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)

and partly witty way Semmelweis attacked his obstetrical enemies in addressing them personally, publicly calling them murderers. How great the difference: Here is Holmes, the beloved and adored teacher and poet belonging to the Boston Brahmins and teaching at a great University in the United Stated showing no anger over the attacks and there Semmelweis apparently overreacting in blind rage. When did the latter's mental sickness begin? Were the Open Letters an outflow of a sick genius? Semmelweis showed increasingly strange behavior and had to be committed to a mental institution on August 1,1865. He died only thirteen days later from a sepsis which originated from a small overlooked wound, inflicted probably during his last gynecologic operation. Thus, the man who had fought his whole life against septicemia died of this disease while an inmate in a mental institution. How can we today, one and a quarter century later, evaluate the conflicting ideas of the main protagonists in these dramatic happenings. There was no controversy between Holmes and the English Contagionists. Holmes studied their views and methods. He accepted them and propagated them adding several P.F. cases which he had gathered from American obstetricians. He did not add any new facts or ideas but used his talent of organizing and summarizing and his remarkable ability of expression in his speech and pamphlet (1843): "The contagiousness of Puerperal Fever." A dispute arose in 1903 between Dr. Simon Baruch [30] professor of obstetrics in New York and Dr. Tiberius von Györy [31], the editor of Semmelweis' collected works over the question: to whom belonged the laurel for the discovery of the cause of P.F., Holmes or Semmelweis? Baruch pointed to the date of Holmes speech and pamphlet published 5 years earlier than the announcement of Semmelweis' discovery: Györy repeated Semmelweis' argument specifically that Holmes and the contagionists had found a part of the truth but not the whole truth. Charles J. Cullingworth [32a] emphasized the earlier date of Holmes' work. As Holmes was not a discoverer the question shifts to another level: Are the differences between Semmelweis' views and the views of the English Contagionists really essential? Most historians of medicine, e.g. Sinclair [8] and Lesky [18] and this author do consider the differences essential, primarily because Semmelweis recognized the importance of infected circulating blood for the metastatic abscesses and exudates. But even here Semmelweis had a precursor as Willis [32] had described and differentiated puerperal septicemia in 1660 almost 200 years earlier. Thus one must not forget the many important observations which were done before the era of Semmelweis. They were described in detail by Holmes [2], G. H. F. Routh [34], Cullinworth [31b], Sinclair [8], I. Fischer [35] and others. There are even some minor points where we may agree more with the English Contagionists than with Semmelweis. He believed that any change of clothes of the obstetrician is unnecessary but today we expect anyone entering the labor (delivery) room of a maternity hospital to put on surgical gowns. We may also disagree with Semmelweis when he said that the relationship of P.F. to erysipelas is the same as to any other disease which produces decomposed matter. The point of controversy was elucidated 20 years later when the streptococcus was discovered. Semmelweis'