So my discussion on how “gentlemen have clean hands” thing is coming up again, and I just want to talk about how science gets done when we don’t have adequate information, because I think it’s fascinating.

(Here’s my prior thread.) https://twitter.com/courtneymilan/status/1241904631023714305?s=20

OBVIOUSLY I was giving a modern paraphrase. But I was not in fact straying far from what they actually said.

This is from a book by Dr. Charles Meigs, a professor of midwifery, published in 1854.

At the time, there was no germ theory of disease. We didn’t know what caused disease yet.

But there were theories. And while those theories were not all encompassing, they at least fit some observable facts.

So the theory was that there was some “contagion” that was being carried around in some fashion. What exactly was it?

Nobody actually knew.

All they had was observable data.

The observable data said, look, if you wash your hands after you do an autopsy and before you deliver birth, the rate of childbed fever goes WAY the fuck down.

And you have two choices:

1. You can say, “what is this contagion of which you speak? makes no sense to me. my hands look clean.”

2. You can say, “don’t really know everything that’s going on here, but hand washing is sounding REALLY good.”

When in doubt, if you have a choice between the thing that fits the data, even if you don’t have a solid explanation, and the thing that fits your self-image, you should go with the thing that fits the data.

The 1850s-1900 era in Western medicine is fascinating, because it’s 100% a fight between data and self-image, with data winning.

Self-image does reassert itself on a regular basis, alas. And here we are.

*gestures at CDC*

By the way, when this was covered in.... gosh, I don’t remember what class I learned this in? bio maybe? It was presented as ”first they believed X, then Y, and finally ended up on Z, the truth.”

If you actually start reading from time period literature, it’s clear that it was a complete mish-mash, just like today. Some people believed X, forever, even after Z had been definitively “proven” by modern standards, and they eventually died.

Some people were like, “Y sounds completely ridiculous and fails to explain all this stuff, so here’s my theory that never got taught to you in class.” Some people were like “look, I dunno I just prescribe arsenic to everyone.”

Self-plug: I wrote a book with a sarcastic, dark-humored Victorian doctor who believes in data and results (and things like prophylactics and education) and chafes at the state of medicine. https://www.courtneymilan.com/a-kiss-for-midwinter/