To Assess and To Improve

While most chapters of this book focus on innovations in modern medicine from the 1850s to the 1990s, the present contribution takes account of the fact that there were innovations in healthcare well before 1850: eighteenth-century examples that come to mind are inoculation of human smallpox, ¹ the obstetric forceps, ² the use of digitalis, ³ the introduction of the “lateral” method for the surgical treatment of urinary bladder stones, lithotomy, the flap method for amputation, ⁴ and the extraction of the ocular lens for the treatment of cataracts. ⁵ For us an innovation would imply comparison to an earlier situation. However, very little is known, historically, about how practitioners presented and perceived these new interventions, either in terms of gains (“advantage” and “benefit” were the concurrent terms) or losses (“harm” or “danger”) for the patient and/or society, or in terms of medical safety. Attempting a systematic view from a long-term perspective, this chapter looks at the histories of inoculation and of a few eighteenth and nineteenth-century obstetrical and surgical innovations, and seeks to highlight the conceptual origins of what was later called “risk”.