Semmelweis, Socratic Ignorance and Listening in an Unjust World

Ignaz Semmelweis, a physician working in a charity hospital in Vienna in the mid 19th century, faced a tragic puzzle: he saw that the rates of puerperal (childbed) fever and consequent deaths were much higher among women who gave birth on the ward led by physicians than on the midwives’ ward (around 10 percent on average compared to 3-4 percent). Their death rates were even higher compared to women who gave birth on the street and not in the hospital. The high death rates among women from the physicians’ ward were common knowledge outside the hospital and women were often begging to be admitted to the midwives’ ward, rather than the physicians’ ward. The physicians, however, did not inquire into the statistics, nor did they consider that they might be responsible for the women’s deaths. The wards were in charity maternity houses and the patients were regarded as mere material for medical procedures that should be grateful for being treated in these charity hospitals. Moreover, the majority of the learned physicians thought themselves flawless because they were learned physicians. They did not listen to the worries of the female patients, nor did they take their deaths seriously.

But Ignaz Semmelweis was different. He recognized the discrepancies and wanted to understand why more women died from puerperal fever on the first ward to be able to reduce the high death rates. He began to suspect the cause of the deaths when he saw a colleague die from symptoms very much like those of puerperal fever after a cut that he had sustained while conducting an autopsy got infected. – Mind you, germ theory was not yet recognized at that time, so strictly speaking, they could not say that the cut was infected nor did they have the conceptual tools for explaining the infection. –  But Semmelweis still argued that the physicians were responsible for the high number of cases of puerperal fever. His colleague’s death had provided him with the crucial insight: the physicians went directly from autopsies on dead bodies to the maternity ward, and when doing so, they brought what he called “cadaverous particles” to the women giving birth. Those “cadaverous particles” were the cause of the puerperal fever, he claimed, and suggested that physicians should wash their hands, using disinfectants and nail brushes, before going to the women giving birth.

We now know that germs are responsible for these infections, but this finding was not known at Semmelweis’ time. And his colleagues regarded his claims as disrespectful and nonsense: they were the physicians; they didn’t need to wash their hands, nor were they responsible for the women’s deaths. Semmelweis moved  from Vienna General Hospital to a small hospital in Budapest where he managed to institute the practice of handwashing among physicians and the number of women dying from childbed fever dropped significantly, suggesting that he was on the right track to finding the cause of the childbed fever cases.

Semmelweis was not exactly conducting a study into the causes of puerperal fever and the high number of deaths after birth, but he wanted to find the explanation for the situation that he and the women were facing. Before he recognized the connection between the autopsies and the women’s infections, he did not presume to know the answer, he knew that he did not know the answer and set out to find it. He demonstrated what we can call “Socratic ignorance”.

Socratic ignorance – not presuming to know what one does not know and thus being aware of one’s own ignorance – is still highly esteemed by philosophers and non-philosophers alike. Socrates himself manifested what we now call Socratic ignorance when he was trying to make sense of Pythia’s verdict that he was the wisest of all people. He comes to understand that he is the wisest of all people because he does not take himself to know what he does not know, unlike the other individuals he meets. Socrates wants to “check the truth” (21b) of Pythia’s claim that [he] is the wisest of all people by talking to “everyone who had a reputation for knowledge” (21e). And it is only after talking to many people, including politicians, poets, skilled craftspeople about their knowledge and their attitudes towards their knowledge claims that he determines that he is indeed wiser than his interlocutors. They all think that they know something even though they don’t know but rather have gaps in their knowledge. After these inquiries Socrates can also explain that he is wiser because of the special relation between his ignorance, his knowledge and his knowledge claims.

Semmelweis’ Socratic ignorance is special because in order to become Socratically ignorant he had to overcome the marginalization of the female patients. Theirs was an unjust society in which the experiences and beliefs of female patients were marginalized by the dominant and privileged group of physicians. In addition, the women who presented at the charity hospital were poor, many lived at the margins of society and they were not taken seriously. In becoming Socratically ignorant, Semmelweis had to overcome the biases and prejudice against the female patients and the credibility excesses awarded to fellow physicians.

His case reveals a central facet of Socratic ignorance that is often overlooked: It requires truly listening to marginalized individuals. Socratic ignorance does not simply consist in knowing that one does not know, but also includes inquiry and self-reflection, as well as listening to and conversing with other individuals.

Such Socratic ignorance is especially apt for dealing with the so-called “listening problem” in unjust societies. The listening problem appears in communities in which dominant groups do not listen, nor give uptake, to the contributions by minorities – as was the case with Semmelweis’ colleagues. They did not even recognize that there was an issue with so many women dying from puerperal fever nor were they able to inquire into the reasons for the higher death rates on their wards.

Truly listening to minorities and giving them appropriate uptake is not easy since conversations and listening in unjust societies are infused by hierarchies and injustice. Semmelweis was unique because he was giving uptake to the women begging him not to assign them to the physicians’ ward. He was able to learn about the women’s fears and worries from their statements. We can only speculate why he was so well-suited for listening to the women and why the listening problem did not affect him. And we certainly should not regard Semmelweis as the standard case since that would be unrealistic.

Being Socratically ignorant is always a genuine achievement. But it is not merely an individual achievement, society can make sure that the individual finds beneficial conditions for developing Socratic ignorance. One shape these beneficial conditions can take are what Natalie Ashton, Josh Habgood-Coote and I have called “receptive publics”: Spaces in which dominant individuals listen to marginalized individuals and learn about marginalizations and oppression and develop the skills to give adequate uptake to marginalized experiences. Socratic ignorance that is developed in receptive publics takes hierarchies between individuals and groups into account and corrects for them. A colleague of Semmelweis conversing with female patients in a receptive public would be led to recognize that the women are not just material for their medical procedures and take into account their fears. They would be able to allow that they may be responsible for the women’s fears and for the high rate of puerperal fever infections on their ward. By becoming Socratically ignorant, they would be able to investigate openly the issue at hand. Socratic ignorance involves truly listening to others, conversing with them, self-reflecting and inquiring – into one’s knowledge, but also into one’s own ignorance.

References

Habgood-Coote, Joshua, Natalie Alana Ashton, and Nadja El Kassar. forthcoming. “Receptive Publics.” Ergo. https://philarchive.org/rec/HABRPN.

Nuland, Sherwin B. 2004. The Doctors’ Plague: Germs, Childbed Fever, and the Strange Story of Ignác Semmelweis. 1. publ. as a Norton paperback. Great Discoveries. New York: W. W. Norton & Comp.

Plato. 1997. Complete Works. Edited by John M. Cooper. Indianapolis, Ind: Hackett Pub.