Antall József szerk.: Orvostörténeti közlemények 62-63. (Budapest, 1971)

TANULMÁNYOK - Meigs, J. Wister: Kontagionisták, antikontagionisták és a gyermekágyi láz (angol nyelven)

colleagues, Professor Michaelis, who jumped into the path of an express train because he believed he had carried the agent to a young woman who had died of childbed fever [30a]. The more common response to such fears, for the earlier obstetricians who did not have to contend with overwhelming evidence, was denial. In scientific discussion this took the form of skepticism, but C. D. Meigs's statements make it clear that the skeptics rejected the basic concept for psychological reasons rather than from rational skepticism. They wanted no part of contagionism because it made their practice emotionally intolerable [24]. There was, I believe, a natural sequel to denial in the form of meticulous hygiene. I doubt that chance alone would have given us the skeptics Collins and Tait as the outstanding examples of cleanliness coupled with successful control of infection. Although we do not have data to compare Meigs's results with those of his colleagues, we do have reports that he taught the value of clean hands, clothes, and equipment, and that he was noteworthy in practising what he preached [7, 23], Furthermore, I have never run across the allegation by contagionists that physicians who were on record as skeptics about contagion had been careless in their hygienic practices. Yet that would have been a logical charge for the detractors to have made. As the evidence accumulated for the communicability of puerperal fever, denial became less and less practical. The weight of opinion shifted and contagionism became the accepted doctrine. This change, which had begun in England in the 1830s was nearly complete in that country within a decade. One feature of the shift was the trend for acceptance of the contagious theory by younger physicians and by those with limited or no responsibility for care of puerperal women. They seem to have been the originators, in written form, of suggestions that physicians who experienced puerperal fever in their practices should be held negligent. A logical corollary was that anticontagionism was a criminal belief. The final step was, perhaps, inevitable. Someone had to bear medicine's collective fear and guilt. The anticontagionists were the appropriate beasts of burden. Alfred McClintock of Dublin gives us an example of the young, eager obstetrician who at twenty-six published his conviction in an 1848 text that the ,,contagiousness, or . . . communicability, of puerperal fever in all its forms" was so firmly established that it would be "almost criminal for any practitioner to act on the opposite assumption" [17]. A few years later, as Master of the Rotunda, he experienced the worst seven year record of anyone up to that time. Only his skeptical successor Denham had a higher maternal mortality rate. McClintock re-evaluated his views about contagion in 1809, twenty-one years after publishing his first textbook. He concluded that practitioners had often been blamed unfairly for carrying the disease, said he did not think he had ever given it to a patient, describing himself, after twenty-five years of practice, as "but a limited contagionist" [27a]. Keep in mind this picture of emotional conflict surrounding everything to do with puerperal fever. For as long as the disease continued, it was a kind of