Abstracts fra Bibliotek for Læger 2/2002

Helsinki Deklarationen. Historien bag 2. udgave fra 1975

Povl Riis:

The Declaration of Helsinki – the story behind the second version from 1975.

Bibl Læger 2002; 194: 113–18.

After the end of The Second World War and the disclosures of severe crimes against humanity in KZ-camps, gulags and prisons, often in the form of socalled medical experiments, several preventive measures were taken. They had the form of international declarations, conventions, guidelines etc., and among them was World Medical Association’s (WMA) Declaration of Helsinki from 1964. Its influence on the strongly increasing clinical research was however very limited, probably because clinical scientists found it too far from the prognostic insecurity that is an integrated part of original clinical science.

On this background WMA asked three Nordic clinical researchers and ethicists to rewrite the Declaration, which then happened in 1974–75. The present article describes the working procedures and the Declaration’s political route until it was adopted by WMA in Tokyo, October 1975. The story further includes comments on the fifth version from 2000 and the appearance of new sets of research ethical rules as the Protocol on biomedical experiments in man from the Council of Europe, and the Nuffield Foundation’s report on ethical aspects of developed countries’ involvement in developing countries’ biomedical research.

Den blinde urmager, universets planløse designer.

Hans Harrestrup Andersen

The blind watchmaker – aimless designer of the universe.

Bibl Læger 2002; 194: 119–27.

Based on neo-darwinistic argumentation, as expressed especially by Richard Dawkins, the role of genes in maintaining species is discussed. A computerized form of the game Prisoner’s Dilemma serves as a model for various survival and reproduction strategies. Of greatest benefit to any given population are strategies containing elements that allow individuals to perform inside a certain amount of “kindness and forgiveness” within a climate of similar based strategies, however, punishing individuals who repeatedly fail to cooperate.

A stable evolution strategy is defined as one which, used by a majority of the population, cannot be improved by any other strategy.

Evolution does not work by farsighted scheduling. It may look as the result of a well-designed master plan, but is in reality the results of natural selection, which again represents the performance of the single-minded genes.

Baltimore-sagen. En lære om forskningens ydre og indre fjender.

Jens F. Rehfeld:

The Baltimore Case: A lesson about external and internal enemies of scientific research.

Bibl Læger 2002; 194: 128–42.

Based on recent comprehensive and critical reviews by D. Kevles and S. Crotty about the widely debated Baltimore-affair, the case is now described for a Danish audience. Moreover, its implications and lessons for science in general and for Danish science in particular are discussed. The Baltimore case, named after the prominent nobel laureate David Baltimore, is one of the most complicated and protracted trials in history about scientific fraud. From a local scientific dispute in Boston in 1986, it grew and metastatised in an uncontrolled manner in the following decade to comprise the entire american scientific society and congress. A legal trial in 1996 finally terminated the case about unfounded accusations of fraud, caused by inadequate sense of science among junior researchers, politicians and civil servants.

Om at være syg uden at fejle noget bestemt. Neurasteniens skæbne

Mogens Mellergård:

Being ill without any diagnosis.

Bibl Læger 2002; 193: 143–53.

During the last decades the pattern of neurasthenia has disappeared from international classifications of disorders, but most of the old complaints have survived in the concepts of dysthymia and chronic fatigue syndrome. The fate of neurasthenia may be explained by the lack of precision in symptomatology and aetiological theories. Many complaints seem to be related to a general feeling of illness and a personal view on severity, and phenomena from this area are often represented in rating scales for the evaluation of general health and quality of life. The paper describes the history of the neurasthenic concepts and it is emphasized that clinical medicine seems to need some patterns of rather low specificity for description and classification of conditions, primarily characterized by subjective distress.

Skyldes den almindelige, fremskridende Parese Syfilis? – En epokegørende dansk disputats i en videnskabelig brydningstid.

Peter Kramp and Gorm Gabrielsen:

Is the General Paralysis of the Insane caused by Syphilis? – an epoch-making Danish doctoral thesis during the encounter of previous and modern scientific thinking.

Bibl Læger 2002; 194: 154–84.

In 1873 the University of Copenhagen accepted the doctoral thesis “Is the General Paralysis of the Insane caused by Syphilis?” by the 29 year old Danish psychiatrist Christian Magdalus Jespersen for oral presentation. He died four weeks later of pulmonary tuberculosis, but the family published the thesis after his death.

During the 1860’s some Nordic psychiatrist suggested syphilis to be an aetiological factor, but influential German and French authors rejected this idea. Jespersen wanted to “prove?” – not to speculate on – that general paralysis is only seen in patients with a previous syphilis, and to do so he carried out an elegant epidemiological study using a statistical way of thinking. Medical statistics had been introduced in Denmark around 1840, but this scientific method was disputed.

