How to Foster the Gain of Knowledge about Disease

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HOW TO FOSTER THE GAIN OF KNOWLEDGE ABOUT DISEASE PAULB. BEESON* In this essay I propose that our accomplishments to date in the management ofdisease have proved that the system now in operation to gain knowledge about disease is highly productive, indeed indispensable. There seems little reason to modify its general character or to seek alternative methods for the study, prevention, and treatment of disease. In what I shall say, I am going to place major emphasis on two points: that only by the study of human beings can we gain certain kinds of knowledge, and that the access of clinicians to "experiments of nature" carries with it an opportunity to open whole new areas for study by scientists working at other levels. Let me begin with some historical notes about biomedical science. The study of man and his ills represents one of the oldest lines of inquiry, stemming from the observations and conjectures of people such as Aristotle and Hippocrates. Some centuries later, during the reawakening of the spirit of scientific inquiry, many people whose names are associated with other sciences first began their scholarly work in the domain of medicine. Some examples are Copernicus the astronomer; Stensen, of parotid-duct fame, who became a geologist; Gallileo, who used his own pulse rate when timing the swinging of a pendulum; and Galvani, who studied the phenomenon of electricity. Among practicing clinicians, Harvey's work in 1628 on the circulation of the blood was surely a landmark of science and the beginning of experimental physiology. When the Royal Society of London was founded in 1663, no less than 24 of the 115 original members were doctors of medicine. Thomas Willis, for whom the vascular ring at the base of the brain is named, was also a chemist, and he was first to report the presence of sugar in urine. The great Dutch physician, Boerhaave, was the author of a textbook of chemistry. Wöhler, who bridged the gap between inorganic and organic chemistry by synthesizing urea, was a physician, and so were many ofthe»Veterans Administration Hospital, 4435 Beacon Avenue South, Seattle, Washington 98108.© 1980 by The University of Chicago. 0031-5982/80/2322-0151$01.00 Perspectives in Biology and Medicine ¦ Winter 1980 · Part 2 | S9 early botanists, including Linnaeus. Thomas Henry Huxley stated in 1874: "Within my recollection, the only way in which a student could obtain anything like a training in physical science was by attending the lectures of professors of physical and natural science attached to the medical schools. . . . Medicine was the foster-mother of chemistry because it had to do with the preparation of drugs and the detection of poisons; of botany because it enabled the physician to recognize medicinal herbs; of comparative anatomy and physiology because the man who studied human anatomy and physiology for purely practical purposes was led to extend his studies to the rest of the animal world" [1, p. 748]. It can be argued, then, that clinical medicine, rather than being disparaged as, at best, a practical applied field, is in fact the arena in which many of the so-called basic sciences had their origins. I grant that some of those branches, such as physiology and biochemistry, moved off rapidly and tended to shape themselves as discrete disciplines at a time when clinical medicine had unfortunately become mired in controversy over elaborate classifications of disease and in metaphysical discussions about its nature. Nevertheless there were some noteworthy clinical contributions , particularly the observations of such clinicians as Louis, Bright, and Hodgkin. Beginning in the middle ofthe nineteenth century the scientific approach to clinical medicine was reborn, mainly in Germany and Austria and led especially by Virchow and some of his followers , who sponsored work not only in morbid anatomy but also in experimental pathology and physiological chemistry. Clinicians associated with Virchow included Schönlein and Traube. Toward the end of the nineteenth century a few university clinics in Germany provided their clinical teachers with laboratories in which to carry on studies connected with the care of patients. A good example is Naunyn, who headed a clinical department where experimental work was done on liver disease and diabetes mellitus. One of...

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