Abstracts fra Bibliotek for Læger 2/2006

Originalartikel: En fysikus i Århus og hans patienter. Stiftfysikus Christopher Ditlev Hahns patientjournaler omkring 1800.

Henrik R. Wulff & Kirsten Jungersen

A physician in Aarhus and his patients around 1800. The patient records kept by Christopher Ditlev Hahn, medical officer of the Aarhus Diocese

Bibl Læger 2006; 198: 145–79.

More than 2000 patient records (bound in 27 volumes) from the practice of Christopher Hahn (1744–1822) are to be found in the archives of the Medical Museion in Copenhagen. Hahn was born in Haderslev, graduated from Halle and set up as a medical practitioner in Aarhus in 1767. In 1767 he was appointed medical officer and he describes his duties in a report to the Health Commission in Copenhagen in 1804. The patient records, most of which date from the period 1790 to 1814, are ordered alphabetically according to diagnosis, which reveals that they were not sorted and bound until the end of his career. Many of Hahns patients belonged to the local aristocracy and upper classes, including a former Prime Minister and his family.

The records, which were kept as meticulously as hospital records, contain information about diagnosis, name, occupation/title, history, present illness and physical findings (often limited to inspection of tongue and palpation of pulse) followed by a brief entry for each visit. They are written in Latin (Tables 1 and 2). We studied, in particular, the 105 records from 1806 and analysed all entries and prescriptions in a number of these. The diagnoses were highly individualised, reflecting the clinical picture of each patient. Often the assumed causes of the disease are noted, e.g. weather conditions, diet, mental state, lifestyle, retention of waste products (constipation). The median number of visits to each patient was 12.3 (range: 1 to more than 60).

A number of cases are described in detail in this paper, including cases of quinsy, whooping cough, dropsy, “false” pleurisy, variolation and vaccination. Hahn was found to use a large number of remedies, including those prepared from the plants listed in Table 8. He favoured evacuative treatment of fever patients by means of emetics and a variety of laxatives, and usually his reason for preferring one drug to another in a particular case cannot be determined. Other drugs said to have e.g. stimulating, sedative, diuretic and sudorific effects were also used. Patients were rarely treated in exactly the same way.

Blood letting was done immediately when the pulse was described as »hard«. The treatments used may have been ineffective, but were generally harmless, and the patients undoubtedly appreciated Hahns individualised care.

 

Originalartikel: E.H. Starling, hormonbegrebet og den manglende Nobelpris. Forelæsning holdt på The Royal College of Physicians, London, den 18. juli 2005,i anledning af 100-året for Starlings Croonian Lectures.

Jens H. Henriksen:

E.H. Starling, the hormone concept and the missing Nobel Prize.

Bibl Læger 2006; 198: 180-200.

The pre-eminent achievements of the English physician and physiologist Ernest H. Starling were his quantitative explanation of the transcapillary transport of fluid, the discovery of the first hormone, secretin, and his formulation of the law of the heart. He introduced the term “hormone” in a series of Croonian Lectures at The Royal College of Physicians, London, in 1905 and he formed a great vision of “chemical correlation of the body” that has set the agenda for medical research for over a hundred years. He was nominated for the Nobel Prize in Physiology or Medicine on four occasions, but did not receive the prize. The chief reason was not a great pressure from more important discoveries, or from more evident candidates. The most obvious hindrances were: 1) suspension of Nobel Prizes during World War I, 2) stringent interpretation of a “recent discovery” and “outdated achievements” by the Chairman of the Nobel Committee and his strained relation to Starling, and 3) lack of nominations from British scientists. In some ways Starling was an outsider, and he was the centre of several scientific and social controversies, which may also have contributed negatively. The hormones have stood the test of time, and the rigorous interpretation of a “recent discovery” has been changed.

 

Originalartikel: Den gyldne legende og det sorte ben. En beretning om kirurgernes skytshelgener – Skt. Cosmas og Skt. Damianus.

Daniel Andersen

The golden legend and the black leg. An account of the patrons of surgery – St Cosmas and St Damianus.

Bibl. Læger 2006; 198: 201–15.

A painting of Fra Angelico represents the two brother-saints St Cosmas and St Damianus tending a male patient with a black leg (Fig. 1). One might think that the leg was gangrenous and that the saints were about to remove it. Actually they are implanting the leg of a dead Moor on the patient as a replacement for his own leg – ulcerated by a tumour. The painting is an illustration of a famous account in The golden legend by Jacobus Voragine (1226–1298) – a medieval best seller second only to The holy bible.

This very early notion of an allotransplantation has earned the saints the patronage of the surgeons. They were especially recognized in France where the Confrèrie Saint Côme et Saint Damien des Maîtres Chirurgiens de Paris was established in 1268. England got its The Barbersurgeons Company of London in 1461 and Denmark had its first confederation dedicated to the saints in 1515.

The brothers who lived and were martyred in Egea in Cilicia in Asia Minor in the 3rd century A.D. prided themselves on rendering their services gratuitously, and a severe quarrel erupted between them when Damianus reluctantly accepted a modest gift from a thankful patient (Fig. 2).

St Cosmas and St Damianus did not gain wide popular recognition in Denmark, but a few fresco paintings presenting the brothers with one of their attributes – an ointment jar – can be seen in Danish churches (Fig. 3).

 

Originalartikel: Da selvudvikling blev en del af den psykiatriske behandlingspraksis i Danmark.

Thomas Hansen, Anders Christensen & Peter Triantafillou:

When self-development became part of the psychiatric practice in Denmark.

Bibl Læger 2006; 198: 216–42.

The article examines how psychological, pedagogical and social elements became part of the psychiatric practice in Denmark from the 1940s.

Before that, psychiatric treatment had been predominantly informed by biological theories of heredity. The new elements presumed that the “mentally ill” through the work on a knowledge about himself would be able to develop the capacity for selfcare, responsibility and autonomy.

Today, these principles are regarded as a self-evident part of the psychiatric pratice in denmark. However, the emergence of these new principles was the result of conflictual and contradictory historical process that cannot be reduced to an evolutionary march towards a more true and/or humanistic treatment of mentall illness.

 

Forsidebillede: Christopher Ditlev Hahn og en af hans sønner.