Much as the ancient Catholic Church expanded and gained worldly power on the backbone of the Roman Empire, Western medicine was able to spread with the hegemonic expansion of Western economic and military interests. The colonialists and capitalists brought with them their doctors and surgeons, to a greater or lesser extent imposing Western medical practices on the various peoples of the world. Raw power insinuated medicine into cultures around the globe, not merit. Physicians had prestige, but little curative competence. Surgeons were a different story (and not yet titled “physicians”).
The surgery brought by Western colonial dominion, especially reparative, was undoubtedly the best in the world, and rightfully impressive. But has any other surgery had so many wars and battles to learn from? But surgeons were not physicians. Historically, medicine successfully co-opted surgery, bone-setting and midwifery from other less politically adroit, less educated but nonetheless skilled practitioners. As physicians assimilated these and other tasks, those lesser arts were transformed by their passage into medicine.
In their medicalization, sensible traditions were set aside for theory; intimacy and bodily inviolability were exchanged for social class differences, educational hierarchy and a presumption of medical authority. Further, the methods and duration of apprenticeships were dismissed for less precise teaching, and, very importantly, the urge for experimentation (trial and error) pervaded.
New techniques were tried on live humans. Learned initially from necropsies and surgeons, strictly reparative work was done exceptionally well (mortality rates from surgery, nevertheless, were very high); however, with something as natural a feature of humanity as childbirth, when physicians began to take over from midwives, the unhygienic physicians among their lot became a vector for deadly puerperal fever pathogens (killing untold thousands of women). They invented and overused forceps to “assist” delivery, damaging the mother and the baby far too frequently. They began unnecessarily cutting the perineum (episiotomy), opening another route for infection and adverse effects.
Physicians have always left a large wake of unintended, but nonetheless inevitable harms. If it were not for the rise of Western economic and military power and the West’s penchant for expropriating raw materials under colonial authority, our medicine, in all probability, would be less bizarrely hazardous. Indeed, medicine may have found itself competing as one of many treatment modalities.