I had read the “official” versions in several standard medical histories. They assume the slow spread of antisepsis was a problem of communications. Gentle reader will note that this is a lie. Methods of communication did not slow in the generation between the two inventions.

And I mention this with some animus, having read a few outraged emails from doctors defending the staff at Alder Hey Children’s Hospital in Liverpool, who in their “disinterested, empathetic” way were eager to terminate the existence of the baby, Alfie Evans, “to ease his suffering,” in defiance of his parents’ plainly expressed wishes. (The child was comatose and not in pain.)

It is forty years since the book, Medical Nemesis: The Expropriation of Health, was published and “progressively” ignored. The author, the thoughtful Catholic anarchist Ivan Illich, went to considerable trouble to document all of the surprising allegations he made against modern, over-professionalized, institutional medicine, and the phenomenon of Iatrogenesis (doctor-created ills) that followed from the “medicalization” and “pharmaceutical invasion” of modern life. I could tell first-hand stories myself to curl my reader’s ears.

The book is worth revisiting because Illich studied these phenomena with the breadth that is rarely accorded to them. He stepped beyond mere technical questions to the larger issue of how we deal spiritually with sickness and death, yet without once lapsing into bathos.

We hear clichés crediting modern medicine with the reduction of the death rate — such that by the mid-twentieth century life expectancy had been restored to what it had been in the parish records of the High Middle Ages. (It plummeted through the Renaissance.) Some of this was due to medical and pharmaceutical advances. But most of it was attributable to improvements in hygiene — to the tradition from Pasteur and Lister. The accomplishments of hospitals and “public medicine” have been relatively modest, though incredibly expensive; fundraising requires that they be wildly overstated.

Alder Hey was a hospital caught in a huge scandal over the sale of baby parts from abortions, only a few years ago. This is an extremely profitable business, conducted at the edge of the law. I’m sure many good and conscientious doctors and nurses have worked and still work in that hospital, and so many like it. God bless all who work tirelessly for causes that are genuinely humane. But please do not tell me that the well-paid agents of modern bureaucratic medicine are all saints. It spoils my breakfast.