Leprosy and heredity
Control of scabies in the district of Ytre Nordhordland
Obstetric care in Ytre Nordhordland 1858-87
Wise Men confound the World!
The last victims of smallpox in Ytre Nordhordland
Typhoid fever in the district of Outer Nordhordland
Michael Sars and cholera in Manger 1849
No connection between scarlet fever and gouty fever
Psychiatric patients in private care
Sandvik H. Leprosy and heredity. Reflections of a district physician in 1884. Tidsskr-Nor-Laegeforen. 1992 Dec 10; 112(30): 3799-801
Full text (Norwegian)
During the 19th century leprosy was a serious health problem in Norway, especially in some western, rural districts. In 1856 it was decided that all leprous patients should be examined by the local doctor (District Health Officer), and registered in a national leprosy register. The patients' family relationships received special attention. Some patients tried to avoid registration, fearing that the data might be misused. After Armauer Hansen (1841-1912) discovered in 1873 that leprosy was an infectious disease, isolation of leprous patients was enforced. In 1884 Thomas Collett (1835-1898), the local doctor in a rural district of western Norway, carried out a survey of all leprous patients registered in his district, a total of 164 patients. The data from his survey provide convincing support for the view that hereditary factors play an important role in the development of the disease. Modern research has confirmed that an important gene controls the susceptibility to leprosy.
Sandvik H. Control of scabies in the district of Ytre Nordhordland. An experiment within community medicine in the 1860's. Tidsskr-Nor-Laegeforen. 1993 Jan 10; 113(1): 40-3
Full text (Norwegian)
19th century Norway may be likened to the developing countries of today. Scabies was very prevalent, and traditional approaches to treatment were in vain. The poor peasant population would not spend money on such. Thomas Collett (1835-98), the local doctor in a rural district of western Norway, initiated a programme for community control of scabies. The local Board of Health agreed to purchase a large amount of sulphur ointment. 1/8 of a barrel of ointment was placed at the disposal of local teachers. The teachers were instructed to initiate treatment of school-children who were found to be infected with scabies. The household to which the child belonged was also to be treated, as well as the other children at the school. Gradually, the prevalence of scabies declined. Self-care increased, and eventually, the peasants ended up making their own sulphur ointment. Experiences and recommendations from developing countries of today agree with the strategy adopted by Collett. Individual medical treatment of cases and their contacts is too costly, and fails to reduce the total prevalence of scabies.
Sandvik H. Obstetric care in Ytre Nordhordland 1858-87. A comparison with national statistics. Tidsskr-Nor-Laegeforen. 1993 Dec 10; 113(30): 3715-7
Full text (Norwegian)
In Ytre Nordhordland, a rural district of western Norway, the number of stillbirths and maternal deaths was 50-60% above the national average. Local unskilled midwives assisted with deliveries, but were of little use in the event of complications. The first educated midwife was appointed in 1860, the second in 1874. In this study, multiple regression analyses were undertaken to examine how educated midwives and obstetric operations influenced maternal mortality and the number of stillbirths during the 30-year period 1858-87. The explained variation was 42% for stillbirths, but only 6% for maternal mortality. While the number of skilled midwives was associated with fewer stillbirths, the opposite was found for obstetric operations, probably because obstetric operations were reserved for the most extreme cases. It is concluded that the local doctors' struggle for appointment of educated midwives was of greater importance than their obstetric skills.
Sandvik H. "Wise Men confound the World!". A district physician's struggle against superstition and sorcery in the 19th century. Tidsskr-Nor-Laegeforen. 1993 Nov 30; 113(29): 3572-4
Full text (Norwegian)
When Michael Krohn (1822-97) was appointed district physician in Ytre Nordhordland in 1855 he had to fight hard against local witchcraft. Health education became his main strategy. He gave a series of lectures to the local Board of Health and also invited the schoolteachers to the meetings. The prejudiced local politicians neglected the school system and actively opposed the propositions he put forward. Nevertheless, a generation later the witches had disappeared. Health education can take some credit for this result, but probably the most important factor was simple trust.
