The Day the Universe Changed - James Burke [102]
Hospital medicine in Hamburg. The ward is mixed, as is the treatment. On the left, the last rites are given. Centre, an amputation takes place next to an eye operation. Rear, the mad stare from their cell doors.
The lecture hall in the Paris School of Medicine, crowded with local and foreign students, most of them middle-aged.
When a patient died his relatives were obliged to pay the fairly large sum of sixty francs for burial, otherwise the corpse would be sent to the dissecting rooms where a post-mortem would be carried out to see why death had occurred. Pathological anatomy flourished, and foreign anatomy students flocked to Paris from places like England, where the only way to obtain a body was to buy it from the body-snatchers and grave-robbers. In France, if the patient’s relatives objected to dissection they had to produce extremely effective arguments to overcome the doctor’s automatic right to examine the corpse of a patient who had died under the knife in a surgical operation he had had no power to refuse.
In this new tissue-oriented atmosphere medicine was free to move away from therapy, or what the patient wanted, towards diagnosis and classification of disease, or what the doctor wanted. All that was needed now was sufficient clinical observation to provide data on which to build statistically valid disease and treatment profiles.
Crude attempts at statistics had been made in England since the sixteenth century, using the mortality bills compiled during epidemics to give some approximation of the total number of deaths. In the seventeenth century, under the stimulus of commerce and mercantile expansion, the Englishman John Graunt had begun to investigate the use of statistical data. In 1662 he made the basic discovery that large numbers displayed regularities or patterns not evident from small numbers. Analysis of the records of births and deaths in London for a period of fifty years showed him that such data could help in prediction and diagnosis of epidemics. He also saw relationships between the chronic and regular diseases and the weather.
The frontispiece of one of the earliest English reports of plague deaths, compiled in 1664 from parish registers.
A view of the Salpêtrière, Paris. Six thousand female patients lived here: one in ten was treated as a lunatic. The institution was as much a workhouse and prison as it was a hospital.
In the early eighteenth century the new insurance companies had begun using statistics to aid them in establishing premiums, basing these on the actuarial analysis of probability of death. Then in the great Diderot Encyclopedic, published in France in the middle of the eighteenth century, an article on probability brought statistical analysis into the mainstream of Enlightenment thinking, particularly with regard to its potential use in social circumstances. It would, of course, also help the state properly to evaluate the size and condition of the population, which is why the term ‘statistics’probably originated in Prussia, where control of the population was most keenly sought by its absolute monarch.
The Kantians and the ideologues of the Enlightenment placed man at the centre of their unified, naturalistic world-picture, and in doing so encouraged the kind of interdisciplinary thinking that made it desirable for all knowledge to be applied in every field. Encouraged by the philosophers, medicine looked to the new science of numbers.
In 1785 the Marquis de Condorcet, another philosophe and contributor to the Encyclopedic wrote an essay entitled ‘The application of mathematics to the theory of decision-making’. If the study of statistics had already worked well for insurance companies, said Condorcet, it should do well elsewhere. It would prove an invaluable aid to the decision-making