Contemporary Reaction To Ignaz Semmelweis - Rejected As Unscientific

Rejected As Unscientific

The quotes below are so selected to demonstrate the speculative theoretical nature of the objections to Semmelweis's theory. The quotes are from a publication by Carl Edvard Marius Levy, a Danish obstetrician, who attacked Semmelweis's findings on such grounds. The first quote shows the improbable, shabbily researched and poorly argued nature of Semmelweis's claim, that there is only one universal cause for the disease.

...Above all it is to be regretted that neither the observations nor the opinions grounded on them are presented with the clarity and precision that would be desirable in such an important matter of etiology. To presume that corpses can and do infect, without considering whether the infection is derived from puerperae or from other corpses, is as much a consequence of unrecognized a priori assumptions as of the cited facts. A strict examination would absolutely require that different sources of infection be taken into account and provide the basis for a classification of the observations. From a scientific point of view, particularly regarding the question of the contagiousness of puerperal fever, it is important to know whether the presumed cadaveric infection is to be ascribed only to puerperal cadaverous matter or rather to all cadaverous effluvium in general. ..... It would be enlightening, insofar as the discussion concerns only puerperal corpses, to consider whether the contagium is present in the superficial parts, since we are concerned with the products of a disease assumed to be transferable to nearby predisposed persons. On the other hand, if the infective matter can originate from all corpses, one must give up every notion of a specific contagium and look instead for an infection of the blood mass.

... if Dr. Semmelweis had limited his opinion regarding infections from corpses to puerperal corpses, I would have been less disposed to denial than I am. ...... the specific contagium seems to be of little importance to Dr. Semmelweis. Indeed it is so little considered that he does not even discuss the direct transmission of the disease from those who are ill to healthy persons lying nearby. He is concerned only with general infection from corpses without respect to the disease that led to death. In this respect his opinion seems improbable.

Doctors and students did wash hands with soap and water and the hands were visibly clean before examinations. How could contaminants in such infinitesimal amounts possibly cause such damage?

...a rapidly fatal putrid infection, even if the putrid matter is introduced directly into the blood, requires more than homeopathic doses of the poison. And, with due respect for the cleanliness of the Viennese students, it seems improbable that enough infective matter or vapor could be secluded around the fingernails to kill a patient.

Why were simpler and more reliable experiments not considered?

To prove his opinion, Dr. Semmelweis ordered chlorine washings to destroy every trace of cadaverous residue on the fingers. Would not the experiment have been simpler and more reliable if it had been arranged, at least during the experiment, that all anatomical work would be avoided?

Levy questions the causality of Semmelweis's findings:

In spite of these reservations, one must admit that the results of the experiment appear to support Dr. Semmelweis's opinion, but certainly one must admit no more. Everyone who has had the opportunity to observe the periodic variations in the mortality rate of maternity clinics will agree that his findings lack certain important confirmation. ...... In the absence of more precise statistical information, it is conceivable that the results of the last seven months depend partially on periodic accidental factors …

Semmelweis's critics were also quick to point out that he had virtually no evidence for his self-infection theory. In particular, it seemed unlikely that the two women could have infected other patients without becoming infected themselves:

... the first case is clearly inconsistent with the possibility of infection, while the second case remains strikingly unclear. Could ichor from this patient have been more damaging when conveyed in vaginal examinations to other patients than it would have been as a result of similar examinations carried out on this patient herself? In our hospital we have frequently recorded ichorous sores on the feet of delivering patients without having noticed any subsequent infections, either of those patients themselves or of other patients. Dr. Semmelweis places great emphasis on the better health of institutions exclusively for the education of midwives; he should consider that ichorous secretions occur equally in both institutions. Moreover, in an institution as large as the midwife clinic in Vienna, one or another of the patients must always be ill and so provide a source of infection. If the infection occurs as easily as he believes, this would reduce the inequality in mortality rates between the clinics.

In conclusion Professor Levy writes:

These are my impressions of Dr. Semmelweis's experiences; for these reasons I must judge provisionally that his opinions are not clear enough and his findings not exact enough to qualify as scientifically founded.