Dansk medicinhistorisk arbog最新文献

Opium has been known for millennia to relieve pain and its use for surgical analgesia has been recorded for several centuries. The Sumerian clay tablet (about 2100 BC) is considered to be the world's oldest recorded list of medical prescriptions. It is believed by some scholars that the opium poppy is referred to on the tablet. Some objects from the ancient Greek Minoan culture may also suggest the knowledge of the poppy. A goddess from about 1500 BC shows her hair adorned probably with poppy-capsules and her closed eyes disclose sedation. Also juglets probably imitating the poppy-capsules were found in that period in both Cyprus and Egypt. The first authentic reference to the milky juice of the poppy we find by Theophrastus at the beginning of the third century BC. In the first century the opium poppy and opium was known by Dioscorides, Pliny and Celsus and later on by Galen. Celsus suggests the use of opium before surgery and Dioscorides recommended patients should take mandrake (contains scopolamine and atropine) mixed with wine, before limb amputation. The Arabic physicians used opium very extensively and about 1000 AD it was recommended by Avicenna especially in diarrhoea and diseases of the eye. Polypharmacy, including a mixture of nonsensical medications were often used. Fortunately for both patients and physicians many of the preparations contained opium. The goal was a panacea for all diseases. A famous and expensive panacea was theriaca containing up to sixty drugs including opium. Simplified preparations of opium such as tinctura opii were used up to about 2000 in Denmark. In the early 1800s sciences developed and Sertürner isolated morphine from opium and was the founder of alkaloid research. A more safe and standardized effect was obtained by the pure opium. Several morphine-like drugs have been synthesized to minimize adverse effects and abuse potential. Opioid receptors were identified and characterized in binding assays and their localization examined. However, the complexity of the system including interaction with several neurons and transmitters indicate the goal of nonaddictive opiates to be elusive. Combination therapy, innovative delivery systems and long-acting formulations may improve clinical utility.

The first hospital pharmacies in Denmark in modern meaning were established of the Copenhagen Municipality: the General Hospital Dispensary (Almindelig Hospitals Dispensationsanstalt) in 1815, the Municipal Hospital Pharmacy (Kommunehospitalets Apotek) in 1863, the Sound Hospital Pharmacy (Oresundshospitalets Apotek) in 1904 and the Bispebjerg Hospital Pharmacy in 1913. Not only did the hospital pharmacies take care of the medicine supply to the municipal hospitals in Copenhagen, but the pharmacies, particularly the Municipal Hospital Pharmacy and the Bispebjerg Hospital Pharmacy, also carried out development and research work in the field of drug. Among other things, the Municipal Hospital composed a series of hospital pharmacopoeias in the period 1871-1922, from 1908 with the co-operation of the chief pharmacist at the Municipal Hospital, first Jens Otto Anton Volqvartz and later Niels Ludvig Møller, and in 1922 also in collaboration with the chief pharmacist at the Bispebjerg Hospital, Severin Søren Marcussen. In addition, Severin Soren Marcussen, also developed an iron mixture, "Idozan", for the treatment of anaemia and a sulphurous ointment, "Kathiolan", for the treatment of scabies, both of which were marketed by A/S Ferrosan, in 1920 and 1921 respectively. In 1936, the subsequent chief pharmacist at the Bispebjerg Hospital, Birger Norman Jensen, invented together with Hans Christian Hagedorn, MD, at Nordisk Insulinlaboratorium the first insulin composition with prolongated effect, protamininsulin, which was put on the market under the name of "Insulin Leo Retard". The Bispebjerg Hospital Pharmacy also participated in the development of medical utensils. In 1948, the pharmaceutical wholesaler Bang & Tegner A/S collaborated with the chief pharmacist Kaj Pedersen-Bjergaard, DSc, and consultant Karl Henrik Køster, MD, in developing the first sterile disposable set to intravenous and subcutaneous infusion, named "Batex Eengangssaet".

