Dissecting vivisection to marry science with medicine

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This is an in-depth historical account of how experimentalism gained hold in English medical practice as a way to improve treatment through a deeper rational understanding of physiology.

Vivisection — albeit pejoratively connoting torture and exploitation of living animals — is essentially a method of experimentation for studying physiology and anatomical structure. It has been a crucial contributor to the modern understanding of the human body. | 'Physiological Demonstration with Vivisection of a Dog' (1832) by Emile-Edouard Mouchy

 

In the history of medicine, the period after 1848 is characterised by the laboratory revolution, when medicine developed close links with science and the experimental method. Physiology was at the forefront of this relationship. As an organised discipline, experimental physiology took off in Britain much later and more slowly than it did in France and Germany; indeed the period between 1840 and 1870 is seen as one of stagnancy in English physiology. Unlike their continental counterparts, English physiologists believed that experiment served at best to confirm functions that could be more precisely determined from anatomy — this “anatomical bias” led them to view function as being not distinct from structure. The few physicians who received a scientific education (rather than clinical training alone) had to make do with training in an outdated chemistry curriculum.

 

The reason most cited for English physiologists’ aversion to experiment was the strong antivivisectionist sentiment peculiar to Britain — perhaps there is truth in the stereotype of ‘the Englishman and his dog’. While anti-vivisectionist sentiment had always been strong, great controversy arose over the publication of the Handbook for the Physiological Laboratory (edited by the respected physiologist John Scott Burdon-Sanderson) in 1873, which was scant in its mention of anaesthesia for painful animal experiments. This led to the setting up of a Royal Commission on Vivisection whose report published in 1875 was a remarkable document revealing much about anti-vivisectionist sentiment and attitudes towards animals, as well as their roots in Victorian society. Published at a time when British physiology was beginning to shake off its lethargy and the laboratory was becoming more central to medical practice in much of the Western world, the report also offers an insight into the views of the medical elite on the utility of experimental physiology as well as on how (if at all) “science” was to transform the practice of medicine.

Attitudes towards experiment

Some physicians found certain results of experimental research to be directly beneficial to their practice, and saw this immediate benefit as the primary motivation for experimental work. Sir Thomas Watson, a former President of the Royal College of Physicians (RCP), said to the commission that present-day surgical and medical practices could never have been established without experiments — he cites the direct influence of William Harvey’s discovery of blood circulation on the treatment on aneurysms, as also the influence Sir Charles Bell and Dr. Marshall Hall's experiments on the nervous system had on present-day methods for pain relief. Sir George Burrows, another former RCP president, cited the importance of Bell's work to the treatment of partial paralysis. 18th-Century surgeon John Hunter's contribution to the ligature of arteries was also frequently mentioned.

John Scott Burdon-Sanderson

 

The utility of physiological study, it seems to me, ought to be judged not so much by its direct applicability to disease as by the certainty which exists in our minds that eventually it will be the guide of practice in medicine

However, these “pro-vivisectionists” questioned particular aspects of experiments on animals. Sir Thomas, for example, questioned how drug trials on animals could be applicable to human therapy, while Burrows said that the results of physiology could be arrived at by the (admittedly onerous) tabulation of a large number of clinical and pathological observations; a sophisticated version of which is perhaps being attempted today by practitioners of Big Data.

Those more closely engaged in experimental research were less likely to crudely cite direct benefits to clinical practice, being more reflexive about the utility of their research and its links to the practice of medicine. They instead painted a picture of a general and long-term improvement in healthcare grounded in the better understanding of the science of health and disease obtained from laboratory research. For example, Henry Wentworth Acland, Regius Professor of Medicine at Oxford, about whom his lifelong friend John Ruskin had said: “Physiology was an entrusted gospel of which he was the solitary preacher to the heathen”, had defended Burdon-Sanderson's experiments on more than one occasion, and had campaigned for massive expenditure for a new physiological laboratory. He however expressed disquiet about the growing disconnect between physiology and medicine:

“[There are] biologists now in the country who are not medical men... Modern civilization seems to be set upon acquiring, almost universally, what is called biological knowledge; and one of the consequences of that is, that whereas medical men are constantly engaged... for the purpose of doing immediate good to mankind — there are a number of persons now who are engaged in the pursuit of these subjects for the purpose of acquiring abstract knowledge... [which may have] some dangerous and mischievous tendencies... I know that would be thought of by many persons a very [...] foolish opinion... The mere desire to attain so much more knowledge [is not] a good condition of mind for a man... But now it has become a profession to discover; and I have often met persons who think that a man who is engaged in original research for the sake of adding knowledge is therefore a far superior being to a practicing physician who is simply trying to do good with his knowledge; that he is a superior being, because he is devoted to pure research.”

