Antall József szerk.: Orvostörténeti közlemények 97-99. (Budapest, 1982)
TANULMÁNYOK - Codell Carter, K: Semmelweis esetleges hatása Kari Mayrhoferra és a tizenkilencedik századi etiológiai elméletek kidolgozóira (angol nyelven)
lar harmful material influence." 20 While admitting that this influence could be conveyed by the air, he observed that infection was usually conveyed by the examining finger. 21 Basing his work in part of Pasteur's work on fermentation, and drawing on the widespread opinion that fermentation and decomposition were closely related processes, he hypothesized that puerperal fever was parasitic decomposition of the animal tissues, and that it was always initiated by a local lesion. 22 In these points, again, Mayrhofer agreed with Semmelweis, but differed from widespread common opinions about the disease. Most significantly, given our interests in this paper, Mayrhofer also asserted that the parasites he identified — vibrions —were a universal necessary (but not sufficient) cause of childbed fever, and he used this etiology as a basis for classifying the specific cases he encountered. 23 Etiological classifications, of course, presuppose etiological characterizations. In all the literature on puerperal fever that appeared in the decade immediately following publication of Semmelweis's Aetiology, Mayrhofer was the only person to identify a necessary cause for the disease and to presuppose an etiological characterization. Mayrhofer, like Semmelweis, was challenged precisely because of this etiological approach. 24 It is just possible that, in spite of all this, Mayrhofer began his work without knowing of Semmelweis or, perhaps, that he knew of Semmelweis but saw no essential connection between Semmelweis's work and his own. By the time he published his third essay, however, he must have been aware of the connection because by that time, other writers had responded to Mayrhofer's first two essays, and in those responses Mayrhofer was explicitly associated with Semmelweis. In a lecture delivered on 5 February 1864 in the k. k. Gesellschaft der Aerzte in Wien and subsequently reprinted in the Medizinische Jahrbücher of the same society, Josef Späth admitted that Semmelweis had been entirely 20 Ibid., p. 112. Carl Braun's discussion of the etiology of childbed fever, published just a few years earlier, included such factors as emotional disturbances, dietary imbalances, epidemic influences, and other miscellaneous factors identified under the heading "individuality of the patient." Carl Braun, Lehrbuch der Geburtshülfe, Wien, Braumüller, 1857, p. 914. Most of the publications on puerperal fever between 1860 and 1 865 still identified atmospheric influences as the most important cause of epidemic childbed fever. 21 Mayrhofer, "Zur Frage nach der Aetiologie," op. cit., note 12 above, p. 125. 22 Ibid., pp. 116f. 23 Ibid., pp. 117, 122, 134. 24 So far as I can determine, the only person who wrote against Mayrhofer was a Berlin physician named Haussmann. Haussmann's argument was based on the claim that he had identified vibrions and other microorganisms in the secretions of healthy women. "Die Aetiologie des Wochenbettfiebers," Centralblatt für die medizinische Wissenschaft, 1868, 6 : 418-420. However, this objection was fallacious; it rested on the assumption that the vibrions were intended as a sufficient rather than as a necessary cause. Mayrhofer himself consistently noted that the vibrions were sometimes present in the secretions of healthy women. Mayrhofer, "Ueber das Vorkommen von Vibrionen," op. cit., note 12 above, p. 18; "Untersuchungen über Aetiologie," ibid., pp. 33, 35, etc.; "Zur Frage nach der Aetiologie," ibid., p. 122. Similar misguided objections were directed against Semmelweis. For example, Joseph Hermann Schmidt, Professor of Obstetrics in Berlin, asked why so relatively few women die of childbed fever given that most of them are examined by students with contaminated hands. (Semmelweis, op. cit., note 18 above, p. 463). Even half a century later, Freud was forced to defend his purported etiology of hysteria from the irrelevant objection that persons subject to the causal factor did not always contract the disease. Sigmund Freud, The Standard Edition of the Complete Psychological Works of Sigmund Freud, London, Hogarth Press, 1962, vol. 3, p. 209.1 believe that these irrelevant objections are an important clue to a fundamental change in the social role of the physician, and that it is impossible to appreciate the profound social significance of Semmelweis's work without a complete understanding of what is involved in these objections. But this is obviously not the place for a discussion of these matters; I hope to explore these issues more fully in future publications.
