Sinclair, Sir William J.: Semmelweis. His Life and his Doctrine (Manchester, 1909)
III. Life in Vienna
20 ETIOLOGY BEFORE SEMMELWEIS Hervieux, we now recognised as local expressions of sepsis. A doctrine maintained all this time, although apparently inconsistent with the theory of an intimate relationship with erysipelas, was that puerperal fever was a species of disease sui generis, independent as an entity, but the most variable in its phenomena owing to fortuitous influences. And this belief still prevailed, especially in England, when all the zymotic diseases were supposed capable of assuming the form of puerperal fever while concealing even their most characteristic features. For example scarlet fever in the guise of puerperal fever without angina, without rash, “Nulla febris est quae non aliquando cadat in puerperam.’’ This was the “variable’’ theory of puerperal fever as enunciated by Eisemann in 1837, and it gave a certain added air of originality to his over-rated work. Ultimately came the dawn of the wound-fever theory as the internal factor, but even in England where the most rational pioneer opinions had developed, there was a general belief in a contagium, and the pioneers of our modern pathology of the disease harked back upon a “specific something,” an “unknown something,” the divinum aliquid, perhaps a specific primary change in the blood, producing the local lesions known to the pathological anatomist. At the early period when this chaos of notions prevailed with regard to the internal factors in the etiology of puerperal fever, the external factors were still more vague and even incomprehensible. As external factors were certain alleged influences of an atmospheric, cosmic, telluric kind, to which the term genius epidemicus was applied; mere changes in the weather are constantly referred by some writers, especially in France and Germany and even in Edinburgh, as sufficient to account for the greater or less prevalence of puerperal sickness. Others maintained that as the result of such changes a special injurious entity developed and spread through the atmosphere, a miasma. The genius
