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

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

firm, practical foundation under the hygienic practices in obstetrics. The most striking feature of the table is the sustained elevation in maternal mortality over the 28 years from 1854 to 1882. Noteworthy also is the low mortality during Robert Collins's Mastership from 1826 to 1833. There was a reason. In Collins's first three years there was a good deal of puerperal fever and total maternal mortality was about 1.5%. This was comparable to the experience of Collins's predecessors going back to the founder, but Collins hit upon a new idea for preventing the disease. Although careful hygiene had been a tradition since the Mastership of Joseph Clarke from 1786 to 1793, Collins improved on it by periodic chlorine sterilization of each ward in succession. He not only sterilized rooms and furnishings with chlorine gas by sealing the wards and all their openings for forty-eight hours every two weeks ; he also enforced regular changes of straw bedding, scouring of blankets and linen, and immediate isolation of patients showing signs of fever [6], He did not, however, insist on anything beyond established rules of personal cleanliness for physicians and nurses. The lowered maternal mortality rate over Collins's last four years as Master can be reasonably attributed, in large part, to his meticulous program of hygiene. The rate of 0.54%, with no deaths attributed to puerperal fever, was the lowest maternal death rate for any continuous four-year period from 1745 to 1900.* Yet Collins was not a contagionist.** He has been classified with the anticontagionist [18], but he gave no opinion beyond admitting ignorance of how puerperal fever was caused or transmitted. Despite his outstanding record he came under criticism from Browne, The reason? With one hundred years of hindsight Browne suggested that Collins had attributed some puerperal fever deaths to other causes [5c]. The suggestion seems to have been incompletely documented and irrelevant. Collins admitted to numerous puerperal fever deaths before chlorine sterilization and none afterward but he provided diagnoses only for deaths combined for the seven years. For each individual year he listed only total number of deaths without diagnoses. Therefore Browne's implication that Collins had covered up some puerperal fever deaths after 1829 was not supported by evidence. Furthermore, the relevant fact was that with chlorine sterilization from 1829 to 1833, the total mortality dropped to one third of its previous level. Other examples of Browne's bias against anticontagionists or skeptics, might be cited, but equally important is the counterpart to this, a tendency to overlook or excuse the high puerperal fever death rates that occurred under contagionist Masters of the Rotunda. The case of Lombe Atthil, Master from 1875 to 1882 will show this. To understand Atthil's experience one needs the reason for listing two columns of figures for maternal mortality in Table 1. The second column was assembled * Between 1745 and 1900 the lowest fatality rate in puerperal fever (0,39%) was achieved by Semmelweis. (The Editor.) ** In the case of Collins we are inclined to put more emphasis on the fact that he fought against sepsis on a contagionist platform (which has been shown above), and whether he had been considered a contagionist is of secondary importance. (The Editor.)