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

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

were vastly more impressive : Their excathedra statements had all the authenticity of gospel" [14]. Perhaps so, but the alleged reactionary influence must have been an astounding phenomenon of the occult if it was the principal factor operating at the Boston Lying-in Hospital in the 1879-1882 period. Presumably the chief of staff at that time had no conscious awareness of the postulated malign influences of long dead anticontagionists from rival Philadelphia. His written reports reflected both understanding and acceptance of the germ theory of disease. The annual report for 1879 had given in detail the extraordinary precautions taken by the staff to prevent transmission of the disease in connection with a prior, less serious epidemic. One concludes that contagion was foremost in the minds of all concerned throughout the entire epidemic period, and that they use what they believed to be the most effective antiseptic and isolation measures [4]. Another stumbling block for Irving's reactionary influence hypothesis was the rejection of anticontagionism and in particular of Meigs's views about transmission of puerperal fever by his own colleagues, in Philadelphia and elsewhere, beginning in the 1850s and continuing for the remainder of Meigs's life [25a], [28]. The leading practitioners of obstetrics had begun to take contagion seriously in the 1830s in England. By 1850 there were few in Britain and Ireland who challenged the importance of contagion in puerperal fever. By 1860, C. D. Meigs, then sixtyeight years old and about to retire from practice, was the only obstetrician in the English-speaking world foolhardy enough to flatly deny its communicability. It was not just the American historians who wrote of anticontagionists as if they had been morally culpable as well as wrong in their scientific views. The most recent history of the Dublin Lying-in Hospital, the famous Rotunda, offers insight into the phenomenon of scapegoating. Carefully written and well documented by Dr. O'Donel Browne, it shows, nevertheless a consistent bias against anticontagionists. At the same time it provides some of the evidence needed to judge whether or not the bias was justified [5]. Dublin's Rotunda has enjoyed a reputation of excellence for over two hundred years. High standards of care, including hygienic practices, were established by the end of the eighteenth century. The maternal mortality rates are known for every year since its founding by Bartholomew Mosse in 1745. With rare exceptions, those rates were lower than similar ones in contemporary maternity hospitals. No other lying-in hospital has published a comparable continuous record. Total maternal mortality rates will be used as indicators of puerperal fever death rates. These total death rates rose and fell with puerperal fever mortality and were not influenced^by changing nomenclature or diagnostic customs. Total rates were, of course, no more accurate than the information that went into them, and pos-partum deaths were not always credited properly to a hospital's lying-in department. Nevertheless, published maternal mortality rates were the best available indicators of death rates from sepsis prior to the twentieth century.