Sinclair, Sir William J.: Semmelweis. His Life and his Doctrine (Manchester, 1909)
III. Life in Vienna
ETIOLOGY BEFORE SEMMELWEIS 21 epidemicus might extend over many regions, or it might be restricted to a narrow area, even to an individual town. A miasma might be developed and remain isolated in a district or a separate building such as a hospital, and it was specially prone to develop if there was overcrowding of pregnant and puerperal women. This was the theory to which Cruveilhier lent the weight of his authority. Denman was among the first in England to express the opinion that puerperal fever was conveyed infection, but his views are by no means clearly expounded. Further, it was believed by many that with a certain intensity and extension of the malady a contagion was brought into existence. Here the ancient dogmatic conception of contagion was maintained. According to this theory a contagion represented a specific virus which could take its origin only in the diseased organism, and from that when conveyed by propinquity or actual contact with another individual could produce in that individual the same disease. In some minds the contagium assumed the form of a mysterious halo or areola which clung to the unfortunate practitioner who came under its malign influence. Coming nearer to the time when the doctrine of Semmelweis was announced, we find an almost general prevalence of the belief that the pregnant and puerperal woman was a thing unique in nature. This last theory of loaded blood and tissues generally, unstable equilibrium on the verge of fever, when even at its best especially vulnerable by the external factor, held the field for long, especially among the older unteachable obstetric mandarins in England; but it had to be completely abandoned in time, and it was the last barrier to the spread of the modern pathology of puerperal fever. Latterly then, with regard to the internal etiological factor, consideration was given at one time more to some modification in the composition of the blood produced by pregnancy, parturition and the puerperium, at another time more was heard about changes in the solid
