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

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

The four years must be only the guess of the pathological anatomist, a reference to the fact that the nervous system had been in a process of deterioration for years, though the symptoms of insanity appeared only much later. But not as late as it is clained by the Semmelweis-literature, that is not on July 13th. That date appears everywhere as the beginning of the illness, and on July 20th he was already taken to Vienna. But if one tries to squeeze all the events described by the eyewitnesses into that week it turns out to be impossible. I do not only mean the symptoms and the change in his personality, which obviously had to be a longer process, I only mean the events revealed by the widow and József Fleischer(S) : "... his unusual, strange private life, his forgetfulness, absentmindedness as well as his childish behaviour was striking in his family, in the school, beside the sickbed, at the faculty-meetings

...", writes Fleischer; in the evenings he insisted on driving to his patients, though "at that time my husband was already not allowed to see his patients", writes the widow, then came the scene of the oath of the midwives, the confinement to his room under the supervision of two physicians, the consultation, some days later another consultation which decided on sending him to Vienna, his wife writing to Hebra, and finally their departure. All that could not happen in a week, especially considering that his behaviour could not be striking then (in the middle of the summer) "in the school", or at the beds, as he was already banned from seeing his patients. Obviously the recollection squeezes the events of several months into the week when the psychosis broke out with its full vigour. The last point makes it very probable that if there was any finger-injury, it must have occured also much earlier. In early summer, perhaps, when Semmelweis was still balanced enough to perform operations. It was in the middle of June that his last article appeared Ín Orvosi Hetilap with the notice: "to be continued" — but it was never continued. He could write it in April, or in May the latest, and it went into print at the end of May or the beginning of June, when Markusovszky still hoped to see the continuation, consequently the beginning of insanity must be put to the first days of June. An injury during an operation could indeed be the first conspicuous sign: only scattered attention, confusion, a trembling hand, incoherency can explain that the otherwise experienced professor cut his finger. Of course such an injury may occur without all that, but the coincidence of the injury and the outbreak of the psychosis strongly suggests the connection of the two. If that is so, one question remains open: why did the physician-friends not notice it? Perhaps because the injury was so insignificant that it already struck nobody at the time of the dramatic July events. It is also conceivable that, as it often happens with paralytics, due to his psychosis Semmelweis became insensible to pain and did not perceive the spreading fester. This would of course not alleviate the responsibility of those around him but makes it understandable that they did not care about it in face of the greater danger; surely they would have cared if they had diagnosed delirium caused by wound-fever. There still remains a third possibility, namely that the physicians did notice and even treated (with conservative methods) the panaritium, which then still