Antall József szerk.: Orvostörténeti közlemények 55-56. (Budapest, 1970)

TANULMÁNYOK - Benedek, István: The Illness and Death of Semmelweis (angol nyelvű közlemény)

pachymeningiosis, emollitio cerebri, etc. — this is something which has not been decided so far and is not likely to be decided for sure even in the future. The presumption of paralysis is supported by the following considerations: 1. the symptoms perfectly fit the diagnosis of paralysis, much better than that of any other disease; 2. paralysis was a much more frequent illness than all the others taken together. The argument against paralysis is the following: 1, there existed neither derangement of memory nor restriction of intellect ; 2. there was no sign of syphilis either in the annamnesis or in the reports of the post mortem and exhumation examinations respectively, neither any specific sign suggesting paralysis in the contemporary histological examination. My standpoint on the questions raised is the following. In the years around 1847 Semmelweis constantly performed autopsies and carried out gynaecological examinations — without rubber gloves — at the Public Hospital of Vienna. Then syphilis was an enormously widespread disease, especially in that section of the society which gave the patients of the lying-in department. Day by day through many years Semmelweis was in contact with living and dead syphilitic bodies, he was constantly exposed to the danger of infection. One scratch, bruise, or wound on the skin was enough to receive the primary affection. In my opinion he did contract it. He may have recognized the disease and treated it, or may not, in either case the primary affection faded away. We know hardly anything of the private life of Semmelweis, therefore we are not in the position to negate his having had syphilis: he never spoke about that. It is even possible that the secondary symptoms, too, developed, and ceased after treatment (that might explain why he married only at relatively old age), but more probably the secondary and tertiary symptoms did not appear at all, only the metalues after about 17 years of incubation. The outbreak of the disease was typical but it had no time to develop fully, as some months later Semmelweis died in sepsis. That explains why neither derangement of memory, nor mental decline did not set in : he did not live long enough for the paralysis to develop fully. Had he not died in sepsis, then after one year he would not have remembered puerperal fever, and after two not even his own name, in the third year he would have died among symptoms of a stroke, mentally completely blunted — as it was customary in an age when paralitics made up one third of the patients of the mental departments. The case-history of Semmelweis at the mental department where he was treated is completely lost. (This is not the only mysterious thing in connection with his illness.) Therefore we cannot know the opinions of the contemporary physicians who treated him, which would not, of course, be decisive in the debate on paralysis, but would be undoubtedly interesting. The clinical diagnosis in the report on the post mortem examination says "Gehirnlähmung", "stroke", that is paralysis. This of course is not sufficient to prove that the illness was indeed paralysis.