Medical knowledge and statistical methods in early nineteenth-century France

Abstract

In the early nineteenth century a persuasive and varied group of physicians urged the profession to consider the utility of numerical methods for medical practice. They were convinced that medical knowledge would rest on firmer foundations if practitioners employed methods that had served the physical sciences so well. Echoing Condorcet's hopeful but perhaps illusory aim, some doctors believed that questions of human judgment, whether social or medical, could ultimately be decided through analytic procedures which would convince rational men of their validity and veracity. This position affirmed that an unambiguous numerical method could decide questions of therapeutic choice. More modest proposals, less threatening to the traditional perception of the doctor's unique role in the medical act, restricted the application of numerical techniques to epidemiology. Yet even here the extensive use of the methodology fortified a more intense concern for questions related to the public's health and, by extension, tended to de-emphasize accepted views of the physician's concern for individual patients. Opposition came from diverse sectors of the profession. Many articulate physicians contested the claims for objectivity advanced by the advocates of numerical methods. In fact, a strong empirical tendency fortified critics who argued against generalization based on a precise number of cases. The variety and complexity of the human subject defied any movement towards uniform treatment of the sick, who ultimately could only receive adequate aid from the talented and perceptive physician. In the 1830s rivals clashed in the Academy of Medicine and in the Academy of Sciences. Both debates provided ample testimony to the divisions in professional opinion concerning the appropriate methodology for evaluating medical judgments. Later, Claude Bernard advanced an explicit objection to statistical methods which, in his view, only deterred the physician from the search for the specific cause of a particular effect. Strict determinism alone could provide the kind of certitude that medical science required. The many-sided debate focused attention on the methods and objectives of medicine and promoted further reflection on the access to useful knowledge at a time when the profession confronted medical and social problems which defied easy solution. © 1981, Cambridge University Press. All rights reserved.