Sinclair, Sir William J.: Semmelweis. His Life and his Doctrine (Manchester, 1909)

VII. Last Illness and Death

OBSTETRICAL SOCIETY OF LONDON 307

of the glands, no rash, and yet the cases have gone on to a fatal issue.”

If we look at what a lying-in woman is we there see a peculiar constitution, ready to receive poisons. . . . Then there is the peculiar condition following labour where the system has been loaded with matter ... a state which is just treading on the verge of fever; at any moment the slightest excitement, or the slightest noxious matter carried into the blood, is ready to ferment and set up a fever. It does not matter what the poison is . . . With regard to scarlet fever, it is enough to set up any mischief in a lying-in woman, and produces all the mischiefs of any other form of poison . . .

Passing to the Autogenetic cases : these cases are as distinct in their origin as many cases of infection ... a little bit of placenta retained, a clot of blood . . . the whole system is in a ferment just as it was from the poison of scarlet fever ... I believe the infection may be propagated by the breath of a medical attendant or a nurse ... A man may walk about charged with infectious disease, and those who are susceptible, with whom he comes in contact, may catch it ... if a patient be in the lying-in state, with the blood ready to ferment, such a person would be ready to be attacked . . .

There is a pure puerperal fever which the patient herself can generate.

The spread of the disease can be prevented by careful isolation of the patient . . .

With regard to the value of antiseptics, to keep a hospital free from puerperal fever is an extremely difficult matter ... You cannot keep a series of patients in a hospital isolated in the proper sense of the word. You have the same nurses going to and fro . . . The consequences of the poisons acting upon one or two patients “may be radiated to others.” Only one secret for safety : have the woman confined at her own home ... A lying-in hospital is not now by any means so serious a matter as it used to be : still, it is always like sitting on a volcano which will explode at any moment” !