Great Feuds in Medicine: Ten of the Liveliest Disputes Ever

The older I get, the more I love lists. I must not be alone because the number of books of lists has grown exponentially as my generation of baby boomers has aged. Hal Hellman has now contributed a second book of lists to complement his earlier Great Feuds in Science(1). Popularly written, these books summarize intellectual and conceptual conflicts. (No violence—not even Ludwig Wittgenstein gesturing with a poker at Karl Popper.) In this installment we have Harvey versus Primrose; Galvani versus Volta; Semmelweis versus everyone; Bernard versus everyone; Pasteur versus Liebig, Pouchet, and Koch; Golgi versus Rámon y Cajal; Freud versus everyone; Sabin versus Salk; Franklin versus Wilkins; and Gallo versus Montagnier.

Medicine from the 17th century to the present, from high theory to laboratory practice, from the nature of the neural net to the primacy of discovery, is presented in vignettes that are readable and accurately summarize the science of these debates. (All of Hellman’s sources are serious works on the history of medicine.)

Yet the very notion of right versus wrong in these pairings means that there was a predetermined victor, even in those moments (as with Semmelweis) when those who were right were destroyed by their claims. All of the victors are Muhammed Ali, and all of the vanquished are stumblebums. Medicine is heroic in that it always overcomes errors, moving toward the light of truth.

Such a presentation of the history of medicine assumes that the players are the heroic characters that confront each other on the stage of history. In medicine (at least since the 19th century) the very notion of the laboratory and the team has meant that such positions are always collective, producing no truly world historical figures. Even in the history of psychoanalysis, Freud comes out of the neurological laboratories of Vienna (which, according to Hellman, shaped him more than anything else) to create psychoanalysis—the one true one-man operation in 19th-century medicine. But it is also true that another collective is also at work in the history of medicine. There is always a consensus-building acknowledgment of what is good medicine and what is quackery, and this consensus comes as much from the general culture as from the medical culture.

Hellman’s accounts are readable, but they really miss the point of such pairings. It is not that one was right and that the other was wrong. Medicine tries over time to accommodate all positions, casts off those which are perceived as too weak by the various collectives in which it functions, and is willing to return to these or demonize them over time. This relationship also shifts as new discoveries, inventions, and beliefs are added to the art and science of medicine. What is true at one moment in medicine becomes anathema the next and then returns in triumph again (e.g., the history of ECT from 1950 until today).

I love lists. I enjoyed reading Hellman’s work. But if you want the nuances and the flux, read the books he lists in his bibliographies.