Abstracts fra Bibliotek for Læger 3/2011

Originalartikel: Behandling og pleje af syge og sårede danske soldater i 1864-krigen
Anton Marckmann

 

Treatment and care of sick and wounded Danish soldiers in the war of 1864 

Bibl Læger 2011;203:190-218. 

                    

The Danish military sanitary forces were not adequately prepared and short of physicians, when the Prussian-Danish war broke out on February 1st 1864. Therefore, general practitioners and medical students with limited clinical experience were recruited for military service. In addition, experienced military surgeons from Norway and Sweden volunteered on the Danish side. The nursing staff consisted primarily of untrained male volunteers. Later on, the Danish queen initiated the inclusion of a few female nurses from Sweden. Patients were treated in camp hospitals divided into three categories: those close to the front, those in safe distance from the frontline, and those far away, i.e. in Copenhagen. Frontline camp hospitals were equipped with mobile units (“ambulances”), led by experienced surgeons. Limb amputations, removal of shell fragments and bullets, as well as revision and closure of wounds were the most frequent surgical treatments. The mortality following amputations was high (at least 33%), and infections, gangrene and shock were commonly seen. Periodically, the troops suffered from contagious diseases such as intestinal infections, which caused many deaths. Diseases of the thorax were frequently seen among the soldiers, as were scabies and syphilis. In total, an estimated 6-15% of the soldiers were unable to fight because of wounds or sickness. After the war, disabled soldiers received pensions according to their grade of invalidity.

 

 
Originalartikel: Spedalskheden og det danske sundhedsvæsens oprindelse
Jesper Boldsen

 

Leprosy and the origin of the Danish health care system.

Bibl Læger 2011;203:219-33. 

 

Infectious diseases have been shaping the pattern of mortality ever since the end of the last Ice Age. Most infectious diseases leave no specific traces on the skeleton. However, leprosy is an exception. Epidemiological analyses have facilitated the estimation of the frequency of leprosy without assessing individual disease status. Based on skeletal samples from five sites in the Danish city of Odense – four samples from ordinary cemeteries and one from a leprosarium – it can be demonstrated that leprosy was present at high frequencies in the city from its foundation in the late 900s A.D. to the first half of the 14th century. The high frequencies of leprosy in combination with the increasingly high level of administrative organisation of the Danish society lead to the establishment of leprosaria in the second half of the 13th century. It appears that the quarantine imposed on sufferers of leprosy reduced the rate of transmission of the infection and eventually lead to the eradication of leprosy in Odense some 75 years after the establishment of the first leprosarium. The leprosaria, thus, form the earliest examples of a health care system in Denmark. 

 
Et billede fra min hverdag
Morten Grønbæk

Originalartikel: Forebyggelse af kroniske sygdomme – den næste store medicinske trium?
Torben Jørgensen

 

Prevention of chronic diseases. The new triumph in medicine?

Bibl Læger 2011;203:236-49.

 

When epidemiologists had identified the central risk factors for cardiovascular diseases and other chronic diseases, huge prevention studies were initiated in the 1970s. One type of study was the high risk strategy, which focused on screening and individualised health counselling, whereas another strategy was mass campaigns conducted as community intervention programs. Literature concluded that none of these strategies were not effective with regard to improving public health. In the 1980s and 1990s focus turned towards the structural strategies to change lifestyle in society, and today the literature points at the conflict of interest between health authorities and corporations within the tobacco, food, alcohol industries etc. 

Taking Geoffrey Rose’s “prevention paradox” as a starting point it is speculated, whether small changes in the whole society have lead to the present situation with a high prevalence of chronic diseases and whether a change towards securing healthy food and daily physical activity in society together with regulation of stimulants like tobacco, alcohol, sugar etc. could direct society towards a more healthy state. A fine balance between corporations and health authorities could secure a more genuine free choice for the citizens than is seen today and thereby support the wish of the majority to conduct a healthy life style. Such a strategy could be compared to The Hygiene Revolution in the 19th century, which is often declared the greatest triumph in the modern history of medicine.

 
Kvartalets genstand
Morten A. Skydsgaard

Forebyggelsesetik
Signild Vallgårda

 

The ethnics of prevention

Bibl Læger 2011;203:252-74.

 

In this article ethical dilemmas in public health are discussed, and three approaches to public health ethics are described. The moral theories in focus are liberalism, paternalism and community-orientated theories; the latter divided into a republican and a socialistic variant. The understanding of humans and society and the underlying ethical principles of the three approaches are discussed, as is the criticism raised by other approaches. The presentation is mainly based on scholarly literature from the USA, where public health ethics have been discussed and analysed much more in depth than in Europe. It is concluded that none of the principles are (or should be) consistently followed in public health policy, and that the present Danish health policy is based on a combination of all three positions.