Communion Of Dreams

In college (I graduated in 1980) I suffered repeatedly from peptic ulcers. My senior year it seemed that I lived largely on a diet of Maalox (which I came to loathe) and Tagamet, supplemented by Pepto-Bismol when I just couldn’t bring myself to drink any more Maalox. “Everyone knew” that ulcers were caused by stress, which produced an overabundance of gastric acid – technology had allowed for better studies of the production of gastric acid and the mechanism of it eroding stomach/intestinal lining – and there were more than a few occasions when my doctor recommended that I consider some kind of mild tranquilizer to help calm me down. I drank, instead.

Which, frankly, didn’t help my ulcers much. In fact, it just made me worse. My senior year was hell, and I actually got quite sick my final semester. Graduation helped, in that a big part of the stress was removed, and I backed way off of how much I drank, but I still had ulcer problems for the next few months.

But in the fall or winter of that year I developed a pretty nasty case of pneumonia (I’m prone to it), and had to go on a couple of courses of broad-spectrum antibiotics before I beat it.

I didn’t think much about it at the time, but the following year I didn’t have any ulcer problems. In fact, since then, I haven’t had any ulcer problems. It wasn’t until several years later that medical science came to understand why. No, it had nothing to do with me, though I had inadvertently stumbled upon the same thing that researchers came to discover: that stomach ulcers are predominantly caused by a bacteria (H. pylori). And the best treatment is a combination of powerful antibiotics with bismuth subsalicylate, the active ingredient in Pepto-Bismol. Yes, stress can be a factor in the development of an ulcer, but the real culprit is a bacterium. It wasn’t until the 1990s that this came to be the accepted model in the medical community.

This was my first personal, direct experience with how a paradigm shift can make a difference in our lives and health. Had I not gotten lucky with a combination of drugs and Pepto-Bismol, I might have been miserable with ulcers for another dozen years before medical science changed treatment regimens.

Now, I knew about Kuhn’s work – had read him in High School, I think, or at least in college. And his ideas were very influential in the science fiction I read, even my understanding of history (which I have written about before). And all of that plays out in Communion of Dreams, which is largely about a shift in perspective of what it means to be human.

This morning I came across another wonderful case study of this very same phenomenon of paradigm shift changing medical science, and how technology actually played a role in causing a misunderstanding of the mechanism involved, leading to more death and misery until a new paradigm came along:

First, the fact that from the fifteenth century on, it was the rare doctor who acknowledged ignorance about the cause and treatment of the disease. The sickness could be fitted to so many theories of disease – imbalance in vital humors, bad air, acidification of the blood, bacterial infection – that despite the existence of an unambigous cure, there was always a raft of alternative, ineffective treatments. At no point did physicians express doubt about their theories, however ineffective.

The disease? Scurvy. The case study? Robert Falcon Scott’s 1911 expedition to the South Pole. Here’s a bit from the beginning of the article:

Now, I had been taught in school that scurvy had been conquered in 1747, when the Scottish physician James Lind proved in one of the first controlled medical experiments that citrus fruits were an effective cure for the disease. From that point on, we were told, the Royal Navy had required a daily dose of lime juice to be mixed in with sailors’ grog, and scurvy ceased to be a problem on long ocean voyages.

But here was a Royal Navy surgeon in 1911 apparently ignorant of what caused the disease, or how to cure it. Somehow a highly-trained group of scientists at the start of the 20th century knew less about scurvy than the average sea captain in Napoleonic times. Scott left a base abundantly stocked with fresh meat, fruits, apples, and lime juice, and headed out on the ice for five months with no protection against scurvy, all the while confident he was not at risk. What happened?

It’s a long but fascinating article. And it perfectly recounts how technological improvements contributed to a misunderstanding of scurvy. One more passage from the article:

Third, how technological progress in one area can lead to surprising regressions. I mentioned how the advent of steam travel made it possible to accidentaly replace an effective antiscorbutic with an ineffective one. An even starker example was the rash of cases of infantile scurvy that afflicted upper class families in the late 19th century. This outbreak was the direct result of another technological development, the pasteurization of cow’s milk. The procedure made milk vastly safer for infants to drink, but also destroyed vitamin C. For poorer children, who tended to be breast-fed and quickly weaned onto adult foods, this was not an issue, but the wealthy infants fed a special diet of cooked cereals and milk were at grave risk. It took several years for infant scurvy, at first called “Barlow’s disease”, to be properly identified. At that point, doctors were caught between two fires. They could recommend that parents not boil their milk, and expose the children to bacterial infection, or they could insist on pasteurization at the risk of scurvy. The prevaling theory of scurvy as bacterial poisoning clouded the issue further, so that it took time to arrive at the right solution – supplementing the diet with onion juice or cooked potato.

Read it.

Jim Downey