Contemporary Reaction To Ignaz Semmelweis - Absorption of Cadaveric Material

Absorption of Cadaveric Material

Semmelweis's key claim was that physicians contaminated their hands with "cadaveric particles" in the morgue while conducting autopsies. He pointed out that ordinary washings with soap did not remove these particles, because the hands could retain a stench for several days in spite of such washings. When physicians later carried out gynaecological examinations, the cadaveric particles were absorbed by the patient, in particular if they came into contact with the freshly exposed uterus, or with genital tract lesions caused by the birth process. Semmelweis was convinced that every case of childbed fever was caused by resorption of cadaveric particles. With this etiology, Semmelweis identified childbed fever as purely an iatrogenic disease— that is, one caused by doctors. (Friedrich Wilhelm Scanzoni von Lichtenfels took personal offense at this, and never forgave Semmelweis for it - Scanzoni remained one of the most ardent critics of Semmelweis.)

A few childbed fever case stories, described below, did not fit well into Semmelweis's theory and led him to expand it, also to comprise other types of decaying organic matter, for instance secretions from an infected knee or from a cancer tumor.

In a case of discharging cancer of the innermost part of the uterus, Semmelweis wrote:

In October 1847, a patient was admitted with discharging medullary carcinoma of the uterus. She was assigned the bed at which the rounds were always initiated. After examining this patient, those conducting the examination washed their hands with soap only. The consequence was that of twelve patients then delivering, eleven died. The ichor from the discharging medullary carcinoma was not destroyed by soap and water. … Thus, childbed fever is caused not only by cadaverous particles adhering to hands but also by ichor from living organisms.

And in a case of a discharging carious knee, he wrote:

A new tragic experience persuaded me that air could also carry decaying organic matter. In November of the same year, an individual was admitted with a discharging carious left knee. the ichorous exhalations of the carious knee completely saturated the air of her ward. In this way the other patients were exposed and nearly all the patients in that room died. The ichorous particles that saturated the air of the maternity ward penetrated the uteruses already lacerated in the birth process. The particles were resorbed, and childbed fever resulted.

Even with the most meticulous chlorine-washings there seemed to be an unavoidable mortality rate of about 1 percent. He therefore suggested that self-infection took place - that internally generated cadaveric particles were responsible, for instance tissue crushed in the birth process and eventually turning gangrenous.

Most of the objections from Semmelweis's critics stemmed from his claim, that every case of childbed fever was caused by resorption of cadaveric particles. Some of Semmelweis's first critics even responded that he had said nothing new - it had long been known that cadaveric contamination could cause childbed fever. But this was only one of many possible causes for childbed fever. The findings from autopsies of deceased women also showed a confusing multitude of various symptoms, which emphasised the belief that puerperal fever was not one disease, but rather many different diseases, which remained unidentified. Semmelweis's critics were also quick to point out that he had virtually no evidence for his self-infection theory.