In 2000 the Danish health authorities published recommendations on the training of specialist physicians. Based on the work of a group under The Royal College of Physicians and Surgeons of Canada the Danish report mentions seven key competencies of the specialist: Medical expert, Communicator, Scholar, Collaborator, Manager, Health advocate, Professional. The detailed description of these roles reveals that they may be universal characteristics of the physician. A number of quotations from the corpus hippocraticum seems to substantiate this view.

Removal of the tonsils, or tonsillectomy, is a very frequent surgical procedure in Denmark (5 million inhabitants). Nowadays, about 7-8,000 patients are operated on each year. The indications for surgery and the surgical principles have largely remained the same for a century, but different techniques have been employed. As in all surgical procedures, there are complications to tonsillectomy, first and foremost postoperative bleeding which occurs in 4-8% of all operated patients. In the last 100 years many studies have been undertaken to shed light on the frequency of postoperative bleeding following tonsillectomy. It is noteworthy that the studies have been carried out at times where there was a certain interest in the subject whereas in other periods of time, the subject has been of little interest to researchers. The definition of postoperative hemorrhage is not unambiguous. Despite the fact that various surgical techniques have been applied, no significant change in the incidence of postoperative hemorrhage after tonsillectomy has been shown over the past 100 years. The study calls for caution when evaluating new surgical techniques since the incidences of postoperative hemorrhage have been shown to change between high and low percentages through the entire 100 year period.

Severin Nordentoft (1866-1922) was born in Aarhus, Denmark and spent most of his time here. He was a self-made surgeon but very skilled and courageous. He treated a patient with Basedows disease with total removal of the thyroid gland in 1894, the first in Denmark, and the patient lived normally 20 years later. Recently he has been recognized, as been the first in the world to construct and use the arthroskope in a knee joint. From 1910 he used most of his time to radiology and especially to radiotherapy and he was one of the forerunners to use radiotherapy in brain tumors- in fact he was the very first to propose it in writing. He suggested 90 years ago preoperative radiotherapy in certain cancer forms which just in the last decennium has been the golden standard. He was however a rather controversial person with a major sense of justice resulting in problems in working with colleagues on the same level. Most of his life he worked in private clinics and when he finally got the job as head of a department of radiology in a major hospital, he was dismissed 11/2 years later. He died just 55 years old from aplastique anemia caused by radiation or rather lack of radiation protection. His name is engraved in a memorial for victims of radiology together with famous names as Marie Curie, her daughter Irene, and Albers-Schönberg. He wrote several books, ranging from popular medical books to books about military and defence subjects, 2 plays and an autobiography.

Smallpox contributed to many deaths in Denmark up to the introduction of the vaccination in the beginning of the 19th. Century. The last minor smallpox epidemic in Denmark was in 1924, and subsequently no doctors had special experience in smallpox. In September 1970 a Norwegian medical student died from smallpox in Copenhagen after returning from a journey to Afghanistan, where he has been hospitalized for enteritis. During the 5 days in Copenhagen before hospitalization he had had extensive contacts with many people. He was hospitalized at Blegdamshospital and was isolated, and the diagnosis of smallpox was verified on day 5. He was then totally isolated in a pavilion with 2 nurses and one doctor. The initial diarrhoea (Salmonella typhimurium), and later septicaemia with salmonella, the copious expectoration up to 1 1/2 l pr day (Streptococcus pneumoniae, Klebsiella pneumoniae, E. coli, 9-streptococci), the enormous exudation from the desquamated skin caused large problems concerning water, electrolytes and protein balance, requiring an input up to 13 1 per day. It was necessary to perform tracheotomy and artificial ventilation. He was treated as a patient with extensive burns with metal sheets and when his body temperature fell to 30 degrees C with electrical heat. He died after 25 days of smallpox with complicating extensive skin ulavs corresponding to a pathological picture of toxic epidermal necrolysis (TEN). The containment was successful in cooperation with the Danish National Board on Health, the Medical Officer of Health from Copenhagen and the county (where the patient lived), police, State Serum Institute, and Ministries of the Interior and Foreign Affairs. Vaccination of the exposed persons and the hospital staff, isolation in small groups (maximum 20 persons) of 589 primary contacts in the hospital pavilion-wards and 12 military tents were performed. No secondary cases occurred. The outbreak of smallpox in Copenhagen ended, and the city was not declared "local infected area", and we avoided a panic mass vaccination of large group of people. The article describes these activities, which are effectuated within a few days and headed by a capable and unanimous leadership, in a serious and complicated situation and with an engaged cooperation from the whole staff.

