Dansk medicinhistorisk arbog最新文献

During the last decades of the 19th century, discoveries in microbiology paved the way for health programmes as an integral part of social modernisation. Public opinion about the consequences for governmental involvement differed, but in Denmark the state's openness to modern medicine encouraged the establishment of Statens Serum Institut (SSI) in 1902, initially for the production of anti-diphtheritic serum. Under its director, Thorvald Madsen (1870-1957), the SSI soon acquired a reputation for the high quality of its products and its cutting edge research. After qualifying in medicine in 1893, Madsen worked both at the Pasteur Institute and with Paul Ehrlich in Frankfurt. During World War I, he served with the Red Cross, caring for German, Austrian and Russian prisoners of war. He had an extensive and expanding network of international contacts, and he was eminently qualified to assume the elected office of President of the League of Nations' Health Committee. The Committee served as the 'parliamentary body' of the League of Nations Health Organisation (LNHO), and Madsen's hand can be seen in much of the work undertaken by the LNHO. The drive to achieve uniform standards for biological products related directly to his own as well as the SSI's interests and expertise. Undoubtedly, standardization of biological products had an immense importance for their distribution, scientifically, commercially and therapeutically. Madsen was president of the LNHO's Commission on Biological Standardisation from 1924, and during the interwar years, the SSI was heavily involved in establishing standards for biological products such as tuberculin and tetanus antitoxin. Madsen's interests extended to application of prevention technologies, and he utilised the opportunities in Denmark to further their use, notably in the case of tuberculosis. The introduction of the BCG vaccine promised a solution to the TB problem, but the Lübeck disaster generated a widespread reaction against the vaccine. Sponsorship from the Rockefeller Foundation led to close investigation of TB incidence in Denmark, and eventually to the offer of vaccination of tuberculin-negative Danes. The programme provided a foundation for later UNICEF and WHO eradication policies. The paper throws light on how local cultures and experience, and personal dedication, shaped the policies developed by the interwar international movement.

In the reorganization of The Royal Medical Society in Copenhagen in 1845, statistics gained a vital role in the activities of the society. Although physicians followed the ill-defined approach to statistics that was popular at the time, they also contributed to the development and refinement of the modern science of statistics. Contrary to the concept of statistics in use at the beginning of the 1840's, medicine was driven by much more concrete questions of disease. Thus, the earliest use of modern numerical statistics in Denmark was found within the medical community. Yet, the use and development of statistics generated the modern approach to definitions of disease that we now debate within the history and philosophy of medicine.

At the turn of the previous century, the number of inhabitants in the City of Copenhagen increased greatly. A new large hospital, Bispebjerg Hospital, stood ready in 1913. At the time, access to light, fresh air, and open spaces was considered to be important factors in the battle against disease. Physical treatment such as different forms of bathing, massage, exercise, electricity and radioactivity were also much relied upon, and a large building for this treatment in the form of a Roman thermal bath was built at the clinic of physical medicine. The first head of the clinic, Hans Jansen (1875-1933), was a specialist in internal medicine who studied physical treatments for a wide range of diseases, including phototherapy, as a collaborator of the Nobel Prize laureate Niels Finsen. Later, Jansen focused on the treatment of rheumatoid arthritis. It was left to the internal medicine ward at Bispebjerg Hospital to introduce the first effective treatment with the gold compound Sanocrysin during the 1930's. In 1918, physical therapy, physiatry (in Danish, fysiurgi), was established as a medical speciality in Denmark. The next head of the clinic, from 1933 Knud Aage Rasmussen (1897-1976), a specialist in fysiurgi, focused on the treatment of regional and general rheumatic pain syndromes. The rehabilitation of patients with different diseases by gymnastic exercises had been in use from the start of the clinic, but in the late 1940's more emphasis was put on this treatment under the influence of impulses from the USA, and as a response to demographic change with an increased number of older individuals with physical challenges in the City of Copenhagen. A rehabilitation ward was established and together with the clinic of physiotherapy formed a new department in 1968 under the leadership of Lone Gjørup (1923-2005). At the same time, interest in the treatment of inflammatory rheumatic diseases rose after the discovery of glucocorticoids as potent anti-inflammatory compounds. The department at Bispebjerg Hospital followed this dual course of treatment of inflammatory diseases with new drugs and rehabilitation. Recent new technology and interest in sports medicine promoted research in physical training in the clinic and eventually gave rise to a separate research and development unit devoted to sports medicine.

Recent medical history is a new trend among medical historians. The new focus on late developments of note to health care providers has inspired me to relate certain personal events related to the establishment of a laboratory of positron emission tomography in a remote city of a small country far away. The record may be appropriate because the laboratory celebrated its 10th anniversary in 2003. The laboratory is the home of an advanced technology with special needs in terms of space, installations and staff. The technology rests on a combination of random discoveries and goal-directed inventions that include the discovery of positrons, the invention of the cyclotron, the development of computerized analysis of huge data sets, insight into the biochemistry of organs and the quest for understanding of the pathology of specific diseases. U.S. researchers played unique roles in the three former areas, while Danish researchers made important contributions to the latter two areas.

This is a personal account of the author's search for primary sources of a biography of Emil Cold (1865-1953), a physician living and working in Esbjerg, Denmark. The work on the biography spanned several years of research, tracking down archives in soiled, pigeon-infested attics and dusty magazines, reading through local newspapers and union pamphlets, interviewing retired nurses and doctors, and establishing very inspiring contacts to the descendants of the Cold, Finsen and Lyngbye families.

