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

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

the intransigent Charles D. Meigs to go on record as refusing to use chloroform because of its obvious toxicity, although he occasionally used ether in difficult cases [25], In the emotional climate of that period, Meigs's accurate prediction of the eventual abandonment of chloroform and his emphasis on the dangers of unnecessary operation and the values of minimal anaesthesia and natural childbirth were regarded as an indication that he was out of date [25a]. More interesting to our case study in bias was the inclusion of Meigs's stand about responsible use of anaesthesia and caution in surgery as further proof of general incompetence [14], Chloroform and surgery were in style and woe to the unstylish! The severe, though indirect influences of anaesthesia and surgery on puerperal infections were ignored for other reasons. The "theory" of contagion was more of an emotional conviction than a scientific proposition. The word "contagion" was defined differently by different participants in the controversy. The general concept of the English school of obstetrics pictured the contagion as a kind of intangible presence with mysterious and almost magical powers of transmissibility, especially by physicians. The non-scientific nature of this view was emphasized by Semmelweis. He discarded as superfluous several of the English hygienic recommendations, notably those about complete changes of clothing and prolonged periods of quarantine for physicians who experienced puerperal fever in their practices [30d], Semmelweis understood more clearly than anyone of his time or for decades thereafter that control of puerperal infection demanded meticulous attention to all possible sources of "decomposed animal organic matter". Yet the subject of contagion and the physician's role and responsibilities in its control were so inherently emotionally charged, that Semmelweis also fell into angry disputes, and his early death may have been hastened in part by emotional illness. II The intensity of the bias against anticontagionist obstetricians had a long and broad historical foundation. Fear of contagion had often dominated behavior. It was characteristic, according to Ackerknecht, for contagionists, whether they were physicians or laymen, to insist that someone must be criminally responsible for outbreaks of any disease thought to be caused by contagion. Jews, lepers, gravediggers, and alleged witches were attacked or persecuted in medieval times. Some were accused of spreading contagion by the evil eye. In the cholera epidemic of 1832, physicians were attacked in France and England, and several German doctors were murdered in St. Petersburg, Russia [1]. In historical perspective, then, puerperal fever was a latecomer as a suspected contagious disease. However, the emotions aroused by the death of a woman after childbirth were probably more powerful than those in almost any other human tragedy. Therefore, once the suspicion of contagion began to intrude seriously on the puerperal fever scene, feelings of fear and guilt began to operate. Every obstetrician had to come to terms with these emotions. Sometimes the sense of guilt was overwhelming. Semmelweis described the suicide of one of his