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)

To fully understand and evaluate this aspect of Semmelweis's work, a great deal more historical and conceptual analysis remains to be done. First, it would be useful to determine whether anyone adopted etiological characterizations of specific diseases prior to Semmelweis and, if so, whether Semmelweis was aware of their work. Second, it would be useful to ascertain exactly when Semmelweis adopted this new strategy. So far as I can determine, the first time Semmelweis or his associates claimed that he had found a universal necessary cause for puerperal fever was in his lecture of 15 May 1850.

4 Virtually everyone who responded to that lecture opposed Semmelweis's claim to have found such a cause. No one, not even Skoda or Rokitansky, ever spoke a single word in defense of this strategy, and none of his friends in Vienna seems ever to have adopted or even understood the significance of that aspect of his work.

5 If the May lecture was the first time Semmelweis advanced the claim about a universal necessary cause, it would be easy to understand why Skoda, who had supported Semmelweis until that time, remained silent during the discussion of the lecture.

0 It would also be easy to understand why Semmelweis felt obliged to leave Vienna a few months later, and why, after that time, neither Skoda nor Rokitansky ever mentioned Semmelweis, even in technical works dealing with puerperal fever.

7 It is possible, therefore, that the May 1850 lecture was the decisive turning point in Semmelweis's career. Nevertheless, even Semmelweis's most 4 None of the earlier published reports

—including those by Ferdinand Hebra, Friedrich Wieger, C. H. G. Routh, or Josef Skoda

—suggest that Semmelweis claimed to have found a universal necessary cause. Semmelweis and his associates also wrote personal letters to various obstetricians announcing his findings. One of these letters, written by Heinrich Hermann Schwartz, was ultimately published in a Danish medical periodical; this letter does not suggest that Semmelweis claimed to have indentified a universal necessary cause. Most of those who responded favorably to Semmelweis's early announcements, for example, Christian Bernard Tilanus, continued to believe that many cases of the disease were epidemic in origin. Those who responded critically to the initial announcements, for example, James Young Simpson, Franz Kiwisch von Rotterau, Wilhelm Friedrich Scanzoni, and Bernhard Seyfert, all said only that Semmelweis's opinions were unoriginal. A detailed discussion of the reaction to the initial announcements, together with complete references, can be found in the Introduction to the abridged translation of Semmelweis's Aetiology of Childbed Fever forthcoming from the University of Wisconsin Press. 6 For example, in the years immediately following Semmelweis's work, Skoda wrote official documents on Semmelweis's behalf. In these documents he is consistently ambiguous; he regularly speaks of the causes (plural) of childbed fever and he never once describes Semmelweis's work as a quest for one necessary cause of the disease. By contrast, in the same period, Johann Klein, who rejected Semmelweis's conclusions, consistently wrote that Semmelweis was seeking the cause (singular) of the disease. See Erna Lesky, Ignaz Philipp Semmelweis und die Wiener medizinische Schule, Wien, Hermann Böhlaus, 1964, pp. 21, 26f, 29, 43, 46. Even in lectures on puerperal diseases given much later, Skoda did not assert that all cases of puerperal fever could be ascribed to a single necessary cause. Josef Skoda, "Ueber Krankheiten bei Puerpern," Allgemeine Wiener medicinische Zeitung, 1858, 3 : 20 : 1 and 21 : 1. I have also discussed this matter in greater detail and given additional references in the Introduction to the Semmelweis abridgement mentioned in the preceding note. 6 The standard explanation, advanced by Schürer von Waldheim and adopted by Gortvay and Zoltán, is that Semmelweis's "great supporters," including Skoda, kept silent "perhaps.

. .in proof of their recognition and to promote the victory of the great discovery." György Gortvay and Imre Zoltán, Semmelweis: His Life and Work, Budapest, Akadémiai Kiadó, 1968, p. 69. A strange way to promote victory. Skoda never, before of after, endorsed or even acknowledged the claims that Semmelweis advanced in the May lecture. Thus, it seems more likely that Skoda was unable to support Semmelweis but, perhaps from personal loyalty, was not willing to oppose him; therefore he remained silent. 7 Ibid., p. 72; and Georg Sillo-Seidl, "Unveröffentlichte und Neuentdeckte Semmelweis-Dokumente," Comm. Hist. Artis Med., 1978, 26: 187-210, p. 209.