Sinclair, Sir William J.: Semmelweis. His Life and his Doctrine (Manchester, 1909)
VII. Last Illness and Death
epidemics enumerated by Hirsch, 178 occurred exclusively in lying-in hospitals. On the subject of overcrowding as a factor in the etiology of puerperal fever, Hirsch has much evidence to produce from Europe and America. He very judiciously concludes: “In estimating the importance of this etiological factor in the production of childbed fever, just as for the genesis of erysipelas, we shall have to see in these unsanitary conditions only a peculiarly favourable soil for the proper cause of the disease to develop in, or for the disease to spread in. It is in this fact of puerperal fever seeming to break out not unfrequently quite apart from such external influences, that has given strong support to the theory of its miasmatic or contagious-miasmatic origin. It has been assumed that there is in childbed fever a specific morbid poison. This doctrine has been accepted by prominent gynaecologists of the most recent period. After an exacting criticism of all the facts which support the theory of miasma, Hirsch comes to the conclusion that this theory is completely untenable. He then comes to the evidence of the transmission of infection. This is the conception that puerperal fever is a septic or infective traumatic malady. This theory was long ago indicated by Willis. In enumerating the causes of febris puerperalium putrida he says: “Huc faciunt partus laboriosus circa uterum unitas soluta, ,1contusio, rerum praeter naturalium retentio, dispositio ulcerosa et pleraque alia accidentia, quae necessitate quadam inducunturThis theory was afterwards, longo intervallo, developed by Eisenmann (1837) and by Helm. The author next proceeds to give further evidence, drawn with amazing knowledge largely from British sources, and it must be said with regret that he confuses completely Contagiost'dt with Uebertragbarkeit, the theory of contagion with that of conveyed infection by contact with the “decomposed animal organic matter” of Semmelweis. This question must be fully considered in the sequel HIRSCH 283