Chr. M. Jespersen looked through the records of 123 patients with general paralysis, who had been admitted to a large mental hospital during a period of nine years, but a previous syphilis was recorded in only around 50% of the cases. He also himself thoroughly examined the 34 patients still in the hospital for signs of a previous syphilis and showed that nearly all had such – often modest – signs, which, however, often had been overlooked at the examination at admission. He therefore concluded that even if a previous syphilis was not mentioned in the record, the patient might very well have suffered from this disease. His approach was that even if the patient (apparently) had recovered from a former disease it might still have an influence on the present health of the patient.

In accordance with this approach Jespersen then took advantage of the fact, that almost all of the patients in the hospital had lived their whole life in Copenhagen. If they have suffered from syphilis, they were treated in the city. He collected information about his sample from general practitioners, venereologists and last but not least he looked through all records on patients, who 1840-1870 were treated for syphilis at public hospitals in Copenhagen. Thereby he showed that 77% of the 123 general paralysis patients had syphilis in the anamnesis, and he concluded: “no General Paralysis of the Insane without a previous Syphilis”.

Jespersen stated that a person could suffer from a disease, syphilis, without being “ill”. His contemporary colleagues, however, neither understood his research methods nor his arguments on probabilities.

Around 1910 a connection between general paralysis of the insane and syphilis was established, but actually Chr. M. Jespersen using a remarkably, modern scientific thinking established this connection 40 years earlier.

Syfilis – sygdommen der skabte det dermato-venerologiske speciale

Kaare Weismann:

Syphilis – the disease that created the dermato-venerological speciality.

Bibl Læger 2002; 194: 185–96.

Syphilis appeared suddenly in Western Europe at the turn of the 15th century. It is believed that the crew of Columbus’ three caravels that crossed the Atlantic Ocean in 1492 and returned from “the New World” in the spring of 1493 brought the infection to Europe from Hispaniola. The theory was put forward by the Spanish physician who treated the crew for a disease which he had never seen before. His treatise on syphilis including the so-called “Columbian theory” was not published until 1539, long after the death of Columbus in 1506.

Syphilis spread rapidly as a pandemic due to the many religious wars at that time involving hundred thousands of mercenaries from all over Europe. Due to the spread of syphilis among French troops besieging Naples, syphilis was called the French disease, an unjust but a popular designation still in use.

From the beginning and for the next 400 years mercury was considered an effective remedy for syphilis, although it was well-known that it caused severe and sometimes lethal poisoning. The side-effects were considered inherent to the disease and accepted as an inevitable cost the patient had to pay to combat the much feared plague.

In 1910 salvarsan was introduced in the treatment of syphilis. As with other heavy metals later on introduced, such as neosalvarsan and bismuth there were considerable toxic side-effects of the compounds. They were still in use in the early 1950’s after the introduction of penicillin.

With penicillin therapy the picture changed, treatment of syphilis was now a reality without sequelae and recurrence. Penicillin has remained and still is the mainstay of therapy for all forms of syphilis.

Dermatology evolved as a specialty within medicine because of the frequent occurrence of the disease and its multiple cutaneus manifestations.

Carl Rasch (1861–1935) was a leading Danish dermatologist and syphilologist at the time of the Great War. He wrote an extensive chapter on syphilis in a Scandinavian textbook of internal medicine, which appeared in 1915. It contributed to establish dermato-venerology as a specialty within medicine.

Carl Rasch is still remembered for his textbook of clinical dermatology which appeared in 1905 and in a second edition in 1927 containing high-quality illustrations and figures.

After a significant rise in the frequency of acquired syphilis in the early 1980’s, the number of cases tended to decline as the AIDS epidemic progressed. Within the last years the number of syphilis cases in Denmark has remained below 50 per year. Syphilis, although seldom today, is still a disease which should not be neglected.

Hvorfor vil vi gerne vide, om Grundtvig var maniodepressiv

Per Vestergaard:

Why do we wish to know if Grundtvig suffered from a manic-depressive illness?

Bibl Læger 2002; 194: 197–203.

Nikolaj Frederik Severin Grundtvig (1783–1872) was one of the most influential spiritual characters of 19th century Denmark: A prolific hymn writer, a religious leader, a great teacher, and an author of numerous books on the history of the church, of Denmark and of the World. Much of Grundtvig’s writing has continued to influence religious and spiritual life of the Danes ever since his death. The majority of hymns song in Danish churches today are from his hand. Grundtvig suffered from a manic-depressive illness with clear evidence of both depressive and manic episodes and the likelihood of long hypomanic periods in the time between full-blown episodes. Grundtvig’s psychiatric illness certainly influenced his work with regard to quantity, he was enormously productive and with regard to quality, he produced religious poetry of great beauty and everlasting significance but also an even greater number of insignificant and boring common verses. Grundtvig’s life and writing is a well documented example of the interesting interplay between psychiatric illness and artistic creativity undisturbed by pharmacological as well as formal psychological interventions.

Forsidebillede: Hans Holbein d. Yngre (?1497– 1543). Portræt af en ung mand, dateret 1525.