Antall József szerk.: Orvostörténeti közlemények 81. (Budapest, 1977)

TANULMÁNYOK - Ehrentheil, O. F.: Oliver Wendell Holmes és Semmelweis Jgnác egy és negyed századról visszatekintve (angol nyelven)

these three famous men became very important in the tormenting years of Semmelweis' struggles. When he became assistant to Prof. Johann Klein of the First Obstetrical Clinic in the General Hospital in Vienna he soon observed a distressing difference between the high morbidity and mortality of P.F. in his working place where medical students were practicing and the much lower incidence of this disease in the Second Obstetrical Clinic where midwives were instructed. He was a very studious and scientifically curious man who visited the dissecting room of the Pathologic Institute of the hospital every morning before going to work in the labor room of the obstetrical clinic. With Rokitansky's permission he came early to the autopsy room and performed vaginal examinations on the female corpses before they were cut open and compared the results of these examinations with the post mortem findings. This activity helped him greatly in his study of gynecology. Semmelweis wished ardently to find out the cause of P.F. (Puerperal Fever). He realized that the usual explanation of atmospheric-cosmic-telluric influences could not explain the differences between the two neighboring obstetrical clinics as these influences were obviously the same on both places. Semmelweis had learned that in England were significantly fewer cases of P.F. He therefore applied for a fellowship to study in England, however permission was not granted by the higher Austrian authorities. When Semmelweis returned from a short vacation he learned that one of his friends, Dr. Jacob Kolletschka, had died after receiving a small wound on his finger during autopsy. Semmelweis read the post mortem protocol and suddenly realized that the description of the pathologic findings (the suppurative metastases and the inflammation) were very similar if not identical to the post mortem findings in P.F. Semmelweis could now see it clearly: P.F. was an infection, originating in decaying animal-organic substances, which could not penetrate the intact skin but which could cause havoc when brought into a wound. The inner organs of parturient women have wounds. The hands of the students and alas his own hands have brought particles of the cadaverous poison to healthy women in labor. The cases of Kolletschka and of the Boston obstetrician both dying after receiving small wounds incurred during autopsies convinced Semmelweis and Holmes respectively of the transmissibility of P.F. Thus, this was his first discovery: The cause of the greater prevalence of P.F. on the First Obstetrical Clinic compared to the Second Clinic where midwives were taught was the transmission of the cadaver poison by the hands of physicians and students from the dissecting room or from a woman sick with P.F. to the genitals of healthy parturient women. Furthermore, he proclaimed the disease to be the same as the so called "surgical fever" and that occuring among pathologists after receiving wounds on their hands (Kolletschka). With the knowledge and approval of his superior (Prof. J. Klein) Semmelweis ordered thorough washing of the hands not only with soap and water (because he had noticed that even after thorough washing with soap and water the hands retained a cadaverous odor) but with a chloride of lime solution augmented by the use of a nailbrush upon entering the labor room. The morbidity and mortality dropped soon. Two more small epidemics of P.F. occurred on Semmelweis' obstetrical ward in quick sequence despite these precautions: one, when a woman with a large decaying uterine cancer delivered a baby (Oct. 1847) and the other when a woman in labor