Although the effect of snake bites and poisoned arrows was known from ancient time, the development of the syringe and the needle lasted several centuries. Forms of intravenous injection and infusion are clearly documented in the 1650s. Sir Christopher Wren used a syringe made of animal bladder fixed to a goose quill to inject wine and opium into the veins of dogs. J.D. Major from Kiel and J.S. Elsholtz from Berlin probably were the first to deliberately administer intravenous injections to people in the 1660s. However, these early injections were not successful and injections did not come into fashion again until the latter part of the 1800s. Forerunners of subcutaneous administration were either the introduction of the drug under the epidermis by means of a vaccination-lancet or the application of a vesicant to remove the epidermis, after which the drug was applied to the denuded cutis. Lafargue, Lembert and Lesieur described these methods in the first half of the 1800s, and the methods continued to be of use in the second part of the century until the advent of subcutaneous injection. Alexander Wood of Edinburgh and Charles-Gabriel Pravaz from Lyon are known commonly as the inventors of the syringe for subcutaneous injection, but other pioneers such as Taylor, Washington and Rynd had already begun this form of administration. Increased use, safety and accuracy were accomplished by the progressive steps introduced by Wood, Pravaz and Luer. Thus, the syringe of Luer was fitted for aseptic heating, and a sharp needle readily perforated the skin. Sterilization by heating in an autoclave was developed by Pasteur, Chamberland and Koch, after managing aseptic conditions by the addition of preservatives such as carbolic acid. A safe method for the storage of sterile injectates was provided by Limousin's ampoule from 1886, and later by the introduction of multi-dose containers. The evolution of the syringe and its needle continues with the introduction of transdermal drug delivery by micron-scale needles and monitored drug delivery.

For several hundreds years, deafness in humans and deaf-mute humans has been a challenge to doctors and other therapists. During the last 50 years, it has become possible to treat deaf people. The reasons for this success in treatment and the introduction of the treatment in Denmark are the topics of this text. To make deaf people hear, patients were treated with electricity for more than two hundred years,in Denmark as well as other countries. This development depended on many important factors for a positive result of the treatment. The first operation of a deaf patient in Denmark was performed in Odense. Some years later the treatment began at Gentofte Hospital and later at Aarhus City Hospital. The start was slow, to some extent because of financial circumstances but also because the necessary equipment was not fully developed. There were also difficulties with selection of the most suited patients, training of patients, resistance against treatment from organisations of the deaf and from conventional teachers of the deaf. The problems were solved over a period of some years, and the population could soon see and meet patients as celebrities, i.e., previously deaf persons who could now use a telephone. More than 600 deaf people have now been operated in Denmark. The term deafness has changed its meaning, and probably there will no new cases of the deaf-mute in the future.

In the years 1926-28, after his retirement in 1921 from the post of professor of surgery at Odense Hospital, Peter Kisby Møller (1847-1940) wrote his autobiography. He dedicated the biography to his four sons, three of whom were medical doctors. He based the autobiography on diaries written daily in a neat hand ever since childhood. As a newly qualified medical doctor at the age of 29 years, Peter Kisby Møller eagerly devoted himself to the field of surgery, and in 1876 he embarked on a tour of foreign study. His main goal was to study the treatments and results of the great gynaecological surgeons of the time and thus increase his store of knowledge of gynaecology. He visited clinics of urology and studied the new antiseptic treatment introduced by Lister that significantly decreased mortality. He visited many famous London hospitals and observed the surgery of sir Spencer Wells who was internationally known for his ovariotomies at the time. Later Kisby Møller visited Jules-Emile Péan, Alphonse Guérin, Louis-Félix Terrier, and Just Lucas-Championnière in Paris. P.K. Møller was hardworking, faithful to his patients, and a devout Christian.

The paper attempts to trace and sketch very briefly the history, role and status of professional physicians in Rome from the 8th to the 3th century BC. The epigrafic sources are even at the best of times meagre and one has to draw heavily upon written sources, especially from the first century AD. A brief sketch of traditional Roman folkmedicine, traces of which still linger in later latin medical literature, and the strong traditions the Romans had of self-care, is given. The Roman public were generally suspicious of physicians, who worked for a fee, but the authorities welcomed the profession and allowed it to settle in Rome, as well as granted it certain privileges. The level of education differed enormously from one physician to the next, since anyone could profess to be a physician without training or proper skills. Thus the range goes from useless quacks to highly educated physicians. They had the right to form guilds like other craftsmen. Physicians were mainly either slaves or freedmen, but there are freeborn among them as well. They worked on all levels of society. Hospitals were built in the fortresses along the Roman borders and a description of the ones found in Vetera Castra in modern Germany is given. Literature spanning from the midfirst century BC to the end of first century AD reveals a growing resentment and an increasingly caustic tone towards physicians and their profession - the impression one gets is that these written attacks are caused by a mixture of cultural and social bias and resentment towards useless and dangerous physicians.

This small treatise does not appear to have been published in Danish in its entirety. It gives a vivid picture of the physician in ancient Greece. The well known first chapter describes the attitudes and attributes of the doctor. It goes on discussing in some detail how the light should be in the surgery, the instruments to be used, the preparations of bandages and drugs, and the use of cupping instruments. The author stresses both the needs of the patient and the necessity of the physician's dignity and integrity.