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)

X-ray investigations were evaluated by Zoltán Zsebők, professor of radiology of the University Budapest. Decalcified sections and slides were made out of almost all bones. In view of the possibility of Axhausen's Grenzstränge, polarizid microscopic examinations were also performed. The result of the palaeopathological examinations (78) can be summed up as follows: The surface of the cranium is smooth and there are no signs pointing to syphilis either on the surface or inside. In the anterior and posterior scala, the impressiones digitatae lines are firm but within the physiological limits. The "osteoma-like" formation and diagnosis of "exostosis" as described by Bartucz (6) are pathologically unfounded. His statement (6) according to which the upper of the two openings on the right mastoid was a "pus duct" whereas the lower one was a "surgical prick" obtained during his lifetime, is erroneous too. Both defects are of post-mortem origin because the three layers of the cranial bone are clearly distinguishable on the edges and there are no reactive bone symptoms. On the radiograph the pneumatic system of the mastoid is intact. On the apex of the pars petrosa, bone laces of individual character are visible. On the back rim of the left petrous bone laterally off the foramen jugulare extending as far as the sulcus sigmoideus there is a postmortem fracture. There is a similar change on the apex of the right petrousbone, the defect extends to the foramen lacerum. Several statements made by Bartucz (6) in the anthropological examination are erroneumous from palaeopathological aspects, but since they had been published we are bound to correct them. This also refers to his opinion according to which the purulent process had destroyed the apex of the pars petrosa (6). The three layers of the cranial bone are well distinguishable here too, the surface is smooth, disintegration or opposition is not traceable either macroscopically, histologically or radiologically (Fig. 2), the post-mortem fracture is certain. The bone structure is well preserved in the histological preparations made of the cranium. Two bone fragments of the right shoulder blade survived (one piece of each the angulus articularis and the angulus caudalis). The edge part of the bony substance is gnawed off, the surface like the rind of tree. Under the microscope it is visible that the bony substance became considerably thin, at some places completely decayed. The lamellar structure disappeared. The hollows of the bonecells, the haversian canals grew wider, their walls are uneven. There is no reactive bone apposition. There is no doubt that these changes point to serious purulent inflammation. Since there are no symptoms of reactive bone apposition, it can be stated with certainty that there was an acute metastatic abscess without ossification having yet developed, I can, therefore, not share Benedek'

s opinion (7) who — in rely to my publication — concludes from the expansion of the bone process that the osteomyelitis on his hand is not of an earlier date than that on shoulder blade although there was already an osteophyta edge on the hand. When an osteitis came into being is not determined by its expansion but by the fact whether