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117 The history of evidence-based healthcare, 1815–1875: barriers to the development of scientific treatment methods
  1. John Wallace
  1. Wolfson College, University of Cambridge, Cambridge, UK

Abstract

Objectives Changes in medical practice are not always enthusiastically embraced. New ideas about treatment methods rarely meet universal acceptance. Science did not achieve its central position within medicine without resistance. By 1850, a new science based on observation and experimentation had developed, changing medical education and therapy. There had been a general move from a religious to a scientific authority. However, change was not inevitable. Based on themes emerging from a literature review, the overall aim of this study was to increase understanding of change in medical education and practice at the School of Physic in Trinity College Dublin between 1815 and 1875. Addressing a significant knowledge gap, this research program identified and then analysed the barriers to, and the facilitators of, a more scientific approach to treatment.

Method This investigation involved a literature review and a case study. Primary manuscript evidence included academic reports, lists of matriculations, legal opinion, letters, minutes of hospital board meetings, diaries, personal papers, and registers. Older books and journal articles from the period under investigation were also utilized. Primary evidence was accessed through

  1. The Manuscripts and Archives Research Library of Trinity College Dublin

  2. The Early Printed Books Department of Trinity College Dublin

  3. The Library of the Royal College of Physicians in Ireland

  4. Electronic databases, including the Lind Library, The Cochrane Library, Medline, and Embase

Results This case study confirms a remarkable cultural resistance to change at the Dublin medical school. More rigorous, scientific approaches to treatment methodology encountered significant barriers internationally. Edward Jenner’s vaccination strategy was met with religious and medical prejudice while Louis Pasteur’s work on septic microbes also encountered resistance. Inhalation anaesthesia had suffered indifference while Joseph Lister’s innovative antiseptic approach to surgery was initially ridiculed. Research was not a priority in medical education and proponents of a scientific approach to treatment, based on anatomy and pathology, were a beleaguered group. Therapeutic skill was undervalued internationally and Trinity College Dublin was uncomfortable with a treatment approach that would no longer to be based on Greek or Latin texts. There was a dislike of chemical experimentation, anatomical dissection, and bedside medicine. The ascent of scientific knowledge over polite learning generated fears that doctors might be perceived as tradesmen or medical journeymen.

Conclusions This investigation found that a medieval respect for tradition and gentility proved a major obstacle to the introduction of change at the Dublin medical school. Translating chemical, physiological, and bacteriological knowledge from the laboratory to the patient’s bedside encountered extensive opposition. Cultural taste trumped knowledge based on rigorous research. There was a clash between a classical and scientific culture. An institutional dualism, where classical and scientific approaches to clinical treatment were seen as mutually exclusive, was maintained by social, cultural, and denominational factors. This binary view sustained an unwillingness to accommodate developments in medical treatment that were slowly gaining ground internationally. Scientific publications, medical meetings, statistical societies, journals, respected experts, and new methods of teaching, all contributed to an increased acceptance of a more scientific approach to treatment methodology. A consideration of social, cultural, and administrative factors is required to understand why new approaches to treatment are resisted initially.

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