Inferring and Explaining

59 Vienna General Hospital. He was unsuccessful in his applications to study under two gifed younger researchers in the pathology depart- ment and was forced to “settle” for an assistant- ship in the obstetrics department. At this time, obstetricswas a newand rather undistinguished specialty. So at the age of twenty-eight, Ignác Sem- melweis began as the second in charge of the Maternity Division of the Vienna General Hos- pital. Medical education was very diferent in those days, and this young, newlyminted doctor assumedmajor responsibilities in clinical medi- cine, research, and hospital administration. We will pick up the sad conclusion to Semmelweis’s biography directly, but we need to frst turn our attention to the scientifc problem he immedi- ately encountered and his systematic discovery of the solution. The Vienna General Hospital For someone who is far from young, it pains me to admit how ofen the history of science reminds us that the truly signifcant scientifc breakthroughs are made by younger research- ers. Tere is nothing particularly surprising about this, of course, because younger think- ers are almost by defnition less tied to the past, both in terms of prevailing knowledge and in terms of their own personal and professional standing. Te Vienna General Hospital was a classic mix of these generational divides.Te Germanic system put great value on experience, loyalty, and political connection. Te senior members of the faculty were described by one writer in 1876 in the following colorful language: a generation that had been reared in an intellectual straight-jacket with dark spectacles before their eyes and cottonwool in their ears.Te young people turned somersaults in the grass, and the old men, whose bod- ies had been hindered in their natural development by the lifelong burden of state supervision, felt their world about their ears, and believed that the end of things was at hand. 2 On the other hand, the hospital possessed some of the fnest young medical researchers in the entire world. Tree of them deserve a brief introduction. In 1844, Karl von Rokitansky, at the age of forty, became the director of pathological anat- omy. He made huge contributions to medical knowledge and formalized the practice of con- ducting autopsies by trained experts of every fatality in the hospital. Semmelweis was a true disciple of Rokitansky’s methodology and although not amember of the pathology depart- ment, was trained by him in the proper tech- nique of conducting autopsies of the fatalities in the maternity division. Joseph Skoda, who among other things invented the stethoscope, was also an advocate of pathological anatomy. His sole professional interest seems to have been in the diagnosis of disease, not its treatment. He felt that medicine, at least in his time, should concern itself with the prevention of disease, through an under- standing of its causes, and not worry about the treatment, since it always seemed so inefective anyway. From Skoda, Semmelweis learned the importance of careful pathological observa- tion and a fxation on understanding both the causal origins of disease and its causal progres- sion within the victim’s body. semmelweIs and ChIldBed feVer