Based on numerous microscopical slides from two eyes from two patients suffering from "inflammatory" glaucoma Christian Frederik Heerfordt (1871-1953) put forward his very original theory in 1910-14: Some cases of intractable glaucoma are caused by occlusion of one (or two) vortex veins, sometimes with a flap, a sino- scleral plate into the sinus ( ampulla). Surgical treatment could be iridectomy in the sector with the occlusion, or perhaps better by blood- letting of the occluded vortex- vein. Heerfordts theory was damned by the Danish Ophthalmological Society as un-scientific and the messages in the danish newspapers un- etical. The consequences for science and for Heerfordt personally are discussed.

In 2003 some letters, written from 1905-1915 by the father to the chemotherapy, the Nobellaurter Paul Ehrlich (1854-1915) and his family written to Dr. Thorvald Madsen (1870-1957), Director of the State Serum Institute from 1909 to 1940 was found. In these letters the personal and scientific relations between the two scientists is described on the background of the letters found. The article is written with the intention to celebrate the 150-birthday of Paul Ehrlich and to document the close relations between Paul Ehrlich and the founders of the State Serum Institute in Copenhagen: Carl Julius Salomonsen (1847-1924) and Thorvald Madsen.

For centuries, drugs that increase the power of contraction of the failing heart have been used for the treatment of congestive heart failure (dropsy). The cardiac effect is due to the content of cardiac glycosides. Squill or sea onion, Urginea (Scilla) maritima, a seashore plant, was known by the ancient Romans and Syrians and possibly also by the ancient Egyptians. Squills were used erratically, but some prescriptions indicate that they may have been used for the treatment of oedematous states. The toxic effect of strophanthus species was known from poisoned arrows used by the natives in Africa. Digitalis, derived form the foxglove plant, Digitalis purpurea, is mentioned in writings as early as 1250; a Welsh family, known as the Physicians of Myddvai, collected different herbs and digitalis was included in their prescriptions. However, the druge was used erratically until the 18th century, when William Withering, an English physician and botanist, published a monograph describing the clinical effects of an extract of the foxglove plant. Later, in 1785, the indication and the toxicity of digitalis were reported in his book, "An account of the Foxglove and some of its medical uses with practical remarks on dropsy, and other diseases". In Denmark, the leaves of Digitalis purpurea or Digitalis lanata were tested for cardiac glycoside activity. The standardized digitalis powder was used in tinctures, infusions, and tablets. The preparations were included in successive editions of the Danish pharmacopoeia, some of the tinctures already in 1828, i.e. before the standardization of the drug. Isolation of cardiac glycosides from digitalis, strophanthus and squill and determination of their chemical structures initiated biochemical and pharmacological studies. The scientific advances led to an understanding of cardiac muscle contractility and the Na,K pump as the cellular receptor for the inotropic action of digitalis. Examination of putative endogenous ligands to the receptor revealed some endogenous cardiac glycosides of similar or identical structures as those found in digitalis, strophanthus and squill. Increased concentrations of these glycosides are found in patients with heart failure. Further investigations are needed to determine whether the secretion of glycosides might be a physiologic response to a diminished cardiac output.

One of the nerve specialists/psychiatrists of the first part of the 20th. century, Professor Daniel Jacobson (1861-1939), chief physician of the Psychiatric Department, Frederiksberg Hospital, was an outstanding person as regards both character and appearance. He was a tall man, and his artistic looks and charismatic authority made him a popular therapist in the Scandinavian Countries. His patients included not only many devoted females, but also several Nordic artists - among these the Norwegian painter, Edvard Munch. Munch was treated in Jacobsons private nerve clinic at Frederiksberg in 1908-09 and during his stay he painted the characteristic portrait of Jacobson. Here we present a new collection of drawing, caricatures, verse and humorous texts from patients, colleagues and friends.