While seldom offering similar critique, other physiologists too did not resort to crude justifications for their disciplines by citing particular cures and diagnostic techniques. For example, William Sharpey, professor of physiology at University College said of the link between his discipline and medicine:

“I believe the influence of physiological knowledge upon medicine is one that may not be very conspicuous, but it is not the less true. It operates perhaps impalpably upon the mind of the physician. In short I say that physiology is not to be compared to the reaping machine but to the plough.”

To John Simon, the medical officer of the local government board, and for a while, Burdon-Sanderson's boss, a more exact knowledge of the causes of disease was the essential hope of being able to prevent them. He admitted that his attempts were, in fact, as the questioner put it, to “increase the range of mere physiological knowledge”. This was to furnish “an exact rational basis” for the prevention of disease. The utility of experiments to his own job was the “general principle” that theory could be converted by experiments to certainty in order to justify the advice of a government department. Indeed, he corrected the much-accepted inference that his discovery of contagion in sheep tubercle had implications for human health, saying that it would be improper to speak of it as an immediately practical result; it however opened up an immense field whose possibilities for preventive medicine were immense but unknowable. The justification for experiment was not immediate practical utility but,

The general scientific principle... we are trying to amend and develop our medical knowledge in accordance with the rules which have been discovered to work well for other branches of knowledge, trying to make our knowledge quite precise.

Thus, justification for the experimental method went beyond a citation of direct influences on practical medicine; “professional laboratory men” saw the role of the experiment in broader terms. While experimental research would have great implications for practice, these implications would be of a more general nature, engendered by increase of knowledge obtained from the scientific method to give medical practice a sound rational basis.

Vision of science and the practice of medicine

Burdon Sanderson and Foster were called in jointly to testify, perhaps because it was the publication of their book which had led to the immediate controversy. Sanderson did most of the talking. When asked in what respects the study of physiology may be useful to the advancement of practical medicine, his opinion was on the lines of other physiologists,

The utility of physiological study, it seems to me, ought to be judged not so much by its direct applicability to disease as by the certainty which exists in our minds that eventually it will be the guide of practice in medicine; and I wish to emphasise this first statement particularly, not because I am insensible to the fact that there are a great many direct applications of physiology but because I think what ought to encourage us above all is the certainty of which I have spoken... we have been working at the subject of the mechanism of the disease [inflammation] but during the last eighty years very small progress has been made in the explanation of its leading phenomena.

There are two key ideas to Sanderson's vision: that certainty must guide practice and that knowledge of underlying mechanisms obtained through research was to produce that certainty. Better medical practices could be discovered by mere fluke. The value of certainty lay in protecting practices from mere opinion and this could not be achieved through clinical experience alone; Sanderson went on:

Long ago it was the custom to subject people to cold effusion, or to the cold bath, in the treatment of fever and then that practice went out of use altogether. Now it is again coming into use, but not on the grounds that a change of opinion has taken place but because by the means of investigation, by the means of experimental investigation too, we know what is the mode of action of cold... Bleeding is a remedy which after having been used a great deal has been thrown aside, and again used... lives were sacrificed simply for want of knowledge. Then came influenza and cholera and they demonstrated clearly that bleeding was injurious by direct experience; nothwithstanding which, bleeding, though less used, still continued to be used till about 25 years ago. Now we know that bleeding is injurious not because experience teaches us that it is so, for we know that experience seemed to teach our forefathers just exactly the opposite, consequently experience is not a safe guide in questions of that sort, but because we know precisely what bleeding does to the animal organism... [Referring to dietary prescriptions] By science we are able to form an exact and positive opinion as to the value of this or that particular article of food, and from that position no waves of medical opinion could possibly drive us.

In his reference to tuberculosis, he again argued that an understanding of the science behind health and disease through laboratory work was central to establishing certainty which clinical observations alone could not establish.

We have known what you may call the natural history of the disease for long; we have known, I mean, the aspects which it presents to the clinical observer at the bed side; but what we have not known has been the intimate nature of the changes of which the disease really consists. [Laboratory] observations have led … towards a really complete knowledge of the mechanism of the process of tuberculosis... our object is to make our knowledge of the nature of those external agents more and more precise.

Sanderson related the rise of physiological laboratories to the larger story of the rise of the experimental method, and the emphasis on accuracy and certainty in physics and chemistry. That perhaps he saw physiological research as a guide to practical medicine in the same fashion that thermodynamics was a guide to the engineering industry or electromagnetic research was a guide to the telegraphy industry was implied when he said,

It is my profound conviction that a future will come, it may be a somewhat distant future, in which the treatment of disease will be really guided by science. Just as completely as mechanical science has come to be the guide of the mechanical arts, do I believe, and I feel confident that physiological science will eventually come to be the guide of medicine and surgery.

