Scientific Method in Biology/Chapter 5
V.
THE NECESSITY OF MEDICAL RESEARCH.
WHILST fully recognising the right of the laity to criticise scientific method when it deals with sentient animals, fashioned on the same general plan as ourselves, and capable of fear, pain, affection, and gratitude, there is another aspect of the subject which we are bound to consider.
The present condition of medicine is that of an art, not of a science. It is erroneous to speak of the science of medicine. There exists uncertainty in diagnosis, uncertainty in the action of remedies, ignorance of individual idiosyncrasy, and terrible inability to meet such devastating diseases as cancer, consumption, leprosy, etc.
No one outside the profession can fully realize the grave responsibility, even desperate anxiety, felt by the conscientious physician when life or death seems to depend upon his action, and he knows that medical resources are not equal to the occasion. It is a noble desire for the advancement of the beneficent art of medicine which makes the great body of busy doctors eagerly listen to those who are supposed to speak with authority, and hail with hope every announcement or supposed discovery which seems to promise improved practical results.
This is really a sound humane attitude of mind in that vast body of the profession who are unable, from the pressure of practical life, to devote themselves to investigation—a profession which has always had its heroes and martyrs, who have not shrunk from risking their lives in the service and for the advancement of their noble art.
Those also who are in the profession can most fully estimate the real and beneficial results, both in surgery and medicine, derived from careful and persistent research, notwithstanding the severe disappointment often caused by the theoretical error and unjustifiable practice resulting from rivalry in erroneous methods of investigation. The conquest of pain and diminution of nervous shock in necessary surgical operations[1]; the disappearance of blood-poisoning, hospital gangrene, and erysipelas, which were the scourges of our public institutions in a former generation, are immense gains, due to the discovery of anæsthetics, antiseptics, and advancing sanitation. These blessings are the direct outcome of persevering and skilful clinical observation, of careful work in the laboratory, of humane experiment, and of happy accident; they are not derived from cruel experimentation.
The successful control of that terrible disease—puerperal fever—which formerly destroyed such a multitude of women, is a striking conquest of humane method in modern medicine. When I was a student in La Maternité of Paris in 1849, this destructive malady of lying-in women produced a mortality varying from 10 to 15 per cent. But when I visited La Maternité in 1889 the mortality was reduced to a little over 1 per cent. This was due to rigorous cleanliness, sanitation, and the use of antiseptics, directed by the skilful sage femme en chef Madame Henri, in spite of the old and unsuitable buildings and the depressing status of many of the patients.
A still more satisfactory result is shown in Dr. Annie McCall's Clapham Maternity, where not a single death occurred amongst the 760 cases first received into the institution.
This excellent result still continues under the same administration. In the 2,100 lying-in cases received to date in the hospital, there has been no death from puerperal fever. This excellent record has been attained by scrupulous cleanliness, absolute isolation on the occurrence of suspicious symptoms, by excellent nursing, and constant oversight by the doctors in charge. Even in the out-patient department, where the conditions of living are not under such strict medical control, the deaths from this frightful malady have only amounted to 4 in 7,000 cases under the same enlightened direction.
This great and beneficent reform in the first and world-wide branch of medicine, by means of which the lives of innumerable women in all our large centres of civilization have been saved, is the result of scientific research. It was initiated and successfully carried out by Semmelweis, of Vienna,[2] and is a striking instance of the value of research carried on by the use of the comparative method, with absolutely no resort to experiment. The history of this reform, the methods by which it was accomplished, the opposition it encountered in the profession itself, and its triumphant vindication, are well worth serious study. An account of this valuable investigation, as also of Pettenkofer's research in cholera (referred to later), and other important discoveries by justifiable methods of inquiry, are given to English readers by the admirable translation published by the New Sydenham Society.
Medical research, therefore, is not only justifiable, but obligatory in a profession that is specially charged with the care and advancement of individual and national health; and, as will be seen later, observation, induction, and rational experiment form the essential methods of scientific inquiry.
These two facts, viz., the necessity of advance in medical knowledge, and the methods of investigation necessary for such advance, must be distinctly recognised by sincere reformers, and should shield the profession from that indiscriminate reproach which is often made against it as a whole; for such hostility tends to strengthen that undue esprit de corps which often hinders sound medical progress in the profession.
- ↑ The former horrors of the hospital operating-room are graphically described from personal observation in Sir B. W. Richardson's treatise, 'The Mastery of Pain.'
- ↑ See the standard work of Hirsch on 'Geographical and Historical Pathology,' vol. ii., pp. 416-466. The value of this translation is greatly increased by its excellent index.