Dansk medicinhistorisk arbog最新文献

Nine portrait busts, eight in bronze and one in euville-limestone are placed in the hall of Rigshospitalet's auditorium of former professors from periods of nearly 100 years. The professors were all outstanding personalities who have left their stamp on a whole generation of medical students and doctors. The bust is a fine way, three-dimension and here in normal size or even over-normal size to give a fine character sketch of the professor's qualities. Different and skillful well-known Danish artists had made the busts all in high calibre, showing the art at different periods.

In 1857 the police doctor in Copenhagen received an anonymous letter from a gentleman. He wants the physician to write a popular book about syphilis and describe how men, who were infected could treat themselves. Regarding to the letter this paper examines how the authorities and the danish physicians tried to stop the disease in the 1850's and to see how physicians were arguing for the regular prostitution in the city. The disease was spreadening very rapidly in these years and the physicians were very concerned about the new growing up population -the children, who also were suffering from the disease. No proper treatment was available in the 1850's. The severe cases were still treated with mercury like in the Middle Ages.

Analysis of the iris has ancient roots, but iridology in its present sense was established by Philippi Meyers in 1670. The discipline was further developed by Ignaz Péczely in 1881 and by Nils Liljequist in 1890. Other studies have been published in Germany, Sweden, Norway, England, France, USA, Australia and elsewhere, and iridology is practiced worldwide. The techniques used are described and the sources of error are mentioned when several photos from the same patient are compared (e.g. the influences of differences in pupil size, magnification and the effect of oblique light). The iris key (irigraphy) and the interpretation of different sights are discussed in some detail; there is little agreement among iridologists. Some iris diagnoses are of little interest to day and some modern diseases are missing in the diagnostic system. Controlled studies reveal that iridology is of no use whatsoever for the detection of cancer and other diseases in the stomach, intestines, kidney, lungs and heart. The reason for the continued popularity of iridology is discussed, and it is concluded that this type of alternative medicine is not harmless.

A complicated and long action for damages is outlined after the train accident in Bramming, Western Jutland, July 1913, where 15 passengers died and 16 passengers were seriously injured. The case came to last for two years, especially due to one doctor's exorbitant fee charged for the treatment of three foreign patients. By this, the doctor came in conflict with his colleagues and the local medical association and filed a suit against the state, which he lost. The case exposed an avaricious doctor and weak collegiate opposition.

Already Aristotle was aware of that an act ethically could not be judged alone by its effect, but circumstances should also be considered. This point of view was later taken over by Christianity in the form of the so called casuistry. The use of circumstances in the judgment of an act as regards the moral permissibility was, however, to some extent misused, especially by the Jesuites in the 16th and the first half of the 17th century. In defence of the "Jansenites" Blaise Pascal launched a direct attack on the Jesuites' use of casuistry in spiritual advice of the sinners. His elegant and vitty satire destroyed any talk of using casuistry for a long time, at least in the protestantic Northern Europe. Casuistry was regarded as synonym with sophistry. In 1988 Jonsen and Toulmin has argued that it is only the misuse of casuistry that is to blame. Used in a proper way it still has a future resolving moral problems especially in medical ethics. The present author is of the opinion that some degree of casuistical reasonning unconsciously is used in the present ethical debate, but more awareness hereof may be an advantage in the debate.

Hospital monographs frequently describe the buildings and the leading staff but rarely the patients. However, the 1980s and 1990s called attention to the importance of the perspective of patients of the past. The chapter reports an examination of the quality and extent of information retrieved through a systematic search of patient records from the Copenhagen General Hospital, extending back to 1855. The charts illuminated the social conditions of the patients in addition to their illnesses and the treatments characteristic of the day. Analyzing the state of medical practice revealed in the records, the author tested whether hospitals in reality were no more than gateways to the afterlife. Comparisons among hospitals showed the extent to which treatments varied across institutions. Correlations between the evidence of the patient charts and the ideals of the professional literature at the time revealed the differences between theory and practice. The records yielded important insights into the daily lives of patients admitted 150 years ago. They generally were younger and of lower social class. For reasons of poor hygiene, poor housing, and poor nutrition, they fell victim to the classical diseases of the crowded urban environment, including lung, skin and venereal diseases. Of these, tuberculosis killed most patients admitted to hospital.