His vision bore close parallels with the arguments made by German physiologists a generation before him when ‘physiological medicine’ was established in that country. Mere description of clinical phenomena was deemed insufficient; clinical observation was to be used together with knowledge of the interrelation of clinical phenomena, their genesis and their development obtained in the laboratory. The father of modern pathology Rudolph Virchow then observed:

The ideal we shall strive to realize as far as it is in our power is, that practical medicine shall become applied theoretical medicine and theoretical medicine shall become applied pathological physiology. Pathological anatomy and clinical medicine, the justness and independence of which we fully recognize, are essential to us as sources of new questions, the answering of which will fall to pathological physiology.

Like Virchow, Sanderson recognised the importance of the clinic. His views on pathological anatomy were also similar to Virchow’s; he believed that the knowledge to be gained from post-mortems was at an end and that pathological anatomy had raised questions about mechanisms and relationships between processes which physiology could answer.

In Sanderson's testimony lay a physiologist's clear vision for his discipline: It was to be complementary to clinical observations and establish certainty in clinical practice through knowledge gained from the experimental method. Its benefits to practical medicine were not to be of an immediate nature but more on the lines of a longer and gradual process of providing a rational basis to medical practice through increased knowledge.

Scientists or bedside clinicians

One explanation for the eventual rise of physiology in Britain is the Royal College of Surgeons requiring that candidates attend a course in physiology during which “the learners themselves shall individually be engaged in the necessary experiments, manipulations &c”. An examination of the pro-vivisectionists’ case, however, raises questions as to what utility the profession saw in practical physiological training for general practitioners. Almost all physicians and surgeons said experiments had little value for training medical students. Where vivisection was required in class, it was to demonstrate a result (such as the beating of the heart) and make an impression on the students that could be not be made by textbook-based learning, rather than to teach the experimental method. Even the surgeons disavowed any utility of experiments on live animals to developing manual dexterity.

While being an advocate for physiological knowledge in pure research, Sanderson not only rejected experiments for pedagogy, he also rejected the value of any physiological training altogether for clinicians, even saying “surgery has no relation to physiology”. Indeed, he said that he would not like to see physiological laboratories established at every medical school. He emphasised the importance of experience in practical medicine and rejected the value to the general practitioner of any scientific education whatsoever:

I do not think it is at all desirable that all students of medicine should have gone through scientific study... I think that it should be confined as much as possible to men who are likely to be advisers to the profession. With reference to medical students in general … [they] should be what we call thorough clinicists [sic], that is to say thoroughly acquainted with the aspects of the disease as seen at the bedside.... Medicine stands on experience, and the man who is most competent to advise is the man of most judgment and most clinical knowledge, in other words, of most experience.

Referring to the advances made in Germany, he said:

It is not the case at all that the ordinary medical practitioner there is more educated in this way than our medical practitioners are; but simply that there is a class of men in Germany who work hard at science.

The influence of the German ideal was also reflected when Sanderson was asked under what conditions experimental investigations could be most advantageously made. In response, Sanderson alluded to his own professional position as an improvement, and made a plea for a research school on the lines of those in Germany; a school which he himself had failed to set up,

In England the professed physiologist has been until recently unrepresented, that is to say, the physiological work has been done by persons engaged in other pursuits at the same time.... My professorship is held under the conditions of devoting myself to original research. ...Every school of science... [must have] a school of physiology... I mean by a school of physiology, not the teaching of students by lectures but the association of workers under the direction of a head, such persons not being students in the ordinary sense, but men who are themselves entirely devoted to science.

The need for training of individuals suited to a new industrial society has been seen by historians as central to the rise of the laboratory in the 19th Century, be it in Germany or physics laboratories in Britain. Sanderson however saw original research and not the training of general practitioners as key role of the physiological laboratory. In his vision, clinical experience was central to the efficacy of the practitioner and scientific training was not only unnecessary but would divert the student from his central goal of becoming a thorough clinician.

However, clinical practice was to be informed by science; akin to how mechanical science influenced the practitioner of the mechanical arts. This vision, which was shaped by how physiologists saw other spheres of human endeavour being transformed through science, reflected the Victorian belief in progress through science and certainty of knowledge; as Sanderson’s biographer Terrie Romano argues, support for Burdon-Sanderson’s larger project was fuelled by the positivist optimism of the Victorian age.

Central to this vision of transformation was the idea that the utility of the laboratory lay in original research, rather than in the training of practitioners. Medicine was to be transformed by science, rather than into a science. It was to remain a healing art, albeit a more certain and rational one.

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