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

TANULMÁNYOK - Réti, Endre: Does the Problem "The Illness of Semmelweis" Exist? (angol nyelvű közlemény)

1865, and the septico-pyaemia was at least in the process of formation. Naturally that was not without effect on the central nervous system and could lead to the emergence of serious, acute, toxic deformations both in the cerebrum and in the spinal cord, in connection with the festering infection." *'.. .Some weeks before his death the conscience of Ignác Semmelweis undoubtedly became deranged. This was caused by pyaemia, which may happen to anyone suffering from an infectious disease." It would have disappeared after his recovery, like a pneumonic delirium (5). "The question arises how the members of the Faculty Committee, who were responsible for sending Semmelweis to the mental home in Vienna, could fail to notice that the delirium was caused by an exogeneous damage, by sepsis. To this the only answer is that then psychiatry was still immature, while the symptoms of sepsis did not appear yet, and the derangement occured in the incubative period of the toxic state, when symptoms were still hardly visible." (6) And yet another statement : "there are no traces of syphilis on the skeleton."

(1) 4. Summing up the above hypothesis: the pathography of mental disorder resulted from a "delirium caused by sepsis". Gyula Nyirő in his book Psychiatry (8) writes about delirium caused by sepsis: "Delirium caused by sepsis rarely comes under the observation of the mental specialist, it is noticed mostly by internal specialists. Its first description, which must be considered valid even to-day, is by Liebermeister (1833—1901). Three stages can be discerned in the course of the delirium, without a clear dividing line. The initial stage usually passes very quickly and the delirium reaches its climax. The initial stage is followed by the second, the delirium proper, within very short time, when the surrounding objects often come to life, the patterns painted on the wall begin to live and move statuesquely, pareidolia-like, figures rise out of the darkness, or just out of the light, the situation becomes dream-like, the pareidolias turn into illusions, hallucianations, with a hypnagogic character; as soon as the patient opens his eyes he regains his contact with the outside world. But the situation is gradually worsening. The contact of the patient with the outside world is becoming more and more discontinous, he mixes up persons and situations, cannot orientate himself in space and time. He responses to his hallucinations with speech, movement, his affections show much vacillation, once he is cheerful, then timid, anxious, or querulous, later resentful, angry. Sometimes one succeeds in raising the patient for a short time out of the delirium by a form warning, when he gives the correct answer to one or two questions, but his attention cannot be held for a longer time. Within a few minutes he falls back into his deranged state and his psychomotor restlessness continues, which may be interrupted by clonic, choreiform, athetoid tics of an organic character. In the third stage it is already impossible to establish any contact with the patient, he does not respond to outside stimuli. The psycho-motorium is in a state of most violent unrest, he throws himself to and fro, the delirium furibund sets in." According to Regöly-Mérei „the osteomyelitis began at least 0—8 weeks