The first intensive care unit in the world: Copenhagen 1953

After an extensive survey of the medical literature we present compelling evidence that the first intensive care unit was established at Kommunehospitalet in Copenhagen in December 1953. The pioneer was the Danish anaesthetist Bjørn Ibsen. The many factors that interacted favourably in Copenhagen to promote the idea of intensive care therapy, half a century ago, are also described.

[Annual report of the Subotica Municipal and Eye Hospital for 1889]

INTRODUCTION

The paper is the translation of the report of the Head physician of the Municipal Hospital in Subotica for 1889. It shows the number of patients, the number of checkups, the number of outpatients and inpatients, distribution by sex, age, place of residence, the frequency of patients by months and groups of diseases, the average length of treatment, the number of cured, unsuccessfully treated and deceased patients, the most significant surgeries, the number of doctors employed and a detailed survey of groups of diseases.

ANNUAL REPORT

From January 1, to December 31, 1889, 6.123 patients were treated, 5.141 outpatients and 982 inpatients; 24.644 visits, 69 patients on average, 2.884 men and 2.257 women; 662 under 1 year of age; 828 aged 1 to 5; 1.655 aged 5 to 20; 1.854 aged 20 to 80; 142 patients over 80 years of age. 4.260 patients were from Subotica and 881 from other parts of the country. 19.436 patient days were required, 19 3/4 on average. 747 patients were cured, condition improved in 132, 60 were unsuccessfully treated and 43 patients died. Cerebral and spinal cord diseases occurred in 73 outpatients and 38 patients (the same distribution: outpatients + inpatients goes for all diseases, respectively); nervous system diseases 82 + 18; ear diseases 139 + 2; eye diseases 1706 + 220; nose diseases 12 + 0; respiratory tract diseases 478 + 95; circulatory system diseases 35 + 13; lymphatic system diseases 51 + 5; mouth and throat lumen diseases 207 + 9; coronary diseases and diseases of intestinal mucosa 711 + 18; genitourinary tract diseases 252 + 66; skin diseases 440 + 107; muscle, gland and tissue diseases 104 + 23; joint diseases 75 + 16; bone diseases 56 + 20; acute infectious diseases 344 + 43; chronic infectious disease 143 + 137; general nutritional disorders 222 + 43; poisonings 3 + 2; childbirths 8 + 6.

The development of nursing at the General Hospital, Birmingham, 1779-1919

In 1996 the archives of many of the Birmingham hospitals were deposited in the Birmingham Reference Library. This has afforded nurse historians the opportunity to conduct research into the development of nursing in the city. This is to be welcomed as there is little published work regarding nursing in Birmingham. This paper examines the development of nursing from the Hospital's opening in 1779 until 1919. By the latter date, a modern system of nursing, consisting of a disciplined, salaried and well-trained staff, managed to a greater degree by nurses had emerged in the Hospital.

Midwifery in the Belfast City Hospital

The process of improving midwifery services for poor women in Belfast was a slow one. Traditional midwives were gradually supplanted by midwives who were trained and controlled by the medical profession, but it was many years before the problems of puerperal infection were brought under control in the new institutions.

[The eye department at Copenhagen municipal hospital. Part 3: the epoch of Braendstrup, 1957-1980]

Poul Braendstrup (PB 1912-80) was the best qualified to become head of the eye department at Kommunehospitalet (KH) in 1957, with an eminent great scientific production. He continued this work all his life. Three assistant doctors with different specialities were appointed 1966-72: M. Norn (external eye), K. Norskov (strabism) and Sv. E. Lorentzen (retina). Reasons for the ideal cooperation in the department are described (staff-meetings, christmas-staff-arrangements, meetings, courses etc). The number of operations increased steadily in the period, especially cataract-extractions. The newest techniques and instruments were used (cornea-grafting, vitreous surgery, xenoncoagulation (PB study tour in 1962) before laser-treatment etc). The scientific production increases, surpassing Rigshospitalet after 1967. The education was effective at all levels: In the eye-department, doctors evenings, A-and B-courses for eye specialists to become, referring eye specialists, students (from 1972 as an independent part (sect IV) of the University of Copenhagen with an ordinary professor from 1975). It was disturbing with the many removals at KH and at last the final total removal to KKHH (Hvidovre), causing loss of some of the best staff members, instrument breaks, increasing waiting lists up to one year, inconvenience for the patients and many other difficulties. This could be a warning against the continued great movings of departments in Copenhagen (H:S). The administration is criticised. PB's rationalisation of the duty-plan for all Copenhagen eye departments already from 1966 independent of the administration is mentioned.

The London County Council Nursing Service 1929-48: the significance of the nursing leadership

'On the vesting day of the National Health Service, the LCC handed over to the NHS the largest and most comprehensive hospital system under a single authority that existed in the world' (1). The careers of the Matrons-in Chief, Dorothy Bannon and subsequently Rosalie Dreyer, demonstrate that the LCC had been able to attract nursing leaders from the voluntary hospitals. Both were able to use their new position within the LCC hierarchy to promote the interests of nursing. They took this opportunity to develop a nursing service which became a model to rival the hegemony of the voluntary hospitals.