Sandvik H. The last victims of smallpox in Ytre Nordhordland. Experiences of a local physician. Tidsskr-Nor-Laegeforen. 1993 Jun 30; 113(17): 2096-8
Full text (Norwegian)
Smallpox caused devastating epidemics in Bergen and surrounding areas down to the early 19th century. A few attempts at variolisation were performed after 1765, and vaccination started in Bergen during a new wave of smallpox in 1803. The more distant rural parish of Manger did not start vaccination until 1829, and was heavily struck by the 1803 epidemic. That year, 208 died out of a total population of 3500. In 1859 Manger again experienced a serious smallpox epidemic. The local doctor ordered mass vaccination, but the peasants were uncooperative, and the campaign was even sabotaged by the assistant vaccinator. Eventually, 27 people died of smallpox that year, the last persons ever to die of smallpox in Manger.
Sandvik H. Typhoid fever in the district of Outer Nordhordland. Ways of transmission, incidence and mortality 1854-1883. Tidsskr-Nor-Laegeforen. 1993 Jun 20; 113(16): 1990-3
Full text (Norwegian)
Typhoid fever was endemic and unmatched in causing the heaviest workload for the local doctors. Around 1870 the incidence suddenly dropped by 2/3. Before that it had been highest in April and subsequent months. After 1870 typhoid fever became most prevalent in the winter, as in other places. The reason for this shift in incidence was probably the cessation of the spring herring fisheries, from which many fishermen used to return with typhoid. The case fatality rate was approximately 5%, only half of that found elsewhere, and what is regarded as a normal case fatality rate for untreated typhoid fever. This was probably due to the endemic state of the disease. Sick infants probably died undiagnosed while older children may have developed milder forms of the disease. Most deaths were found among adolescents and young adults.
Sandvik H. Michael Sars and cholera in Manger 1849. Tidsskr-Nor-Laegeforen. 1993 Mar 30; 113(9): 1082-5
Full text (Norwegian)
In December 1848, cholera struck the city of Bergen, Norway. During the following months the distant parish of Manger was also affected. The local doctor was among the first victims, and although he survived, he was unable to take part in the fight against the epidemic. Instead, the local priest, Michael Sars (1805-69), took command of the situation. He organized new graveyards, materials for coffins, medicines, a cholera doctor from Bergen, and a local cholera hospital. Some of the peasants who were unwilling to comply with the regulations for burial of cholera victims were reported to the police. Michael Sars left the priesthood in 1854, and was appointed professor of zoology. He became one of Norway's most famous marine biologists.
Sandvik H. No connection between scarlet fever and gouty fever. Historical analysis from Ytre Nordhordland during 1862-1884. Tidsskr-Nor-Laegeforen. 1992 Dec 10; 112(30): 3803-5
Full text (Norwegian)
In 1987 there was an unexplained increase in severe streptococcal diseases in Norway and other western countries. In Norway this increase was not accompanied by a corresponding increase in acute rheumatic fever. This study investigated the occurrence of scarlet fever and acute rheumatic fever in a rural district (approximately 15,000 inhabitants) of western Norway during the years 1862-1884. Four epidemics of severe scarlet fever occurred during this period. The local doctor treated 1,155 patients (96% children), of whom 154 (13.3%) died. Acute glomerulonephritis with subsequent kidney failure seems to have been a major cause of death. During the same period 76 patients (96% adults) were treated for acute rheumatic fever. These cases were not related to the severe epidemics of scarlet fever. It is probable that different, co-circulating strains of streptococci caused the infections, which were followed by glomerulonephritis and rheumatic fever. It is possible that rheumatic fever was caused by the strain that induced the more benign "Angina tonsillaris".
Sandvik H. Psychiatric patients in private care. Historical analysis from a municipality in western Norway. Tidsskr-Nor-Laegeforen. 1990 May 20; 110(13): 1666-8
Full text (Norwegian)
Radoy, an island (4,500 inhabitants) in Western Norway, has traditionally accepted many psychiatric patients for care in foster homes. Since the end of the 19th century, 855 patients placed in foster homes have been registered. Only 7% of these were original inhabitants of Radoy. The mean duration of stay was 13 years (median: 9). The tendency has been towards longer periods of stay, older patients, an increasing number of female patients, and more schizophrenic patients. It takes on average nine months (median: 5) after cancellation of the foster contract before the patient receives alternative accommodation. The waiting period for a place in a nursing home is especially long. This problem must be solved if care in a foster home is to be a suitable alternative in the future.
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