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)

3. There are no pathognomonic signs pointing to either paralysis progressiva or tabes dorsalis. Cerebral atrophy and hydrocephalus are — in our view — due to arteriosclerosis whereas the adhesions of the meninx are the result of pachy mengiosis. 4. Schaffer emphasized the hyperaemia, respectively inflammation of the cerebrum and the meninx (57), which is in causal relation to the septic condition. Haranghy points to the arteriosclerosis in the cerebral vessels. The changes of the brain are also explained by these pathological processes. There was no atrophy of the spinal cord on the contrary it was swollen and prolapsed from the cut surface. The histological picture is not characteristic of tabes. The spottedness of thi carmine staining only points to glia proliferation. At the time of Semmelweis degeneratio grisea was still a collective term including a number of various diseases of the spinal cord. 5. The change of personality that started four-five years before his death and premature ageing are, in my opinion, the result of arteriosclerosis. 6. The hand-injury originates from an operation at the middle of June 1865. 7. The hand injury brought on panaritium osseale and articulare causing osteomyelitis of the metacarpal bone (not mentioned in the autopsy report). The sepsis developed thereof was the immediate cause of the death. 8. The autopsy report mentions metastatic abscesses but a part of the described symptoms (left hand and arm, right elbow, knee and ankle) may rightly rouse the well-grounded suspicion of external violence used. 9. According to Mrs, Semmelweis the serious symptoms of the nervous system started on July 13th 1865. This is, chronologically, in agreement with the osteomyelitis developed on the right hand and started — according to the palaeopathological examination — 6—8 weeks before the death set in (result : sequester, cloaca, osteophyta-formation). 10. Till the middle of 1865, Semmelweis carried on a creative and medical activity with unswerving fervour. This fact, however, cannot be suitably employed from the aspect of pathology for similar symptoms can also be observed in the case of paralysis progressiva. 11. Because of the chronological coincidence, Schaffer rejects the possibility of genuine insanity and considers the disease a secondary phenomenon. 12. According to Haranghy, Nyirő and Regöly-Mérei the suppuration on the hand and/or the septic process caused by osteomyelitis developed mental processes of exogenous, acute infectious-bacteriumtoxinic origin of secondary character. On the basis of the catamnestic analysis and the palaeopathological examination I consider it proved once again that Semmelweis was not afflicted by genuine insanity; his nervous breakdown was due to an acute exogenous reaction type as interpreted by Bonhoeffer. The mediastinal abscess compressed the left lung add due to hypoxia the cerebral function continued to get worse.