Sinclair, Sir William J.: Semmelweis. His Life and his Doctrine (Manchester, 1909)
III. Life in Vienna
24 ETIOLOGY BEFORE SEMMELWEIS locus minoris resistentiae, for the noxa or injurious agent absorbed by the lungs and circulating in the blood. But the opinion that the placental site must be considered a wound surface was prevalent in England at least a quarter of a century before Cruveilhier. Generally speaking, as yet the conception of the identity of childbed fever with pyaemia was still far from the minds of the obstetricians at the time when Semmelweis began to try to solve the problem of the appalling mortality in the Vienna Lying-in Hospital. Puerperal fever was considered to be as a disease something peculiar to pregnancy and the puerperal state. The great difference between Continental and British opinion was that in Continental Europe more consideration was given to the genius epidemicus before which men could only helplessly bow their heads; how could they fight an “atmospheric cosmic telluric influence?” In Great Britain and Ireland the mysterious contagium received most attention; it was believed that the contagion could be destroyed, and that belief produced a most anxious and remarkably effective prophylaxis. In the United States of America there was no theory of the etiology of puerperal fever of native growth; the chief teachers of midwifery refused to believe in either epidemic influence or contagion, and the medical practitioners, including O. W. Holmes, who did accept the contagion theory, borrowed their working hypothesis almost entirely from the writings of English obstetricians. Such then were some of the opinions with regard to the causes of puerperal fever which Semmelweis would have to learn in preparation for that examination for the degree of Master of Midwifery which he passed in 1844. From July, 1844, as Aspirant, he had the opportunity of examining patients under the direction of Breit, the assistant in the First-Clinic, and he heard the theoretic opinions and sought for the expected phenomena in the individual case. But his efforts to reconcile the clinical phenomena with the etiological factors entirely failed,
