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Download a PDF of the following book which summarises the main points in the thesis: Tröhler U (2000). “To improve the evidence of medicine“: The 18th century British origins of a critical approach.” Edinburgh: Royal College of Physicians, 2000:59-68.

Abstract

The aim of this thesis has been to enquire into the development of mathematical methods of assessment in the study of disease and treatment. The traditional view has been t ha t quantitative analysis was “delayed” until around 1830 when it became recognized as an achievement at the Paris hospitals. The principal reasons advanced to account for this delay are t hat large hospital Services hardly existed in the l8th Century, and that the imperfect state of pathology prevented sufficient identification of disease entities. Furthermore, Paris was a centre for mathematical science, and the quest for certainty in medicine acquired a considerable momentum there from the late 1820s.

Upon examination, these factors have been found inadequate to account for this delay äs a European phenomenon: For instance my re-search on British medicine from 1750-1830, concentrating on the major medical problems within the growing towns and the armed forces (fevers, scurvy, syphilis, midwifery and the major surgical operations), has un-earthed a much earlier, deliberate use of quantification in clinical medicine.

This thesis describes a movement comprising doctors who were promoting the analysis of (mass) observations by simple arithmetic äs a new and the only sure way to gain certainty in medicine. They have thus been termed “arithmetic observationists”. The movement took distinct shape in London, the provinces, and in the Navy around 1780. Thereafter, the method spread steadily despite Opposition, becoming a Standard technique äs revealed in the publications of authors associated with dispensaries, specialized hospitals and the armed forces in the early 19th Century. This thesis also discusses, in philosophical, social and institutional terms, the origins, significance and limitations of this movement, and its men both in civilian and military life.

My conclusions are l) that historiographically the French contributions to quantitative nosography and evaluation of therapy, and the many subsequent endeavours right up to the early 20th Century, should be reconsidered in the light of these earlier British achievements, and 2) that arithmetic observationism marked a shift away from reliance upon Authority,to personal responsibility. For, to work credibly, the investi-gator required, as he still does, the observation of stringent moral Standards both in the conduct of research and in the Interpretation of results.