Sinclair, Sir William J.: Semmelweis. His Life and his Doctrine (Manchester, 1909)
VII. Last Illness and Death
Hirsch then proceeds to discuss “Puerperal Fever in former times.” “ There is no doubt that puerperal fever has been prevalent in all ages, just as its geographical distribution extends over the whole habitable globe. ...” The whole subject is analysed and discussed with remarkable patience and thoroughness. Hirsch enumerated the historical epidemics in Europe from the first at the Hotel Dieu of Paris in 1664 to the last at the Charité of Berlin in 1879. On the question, the prevalence of epidemics according to the season of the year, he says : “Almost all the observers, both old and new . . . are agreed in saying that the epidemic or endemic prevalence of the disease falls in winter or spring; and these observations of individual authorities are fully borne out by statistics.” The influence of cold weather is an indirect one. It is a change in the hygienic conditions of the lying-in hospitals, brought about by the cold season, which furnishes the real grounds for the rise of the sick-rate and death-rate. Nothing in the history of puerperal fever, so far as we can follow it during the last three centuries, comes out so prominently and uniformly among the various factors in the etiology, as its great prevalence in lying-in hospitals, contrasting with its comparatively rare occurrence outside these institutions. For statistics on this point, in illustration of the evidence that had to be resisted by many authorities on midwifery, it may suffice to quote only one or two sets of figures. Le Fort calculated that of 934,781 women who were confined at their homes in various towns of Europe 4,405 died in childbed, that amounts to 0^47 per cent.; whereas among 888,314 women confined in lying-in hospitals, the deaths were 30,549 or 3'4 per cent. In the six great lying-in institutions of Paris the mortality among puerperae, according to observations extending over 60 years, averaged 4'8 per cent., whereas among women confined at their homes in the city it was reckoned at not quite o'6 per cent. Lastly, it is a noteAvorthy fact that of the 288 282 HIRSCH
