Sinclair, Sir William J.: Semmelweis. His Life and his Doctrine (Manchester, 1909)
III. Life in Vienna
ELIMINATION OF FACTORS 45 medical dignitaries, sometimes the mortality was attributed to one of the endemic causes, sometimes to another, and sometimes to several combined, and certain measures were adopted accordingly without bringing the mortality in the First Division down to that of the Second. Towards the end of 1846 a Commission reported that the prevalent puerperal illness was the result of injuries to the genital organs produced by the examinations made for purposes of instruction, although such examinations were also made by pupil-midwives in the course of their training. In order then to make intelligible the more frequent occurrence of puerperal illness in the First Clinic, blame was cast upon the students of medicine, especially the foreign students, for making examinations in a rougher manner than the midwives. The practical result of this report was that the number of students was reduced from 42 to 20. Foreigners were almost completely excluded, and the number of examinations was reduced to a minimum. The mortality then diminished to a marked extent in December, 1846, and during the first three months of 1847, but in spite of all precautions it rose in April, 1847, to over *8 per cent., and in May to over 12 per cent. From all which facts it became evident that the alleged cause was not the real cause of the mortality. Table XV. shows a frightful mortality in 1846. If the month of December is excluded we reckon 443 deaths among just over 3,000 patients, which amounts to an average mortality of i4'5 per cent, for the year. So the Reports of the Commissioners fatuously attributed the high mortality in the First Clinic “ to epidemic causes with unusual characters,” and they had no remedy to propose. It was the confusion of epidemic with endemic influences, owing to the incomprehensible contradictions observed, which delayed so long the discovery of the true causes of puerperal fever. “ I was convinced that the greater mortality in the First Clinic was due to some unknown endemic cause which