In March 1941, two months after her wedding, Karen Blixen was diagnosed as having syphilis in the second stage. She was treated initially with mercury and later on in Denmark with salvarsan. Years later she received more treatment with mercury, salvarsan and bismuth, but in fact she was cured already in 1915 and told so by her venerologist Carl Rasch. However, she did not believe him, and several physicians, including well-known specialists in internal medicine and neurology told her many years later that she had to accept the diagnosis tabes dorsalis, i.e., syphilis in the third chronic stage. This paper claims, based on her medical records from several hospitals, that her physicians' attitude resulted in the delay of right treatment for her real disease for many years and led to at least one unwarrented surgical procedure (chordotomy). In 1956 she finally received surgical treatment of her stomach ulcer which for many years had caused her attacks of abdominal pain. The procedure was delayed for ten years because of a lumbar sympathectomy, which removes the pain for some years but not the ulcer itself, nor the bout of vomiting. Many doctors (and biographers) have been puzzled by her life-long bowel symptoms. It was often called tropic dysentery, in spite of the fact that this diagnosis was never confirmed by stool analyses. Instead it is suggested that most likely the Baroness caused the symptoms. She misused strong laxatives during her whole adult life. She did not tell her doctors about this until very late in her life and then it was far too late. Many times barium enemas showed a severe chronic condition with dehaustration and dilatation. The reason for her misuse was the fact that she was afraid of gaining too much weight. She used amphetamine during her life in Denmark after her return in 1931 in order to reduce her appetite, and probably she used Chat in Africa. She also constantly smoked cigarettes which in combination with minimal food intake facilitated the development of her stomach ulcer. It is concluded that Karen Blixen would have had a much better life, if communication between her and her physicians had been better. She should have told them and they should have been better to listen to that which was unsaid.

A painting made by the Danish painter and author Henrik Have (born 1946) illustrates the front page of Jette E. Kristiansen's medical thesis The Antimicrobial Activity of Psychotherapeutic Drugs and Stereo-isomeric Analogues (1990). The painting illustrates beautifully that art and science can go hand in hand. Even very complicated chemical, pharmacological and microbiological questions can be expressed by means of colours and by means of symbols used in everyday life, such as a spiral (DNA), or a pair of hands expressing working together. Prayers, wishes and the most difficult questions in receptor stereo-chemistry in eucaryotic and procaryotic cell-systems are illustrated in this painting. Synthetic chemistry and pharmacology are linked in the development of the synthetic dyes. The chemical colours are often the same in dyes and drugs. The red colour in the pharmacology is associated with the antibiotic drugs as sulfonamides as well as with the staining of Gram-negative bacteria. The yellow colour is associated with the antibiotic drugs, quinolones and the Ziehl-Neelsen staining for tubercle bacillii. The blue colour is associated with the psychoactive drugs, phenotiazines, as well as with methylenblue staining and the staining of Gram-positive bacteria. These association and symbols have been used in this painting.

Danish veterinarians are still allowed to prescribe and distribute drugs sold by Danish pharmacies to be used for treatment of animals under their care in agreement with the Danish rules and EU directives (4). Since the first student graduated from Danish Veterinary School in 1775, Danish veterinarians have also, in agreement with their education, had the right to dispense drugs produced in their own dispensary. However, due to the development of the methods for drug production, the introduction of registered products from medical companies, and the justified demands for documentation of drug efficacy and safety was abolished in 1988, and no exemptions were granted after January 1st 1990 (1). The controlled use of drugs with documented efficacy and safety has improved the clinical effect of animal treatment, minimized side effects in treated animals and unwanted effects on the environment and the consumers of animal products (22).

Some aspects of the opthalmologic history of Denmark are briefly mentioned. Lens extraction in 1667 in Copenhagen, Edmund Hansen Gruts stereoophtalmoscopy in 1857, Ludvig Panums area in 1858 (single vision) space perception and outside this area double vision), squint treatment, Marius Tschernings periscopic spectacle lenses, Henning Rønnes stereoortograph and keiroscope and Gerhard Rønnes stereoscope. Space perception depends mostly on binocular function (convergens), but in fact some space perception occurs in vision due to perspective, accommodation, parallaxe, blurring, colours and shadows. The Danisk Poet, Hans Christian Andersen, has in his novels mentioned latent squint. The German poet Rainer Maria Rilke was much interested in perspective in connection with the development of impressionism, especially Paul Cézanne. Rilke in his later period developed the view that concentration on perspective removed those essential aspects from the world, in which he found God or a fourth dimension, as exemplified in the presence of ghosts.