Antall József szerk.: Orvostörténeti közlemények 97-99. (Budapest, 1982)

TANULMÁNYOK - Codell Carter, K: Semmelweis esetleges hatása Kari Mayrhoferra és a tizenkilencedik századi etiológiai elméletek kidolgozóira (angol nyelven)

SEMMELWEIS'

S POSSIBLE INFLUENCE ON KARL MAYRHOFER AND ON THOSE WHO SUBSEQUENTLY DEVELOPED NINETEENTH CENTURY ETIOLOGICAL THEORIES

1 K. CODELL CARTER Preventive medicine consists largely of finding necessary causes for particular diseases and of insuring that those causes do not occur. In order for such a project to be possible, particular diseases must be characterized so that they have necessary causes, and this requirement is by no means trivial. Historically, diseases have usually been characterized in terms of signs and symptoms or in terms of morbid alterations of specific tissues. Since any given physical state can, in principle, be caused in more than one way, diseases that are characterized in terms of signs or symptoms or in terms of physical lesions will not always have necessary causes. For example, in the early nineteenth century, one typical characterization of hydrophobia was a "complete horror of fluids, reaching to such a degree, that their deglutition becomes almost impossible."

2 But, as contemporary physicians realized, a horror of fluids could come about in many ways, some psychological, some physiological. Thus, given this characterization, there was no necessary cause of hydrophobia. But given sufficient rather than necessary causes, systematic and reliable prophylaxis and treatment were impossible. This situation could only be corrected by conceptual innovations. In the middle of the nineteenth century, physicians began recharacterizing particular diseases in terms of some causal factor that could be identified in many or most cases. These recharacterizations made it true, by definition, that each recharacterized disease had a necessary cause. The formulation of these new etiological characterizations rested, in part, on the empirical discovery of controllable causal factors, but they were also partly semantic manoeuvres since they involved reclassifying many specific cases. Perhaps for this reason they were often greeted with skepticism and hostility. Yet precisely these changes in meaning were necessary for the development of systematic medical practice and for scientific medical theories. To a large extent, therefore, the rise of modern medicine rests on the adoption of these new characterizations. Obviously, an understanding of the process by which these characterizations came into medicine is crucial for understanding medical history. In an earlier paper I argued that Semmelweis was the first, or among the first, to claim that a particular disease had a universal necessary (but not sufficient) cause and to recharacterize the disease in terms of that cause.

3 If Semmelweis did, in fact, originate the use of etiological characterizations, the Aetiology was probably the most revolutionary and innovative book in the history of medicine. 1 Part of the research reported in this paper was carried out at the Semmelweis Institute for the History of Medicine in Budapest. I wish to thank József Antall, General Director of the Institute, and the staff of the Institute library for their great courtesy and help. 2 Gabriel Andral, „Perversions of Sensibility: Hydrophobia," Lancet, 1832, 7:805—809, p. 806. 3 K. Codell Carter, „Semmelweis and his Predecessors," Medical History, 1981, 25:57—72.