These words appear in An Essay on Clinical Instruction by the 19th-century French physician Pierre Charles Alexandre Louis, but they could have been written at any time in the long history of medicine. They reflect an aspiration of physicians since at least the time of Hippocrates, but which is now rarely stated so bluntly: the use of evidence to establish certainty in diagnosis, treatment and outcome. In the first part of this brief history of this aspiration, I examine the origins of attempts to turn it into a reality, beginning in the 5th century BCE with simple reasoning and intuition, followed by the use of logic and quantification. The second part will describe the emergence of attempts to use probability theory to deal with the challenges of uncertainty around 1700. I also describe the controversies engendered by these approaches. Perhaps their most striking feature is their durability. Concerns raised millennia ago remain at the forefront of current debate in clinical medicine: how to infer reliable conclusions from observations, the meaning of ‘convincing’ evidence and the recognition of sources of uncertainty beyond the play of chance. No less striking is the vociferous nature of the arguments engendered by attempts to reduce uncertainty, especially through the application of mathematics.

中文翻译：

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临床医学中不确定性治疗的起源。第 1 部分：古老的根源，熟悉的争议

这些话出现在 19 世纪法国医生皮埃尔·查尔斯·亚历山大·路易斯的《临床教学论文》中，但它们可能在漫长的医学史上的任何时候写下。它们反映了至少从希波克拉底时代以来医生的愿望，但现在很少如此直白地表达：利用证据来确定诊断、治疗和结果的确定性。在这一愿望简史的第一部分中，我研究了将其变为现实的尝试的起源，从公元前 5 世纪开始，通过简单的推理和直觉，随后使用逻辑和量化。第二部分将描述 1700 年左右出现的使用概率论来应对不确定性挑战的尝试。我还描述了这些方法引起的争议。也许它们最引人注目的特点是耐用性。几千年前提出的问题仍然是当前临床医学争论的前沿：如何从观察中推断出可靠的结论、“令人信服”的证据的含义以及对机会之外的不确定性来源的认识。同样引人注目的是，由于试图减少不确定性，特别是通过数学的应用而引起的激烈争论。