Sunday, June 14, 2020

Infectious Diseases and Charles Meigs, M.D.

My guest author this week is David Gurmai, a friend who is Weekend Coordinator and unofficial historian at Laurel Hill Cemetery in Philadelphia. Enjoy!
“Wash your hands!” is a common refrain of mothers everywhere, and one that’s become even more important with a global pandemic on our hands (pun intended). It has long been forgotten that hand washing is a relatively recent habit with contentious beginnings. Before it became widely accepted among the general population, it had to first be accepted by the medical community.

Dr. Charles D. Meigs (1792-1869) was an obstetrician caught in the middle of a paradigm shift in medicine. He went to medical school at a time when miasma theory—the idea that diseases are a product of one’s environment—was the accepted belief. Germ theory was in its infancy, though making demonstrably provable claims, particularly with Louis Pasteur advancing vaccination science and inventing pasteurization in the mid-1800s. Dr. Meigs thought germ theory was hogwash. He insisted on having treatment rooms cleaned thoroughly, removing any traces of miasma and effluvia, but hand washing was absurd to him. As a gentleman, a God-fearing and educated man of high standing, contagion couldn’t possibly be spread by his touch.

That’s the stance that Dr. Meigs obstinately took, despite otherwise excelling in his field. There was no regimen of thorough hand washing as he moved between patients. He didn’t merely ignore the idea, but was actively outspoken and hostile toward it. He would invoke reductio ad absurdum-style arguments against it: suggesting that believers of germ theory shouldn’t touch anyone lest they infect everyone, while pointing out that physicians can’t practice in such a manner. He wasn’t the only doctor opposed to hand washing, but he was among the most prominent. 

By the time of Dr. Meigs’ death, germ theory was prevailing over miasma theory. One has to wonder how many infections he passed among the mothers and newborns who were his patients. As the 19th century closed, germ theory was fully accepted by the medical establishment. Another few decades and society at large had caught on; by 1940 everyone was washing their hands before meals and performing surgery.

So, listen to your mother…and the CDC: Wash your hands.

Epilogue by Ed Snyder

Meigs’ professional embarrassment and widely publicized rebuke by the AMA (1850s) is well-documented in the book, Dr. Mutter’s Marvels (2014, Aptowicz). Dr. Thomas Mutter (of the famed Mutter Museum in Philadelphia), a surgeon and professor at Jefferson Medical College in Philadelphia, was one of medicine’s earliest proponents of aseptic technique. Although he could not prove that infections were transmitted by pathogens and non-sterile technique, he did realize early on in his surgical career that if he washed his hands and instruments before conducting a surgical procedure, there were fewer infectious complications. He and Meigs taught at Jefferson at the same time and were at odds in their opinions and teachings.

David’s statement above, “One has to wonder how many infections he passed among the mothers and newborns who were his patients,” is frighteningly addressed in Apotowicz’ book. She states that “Meigs was unable or unwilling to understand the concept that diseases could even be contagious,” and that as an obstetrician he transmitted infectious and sometimes deadly diseases to hundreds of patients. Oliver Wendell Holmes, Sr., MD, a renowned Harvard anatomy professor in 1855, published a scathing article on infectious disease, calling out Meigs by name as “the pestilence-carrier of the lying-in chamber,” who “must look to God for pardon, for man will never forgive him.”

Meigs inadvertently killed many of his obstetrical patients as a result of his stubbornness and grandstanding. He simply refused to believe what we all now know, that the best way to prevent the transmission of infectious disease is good hand hygiene. As David says above, wash your hands, wash your hands, wash your hands!

I thank David Gurmai for directions to Meigs’ grave in Laurel Hill Cemetery. I had just finished reading “Dr. Mutter’s Marvels” and was fascinated that the science being discovered during the time of Mutter and Meigs (1840s – 1860s) has such a direct relation to the pandemic we are now experiencing. I went to Meigs’ grave and taunted him with germicidal wipes, gloves, and a mask – items he would have scoffed at, yet items we realize are instrumental in saving lives.