Historical reflections on cause, responsibility and blame in medicine

In the early years of British settlement in Australia the colonial authorities regarded drunkenness as one of the major evils of the day. Their preoccupation with this social problem was mirrored by the concern of the colony's medical men with drunkenness as a cause of illness. In 1821, for example, James Bowman, Principal Surgeon of New South Wales, advised a Commission of Inquiry that dysentery was "attributable to the abrupt changes of the temperature as well as to debauchery." This view persisted well into the nineteenth century, with the editor of the Australian Medical Journal in 1846 "still citing climate and intemperance as a source of dysentery." It is noteworthy here that social or moral judgments about drunkenness were combined with an attempt to identify a purely natural cause, such as the weather, in explaining the occurrence of dysentery in New South Wales. The weather was seen as a contributing cause of dysentery, but since it was a natural force, it was no one's responsibility. Drunkenness, on the other hand, was considered both a cause of dysentery and a matter of personal responsibility. If, as a result of "debauchery," you brought on a case of dysentery, you presumably had only yourself to blame, no matter what the contribution of the weather to this state of affairs may have been.