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

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

hangman's noose around the neck of every practising obstetrician. And remember that the noose was there until a very few years ago when antibiotics removed it. At this point Semmelweis and Holmes should enter the story in more detail. As a clinical epidemiologist in the study and control of childbed fever, Semmelweis was in a class by himself. He moved logically from one observation to another and managed to dispose of most of the mistaken beliefs of his contemporaries by systematic observation and experiment. He insisted that the active agent was found in finite particles of "decomposed animal organic matter", and that control required destruction of these particles. He soon recognized a variety of sources, including purulent material from any inflammatory process. Thus he could reject the idea of a unique contagion. Along with this he threw out unidentified epidemic causes or vague cosmic or climatic factors. Instead he demanded adherence to a more and more meticulous program of antisepsis and sterilization of the entire environment and instruments, as well as the strictest chlorine washings of the hands of all attendants [30]. It was Semmelweis's enormous experience with puerperal fever that led him to reject the English theories of contagion and to devote an entire essay to that rejection two years after publishing his great work in 1858 [9], When he rejected the English theories, he was also, it would seem, disagreeing with a good deal of what Oliver Wendell Holmes hand recommended as necessary rules for preventing the disease.* Thus we come to a consideration of Holmes and his contributions. A century and a quarter ago, on the 13th of February 1843, Oliver Wendell Holmes addressed his colleagues at the Boston Society for Medical Improvement. His subject was "The Contagiousness of Puerperal Fever", and in the opening paragraphs he said: "The disease known as Puerperal Fever is so far contagious as to be frequently carried from patient to patient by physicians and nurses." He stated that the disease was preventable and concluded that any series of cases occurring in the practice of any physician should be regarded as a crime to be suitably dealt with by society [10]. Each of these insights and conclusions has been confirmed by later events. The published essay has been regarded as outstanding by readers far and wide. It carries the same kind of conviction today that it did in 1843. Yet there are puzzling facets to the essay. Some are indicated by the following table of chronology. Some Chronology for Holmes's Essay 1795- Alexander Gordon proposed that doctors and midwives could be carriers of puerperal fever. 1832- Robert Lee wrote a monograph favoring contagion. * It would be interesting to examine more thoroughly in what and why was there a difference between Semmelweis and the English physicians. Semmelweis himself gave ample evidence of that in „A gyermekágyi láz fölötti véleménykülönbség köztem és az angol orvosok közt" (The Difference of Opinion between Myself and the English Physicians), Orvosi Hetilap (Medical Weekly) 1860, 44, 849-851 pp., 45, 873-876 pp., 46, 889-893 pp., 47, 913-915 pp. (The Editor.)