Inferring and Explaining

58 InferrIng and exPlaInIng proportions at the beginning of the nineteenth century. In order to appreciate the signifcance of Semmelweis’s discovery of the cause and treatment of childbed fever, we need to imagine a time, surprisingly recent, in which the true nature of infection, the role of microorgan- isms, and the so-called germ theory of disease were completely unknown. Doctors had specu- lated about what was going on in these usually fatal cases, but in fact, they really had no clue about the disease’s etiology . Tis fancy Latin term simply means “cause,” or “causal history.” In fact, there were two distinct sorts of causal ignorance about childbed fever. One had to do with the causal origins of the disease. Te other was the causal progression of the disease within the victim’s body. Tis helps us understand why the prevailing theories about the disease were so wildly misguided. Te two theories that focused on the second causal question both misunderstood—indeed, misidentifed—the massive amounts of pus in the poor infectedwoman’s body. One theory that went clear back to the Greeks misdiagnosed the putrid fluid as a corrupted form of lachia , the naturally occurring fuid that accompanies normal delivery. Tis led to much speculation about the efects of the latter stages of preg- nancy.Te other, whichwas favored by Semmel- weis’s teachers and supervisors, misidentifed the pus as corrupted and misdirected milk. Te reason for this physiological disaster was a com- plete mystery. A very diferent causal account of childbed fever focused on its causal origins. Doctors were struckby the epidemicproportions of thedisease and other epidemics they were familiar with, such as cholera and smallpox.Tey attributed all this to a generic cause called miasma, or “atmo- spheric cosmic-telluric changes.” But as to what all this really was, they were again completely ignorant. Nevertheless, at least three theories about puerperal fever were on the table for doc- tors to investigate. t 1 . Lochial discharge theory t 2 . Lactescent fuid theory t 3 . Miasma Ignác Fülöp Semmelweis It is time to introduce the tragic hero to our story, Ignác Semmelweis. He was born of relatively humble origins in Hungary in the year 1818. At this time, Hungarywas a relatively insignifcant part of the Austro-Hungarian Empire, and its capital, Budapest, took a distinct backseat to the empire’s capital of Vienna. Evenwithin his Hun- garian background, Semmelweis faced another source of prejudice—his family spoke a rather obscure regional dialect, and he carried a dis- tinct accent for his entire life. All this is relevant to understanding Semmelweis’s academic and professional life because like many victims of ethnic prejudice; he seems to have always seen himself as an outsider within the privileged class and sufered from something many of my students can identify with—a fear and loathing of formal academic writing. Nevertheless, Ignác was a gifed student. He began college as a law student at the University of Vienna but was soon won over to the study of medicine. Splitting time between the University of Vienna and the Royal University of Pest, he completed his degree in 1844 and went looking for what we would now call an internship at the