[The insulin preparation - Diasulin - that annoyed August Krogh]

After the two Canadian researchers, Banting and Best, had succeeded in extracting the pancreatic hormone, insulin, from bovine pancreatic tissue in 1921, August and Marie Krogh brought insulin to Denmark on 12 December 1922. With H.C. Hagedorn, who at the time was senior registrar in the III Department of Kobenhavns Kommunehospital (Copenhagen Municipal Hospital), August Krogh immediately began experiments to produce insulin, and already on 21 December, they succeeded in isolating a small amount of insulin from a bovine pancreas. August Kongsted, owner of Lovens Kemiske Fabrik (Leo Chemical Factory), paid the expenses for the experiments and afterwards helped to start the production of >>Insulin Leo<<. At the start, there was not enough insulin to treat all the diabetics in Denmark, and since Hagedorn was employed in the III Department of Kobenhavns Kommunehospital, this department was the first that had insulin at its disposal. Krogh made it clear that it would probably take several months, maybe even a year, before insulin would be available for all the diabetics in the country. The II Department of Kobenhavn Kommunehospital could not accept this, and as early as May 1923, this department began to treat diabetics with Diasulin Medicinalco, a pancreatic hormone preparation manufactured by H. L. Gad Andresen at Det Danske Medicinal- og Kemikalie-Kompagni (Danish Medicine and Chemical Company). Later Det Danske Medicinal- og Kemikalie-Kompagni began to sell Diasulin under the name Isulin Medicinalco.

[Health anthropology and hospital archiving. The Museum of Pathological Anatomy of the City Hospital of Trieste]

The preparations found in the Trieste Hospital Museum of Pathological Anatomy fit into the context of a medical semiotics which has its origins in the anatomical clinical method. The study of the practices involved in the museum preparation leads back to its purely diagnostic function inasmuch as it convalidates or contradicts the suppositions that, from the symptomatological case history, made from the study of the lesions and the diseased organ. This whole investigative process corresponds to a break in the field of scientific knowledge which marks the birth of a new approach to diagnosis and a new form of nosology, made possible by the great number of sick people and deaths available in a modern hospital. The Museum is permeated with empiricism, morphologism and localisation, and its exhibits fluctuate between macroscopic and microscopic anatomy, between organic and cellular pathology. In the exhibits of infectious and contagious diseases, one can see traces of the revolution brought about by bacteriology and laboratory techniques; in the considerable collection of malignant tumours, one can detect an oncological awareness which relates explicitly to a nosology based on the work of Virchow. The preparations which refer to pathologies that cannot be reduced simply to localisation illustrate an increasing awareness of functional medicine and clinical biochemistry. The Museum has the task of showing and teaching in order to train the hospital doctor. The Museum--through pathological anatomy--directed the community towards a knowledge of healthcare methods destined to change the morbidity and mortality rates due to a certain disease, in relation to those diseases typical of the times.

[Neurology in Paris hospitals, particularly the Salpêtrière before Charcot: Rostan on brain softening]

In the beginning of the 19th century, many studies were devoted to the diseases of the nervous system in France, long before the work of Charcot. The researches of Léon Rostan on the cerebral softening (1819, 1823) were based on the anatomoclinic method developed by the School of Paris whose most famous representatives were Corvisart and Laennec for the study of heart and lung diseases. The researches of Rostan were performed in the Salpêtrière hospital which was, at this time, an hospice for old women. Rostan was appointed Inspector of the Health service in the Salpêtrière hospital in 1812 then Head of a department in 1818. He was 28 year old when he published his book "Researches on the cerebral softening" in 1819. Rostan was the first to describe the spontaneous cerebral softening as a special anatomoclinic entity distinct from encephalitis and apoplexy. He compared this entity to the senile gangrene and stated that it was related to the ossification of cerebral arteries. He described the pathologic features of the brain softening and also its clinical symptomatology in opposition to that of apoplexy. The concept of brain softening according to Rostan was harshly fought by the followers of the Broussais's physiological medicine (from Lallemand, 1830 to Calmeil, 1859) who claimed that all brain softenings were due to the inflammation process and thus should be described as encephalitis. In opposite, the ideas of Rostan were accepted and developed by others such as Carswell in England (1835), Abercrombie in Scotland (1836) and Andral in France (1827, 1840). These authors agreed that some type of cerebral softening was related to a disease of the arterial system. Nevertheless, the modern concept of brain softening was not definitively accepted before the description of the thromboembolic mechanisms by Virchow in Germany (1856) with the help of the microscope, and the anatomoclinic studies of Proust, Laborde and Prevost and Cottard in France (1866). The book of Rostan was dedicated to the "Conseil Général des Hospices" which was created in 1801 to unify the administration of the hospitals in Paris and became the "Administration Générale de l'Assistance Publique à Paris" in 1849. One hundred and fifty years after its publication, the work of Léon Rostan was outstanding by its modernity of the form as well as the substance.