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)

At the middle of the last century degeneratio grisea did not mean specifically tabes dorsalis but only implied a regressive process of the nerve elements of the spinal cord and additional glia proliferation. (9, 10, 04, 60), Various kinds of pathological processes were classed among the latter e.g. "ringförmige Sklerose", "bandförmige Sklerose", tabes dorsalis, Friedreich's disease etc. In the case of tabes the myelon is not swollen as it was in the case of Semmelweis (with the exception of the cervical sector's transversal diameter). In the case of tabes the posterior columns and the periphery of the ganglions are sunk and greyish on the cut surface; in the case of Semmelweis—according to the autopsy report — the substance prolapsed and was sapful. Semmelweis's spinal cord stained spotted with carmine and during the carmine reaction faint spots were visible with the naked eye on those areas where the glia propagated. (See works on pathological anatomy by Rokitansky, Scheuthauer and Birch-Hirschfeld quoted earlier), thus, it is not a pathognomonic symptom of tabes, at the very most it also can be detected in the case of tabes, too. Just for this reason, this method is not used in our days any more. The reddish streakiness described in the autopsy report (corresponding to the vessels, see the books referred to above) can be considered as a rule as a sign of active hyperaemia (e.g. acute inflammation). According to Birch-Hirschfeld (40) in the case of inflammation: "., .doch kommen je nach der Reichlichkeit des Blutpigmentes auch rostfarbene, ziegelrote Färbungen der Herde vor. In den bisher erwähnten Stadien der entzündlichen Erweichung erscheint das Volumen des ergriffenen Theiles vermehrt, das Gewebe quillt auf der Schnittfläche vor". This opinon prevailed in pathological anatomy in the last century. Under the microscope Meynert found hyaline in the arteries of the soft cerebral membrane and adisposis in the finer branches. The latter as well as globular lumina were also observable in the cerebral vessels. On one area there was colouring matter (extravasatum) and rupture of the vessels. Destroyed vessels and glia proliferation. On the inner part of the cortex, nuclei of the glia and swollen ganglion cells could be seen en masse. "Luminous vesicles" in the nuclei of cells. Cells of uncertain outlines. Detached large nuclei of ganglioncells. Swelling and decay of the ganglion cells. The "nerve tubes" survived. Swollen section of the medulated elements. Disintegrated axis-cylinders on some areas. Thus, serious regressive symptoms (degeneration and decay of cells) were observable in the cerebral nerve elements. The cutting of the myelon stained with carmine was spotted. In the area between the posterior horns near the vessels there were red islands containing scarce sections of the modulated elements together with varicose veins and hyperaemia. Adipose disintegration of the Axon, adiposity of the glia. Longish appendage of ganglion-cells. The outlines of the posterior horns were indistinct and of oedematic loosening ( !) containing amyloid nodules. Collodial degeneration of the fibrae medularis. Adiposis of the blood vessels. The hyperaemic oedematic brain, wide and hyperaemic vessels etc. as well as the swollen oedematic spinal cord, can be considered a hyperaemic, oedematic substance, possibly related to the septic condition. Several histilogical symptoms are reminiscent