The rule of ignorance: a polemic on medicine, English health service policy, and history

How medicine learnt

In 18th century Britain, in the reign of mad King George, there were two main schools of doctors. Some tried to sell remedies that had seemed to work in similar cases; they were called empirics, or often “mere empirics.” Some doctors of higher status tried to apply first principles or dogmas—hence the dogmatists. But neither approach was reliable: it was hard to know which cases were similar, and dogmatists could choose from several sets of competing principles. The medical pamphlets promoting rival theories or expensive cure-alls would have sold well in modern airports, somewhere among the self help books, the management pot boilers, and the discussions of whether national economies should be inflated or deflated.

In other technical enterprises at that time, a potential buyer or investor might have asked to see previous work or whether the engineer himself had invested, but neither test was easily applied to medicine. Worse still, some of the doctors who sold “heroic” remedies or dangerous operations were itinerants; and when the bandages came off and the pathological chickens came home to roost, the quack doctors had left town.

Victorians had other answers to …