In his 2004 book The Great Influenza, an epic account of the 1918-20 pandemic that has been called “the deadliest in history”, author John M Barry says, “Before medicine could confront this disease with any promise of effect, it had to become scientific. It had to be revolutionised.”
He continues: “Medicine is not yet and may never be fully a science… up to a few decades before World War I, the practice of medicine had remained quite literally almost unchanged from the time of Hippocrates more than 2000 years earlier.”
A key participant in advancing the practice of medicine was Pierre Charles Alexandre Louis, a French physician and pathologist known for his research into pneumonia, tuberculosis and typhoid fever.
One of his most important achievements was to call into question the efficacy of the 3000-year-old practice of bloodletting as a treatment for all manner of ailments.
Louis was born on 14 April 1787 in France’s Champagne province. In the 2002 book Doctors and Discoveries: Lives that Created Today’s Medicine, author John Simmons says that after completing his medical training in Paris, Louis worked for six years as a physician in Russia.
Returning to the Paris hospital system, Simmons says, Louis “was a doctor with a mission, intent to learn from experience… He took copious notes on cases he saw and on postmortems he examined, and he accumulated great quantities of data.”
What he was doing, Barry says, was “using the most basic mathematical analysis… he correlated the different treatments patients received for the same disease with the results”. “For the first time in history, a physician was creating a reliable and systematic database.”
A 2001 article published in The Lancet – “Reproducibility of Louis’ definition of pneumonia” – says “his most famous application of quantitative measure was in patients with pneumonia who had undergone bloodletting at varying times since the beginning of their illness”.
A 2005 article in BMJ Quality and Safety in Health Care, headlined “Pierre Charles Alexandre Louis: Master of the spirit of mathematical clinical science”, describes in detail how he analysed 77 cases of pneumonia based on “duration of disease and frequency of death stratified by time of first bloodletting”.
An article on the practice of bloodletting, published in 2010 in Canada’s British Columbia Medical Journal, says Louis “compared the results in patients treated with bloodletting in the early phase versus the late phase of the illness. In his conclusions he did not condemn bloodletting but concluded that the effect of this procedure ‘was actually much less than has been commonly believed’.”
The Lancet says modern analysis “confirms Louis’ main conclusion, that bloodletting was not indicated to treat pneumonia in these patients, and was possibly harmful to them”.
In a 1992 lecture titled “Health Care Research: Old Wine in New Bottles”, Kerr L White said Louis’ studies “incurred the wrath of many fellow clinicians, he put numeracy on the clinical map”.
“He challenged the notion that the experience of individual physicians with individual patients was a reliable guide to understanding the origins of disease or its prevention, diagnosis, treatment, and prognosis.”
White continued: “Recourse to facts and figures in place of the vague theorising that characterised most of medicine at the time was Louis’ epoch-making contribution”.
“Louis probably influenced more medical men to undertake scientific investigations than any of his contemporaries. He had an enormous impact on clinical practice both in France and abroad. Indeed, a plausible theory asserts that Louis’ numerical method was the intellectual antecedent of what is now called ‘clinical epidemiology’.”
Jeff Glorfeld is a former senior editor of The Age newspaper in Australia, and is now a freelance journalist based in California, US.
Read science facts, not fiction...
There’s never been a more important time to explain the facts, cherish evidence-based knowledge and to showcase the latest scientific, technological and engineering breakthroughs. Cosmos is published by The Royal Institution of Australia, a charity dedicated to connecting people with the world of science. Financial contributions, however big or small, help us provide access to trusted science information at a time when the world needs it most. Please support us by making a donation or purchasing a subscription today.