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

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

from the annual reports of the Board of Superintendence of Dublin Hospitals, beginning in 1854 [3]. The differences in rates given by Browne and the Hospital Board are due chiefly to a lag of several months in the Board's reporting year, which began on the 1st of April instead of, presumably, the 1st of January. (The Rotunda records are not explicit on this point.) Denham inherited from McClintock a severe epidemic of puerperal fever that continued for several months [5d]. This explains the discrepancies in the two columns for those two Masters. Thereafter, the rates from the two sources agreed, except of course, where no data were available from published Rotunda records. This critical deficit for the Masterships of Atthil and Macan was filled by Board reports. Only fragments were available from the Rotunda records collected by Browne. Remember that Atthil was a strong contagionist as we study his maternal mortality experience, shown in the Table as 2.23 percent for the seven year period. Here is Browne's description of it: ". , . although we do not know what happened during his last four years, no Reports being published, the Board of Superintendence of the Dublin hospitals gave the maternal mortality rate for this time as 1.70 per cent" [6c]; Actually, the Board gave a good deal of additional information that Browne did not share with the readers of the Rotunda's history. You will recall that Browne was critical of Collins's diagnoses. He had written as follows: "In Collins" [16, 654] admissions there were at least 59 deaths from puerperal fever and 29 other deaths which we would nowadays regard as having been due to the same cause. Thus . .. puerperal fever was responsible for approximately 88 of the 164 maternal deaths ..." After describing Collins's sterilization procedures, Browne noted that from 1829 ". . . until the end of Collins's Mastership ( 1833) there was not a single death from what he regarded as puerperal fever" [5b, 5c]. Now let us return to Atthil and the Board reports. To understand these, you should know that there had been, since 1835, a gynecological ward, later enlarged and called in the Board reports an auxiliary hospital. Maternity patients had occasionally been transferred to this ward after delivery and had died there, but according to Board records, only a few such deaths occurred before Atthil's time. Under Atthil, 46 women who were transferred from the maternity wards to the auxiliary hospital died there within 30 days of delivery; 38 of these deaths were classified as puerperal fever, peritonitis, or some equivalent diagnosis. The Board Report for Atthil's first year stated: "With respect to the causes of death in the auxiliary hospital, and their relation or connection with labour wards, it is to be regretted that we have no data ; the head of the institution having informed us that no proper record exists . . . ; but we are happy to learn that in the future we shall be furnished with full particulars." Several y eras later the Board noted hat "... women who become very ill after confinement are, as soon as possible after the eight day, removed to the Auxiliary Hospital, where, if they die, their demise is not credited to the lying-in department" [3]. The Board records confirm that the 1.7% death rate quoted by Browne was calculated from maternal deaths occurring on the maternity wards. But, when one adds deaths of maternity patients in the auxiliary hospital in the same four