Sinclair, Sir William J.: Semmelweis. His Life and his Doctrine (Manchester, 1909)
III. Life in Vienna
ELIMINATION OF FACTORS 41 the diminished flow or cessation of lochia, the suppression of milk secretion, death of the foetus in utero, some idiosyncrasy of the individual. Such are the influences which have so much or so little effect in causing puerperal fever. But whether they are harmful or not, they can give no explanation of the striking difference in the mortality; all were the same in their incidence in the Second Division.” Along with the allegations regarding the causes of the higher mortality in the First Division in which I could find no satisfactory explanation, there were other circumstances connected with the First Division alone, for which no explanation whatever had ever been offered. In the First Division all women in labour in whom the first stage was so tedious that it lasted 24 or 48 hours or longer sickened almost without exception, either during the process of parturition or within the first 24 or 36 hours after labour, and died of puerperal fever running a rapid course. Such lingering labour in the Second Division was devoid of danger, and no bad consequences were observed to follow. As such a tedious course of the stage of dilatation as a rule occurs only in primiparae, it was chiefly among primiparae that the deaths occurred. “ I often and often called the attention of my students to my conviction that some blooming young woman in exuberant good health with a tedious first stage of labour would, either actually during labour or immediately after the birth, become ill and die of puerperal fever marked by a rapid course. My prognosis was almost invariably correct; I did not then understand why it should be so, but I observed the sequence of events often enough; and the fact was all the more inexplicable that no such thing occurred in the Second Division.” This was true of the tedious first period, not of the expulsion stage, so there could be no question of traumatic causes. But not only the mothers with prolonged first stage
