ABSTRACT
The Russo–Williamson thesis (RWT) presupposes that the same causal hypothesis in medicine can be supported by two different types of evidence, namely statistical evidence and evidence of mechanism. Russo and Williamson argue that "pluralism about the nature of causality faces a crucial problem – it cannot account for the homogeneity of causal language". The McArdle disease is produced by a malfunctioning in the skeletal muscles. Muscles naturally require energy to work, and much of this is obtained from glucose. Some glucose circulates in the blood, but this is soon exhausted by exercising muscles. The muscles then have to utilize their stores of glycogen. Both Broadbent and Howick give statistical counter-examples to the Russo–Williamson thesis. Howick mentions Ignaz Semmelweis explicitly. He writes of the dangers with requiring mechanistic reasoning alongside comparative clinical studies to establish causation. This chapter provides a brief account of I. Semmelweis' work on puerperal fever.
