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

TANULMÁNYOK - Regöly-Mérei, Gyula: The Pathological Reconstruction of Semmelweis's Disease on the Basis of the Catamnestic Analysis and Palaeopathological Examination (angol nyelvű közlemény)

gangrenous process on the right hand. This is obviously due to the fact that the dissection was not made in accordance with Virchow'

s method—in use at present too—but by applying the Rokitansky in situ technique. The name of the dissecting physician had not been indicated on the heading. The cause of it is not known but it can be assumed that it did not merely happen by chance, and Professor Chiaris (Vienna) kindly drew our attention to this fact quite uncommon in the Rokitansky Institute. Maybe that the lesions—precisely described by the report

—giving rise to the suspicion that they are due to violence, could provide an explanation. These also attracted Benedek's attention (7) ; we shall revert to this question later. Signs pointing to syphilis were not to be found either on the skin, the mucuous membranes or the internal organs e.g. liver. On the other hand, it is conspicuous that pachymeningitis, arachnoiditis adhaesiva, ependymitis granulosa, atrophy of the frontal lobe and hydrocephalus internus are mentioned which undoubtedly also occur in the case of paralysis progressiva, although—according to Entz (19)—they are not exclusive and pathognomonic signs of this disease. Thus, the opinion of authors who attributed Semmelweis's malady to paralysis progressiva was founded on pathological symptoms, mainly if it is also added that degeneratio grisea is synonymous with tabes dorsalis since the turn of the century. In the opinion of K. Schaffer—as it had been mentioned earlier—the signs are secondary symptoms "since the dissection revealed meningitis"

—he wrote—"...in these cases... as preliminary symptoms a melancholic hypochondriac state, moreover, so-called catatonia of the muscles can occur and the inflammation of the brain can be accompanied by delirious symptoms"" (56). According to Haranghy there was neither paralysis nor tabes (24, 25a and b). Different causes can bring on pachymeningitis externa, for in addition to paralysis it can also be caused e.g. by pachymeningiosis. Also on the basis of the autopsy report it is justified to assume pachymeningiosis, moreover the small bone-hollows found in the palaeopathological examination on the inner surface of the calvaria covered by a smooth edged intact vitreal plate yet showing signs of earlier bone reactions, decidedly support this diagnosis. According to Haranghy (25a and b) trauma, Semmelweis was afflicted with twice, could have caused pachymeningiosis. Although there is no paralysis without ependymitis granulosa, it is not a pathognomonic symptom for it can occur whenever the brain or the meninx become inflamed. (Entz 19). Ependymitis granulosa can also cause hydrocephalus (per occlusionem). Hence, neither hydrocephalus nor ependymitis are pathognomonic symptoms of paralysis progressiva in the case of Semmelweis. However, the autopsy report of Semmelweis comprises a pathological change that has scarcely been discussed in literature hitherto although it may be decisive regarding the pathological character of the process i.e. perforation of the septum pellucidum and formation of a pseudomembrana. These changes indisputably prove a purulent inflammation.