Last updated: 2008-10-08
DVT 083, 145
Problems of Retrospective Diagnostics in the History of Medicine
Problém retrospektivní diagnostiky v dějinách lékařství
The purpose of the article is to introduce recent insights
in Czech medical history. It begins with a description of
the most important features of a discussion about
identifying medical diagnostics based on historical records.
It sums up recent approaches to this issue, focusing on the
socio-constructivism that has developed during last three
decades and explaining the consequences of this orientation
for modern medical history.
The following section shows how this approach affects our understanding of an “illness.” If we want to deal with historical records, we have to start by redefining our modern construction and disconnecting direct links between modern “medical terminology” and the historical one. Even the most basic terms that we use – “disease,” “well-being,” “illness,” etc. – are tricky to translate and represent a complex net of mutually dependent meanings.
The next part defines those historical phenomena which have, according to the author, important impacts on medical history. These include the development of nosological structures in western academic medicine during the early modern era and the influence of religion.
The last section points out another feature that we have to deal with: Changes in the relation of medical specialists (especially those with academic education) to patients and the transformation of the medical-service market, which was substantially different in the past compared with what we witness today.
history of medicine • methodology • diagnosis
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On Diagnostics in Czech Written Medical Collections of the 15th and 16th Centuries
K diagnostice v česky psaných lékařských sbornících 15. a 16. století
The diagnostic methods of medieval medicine are represented in Czech written manuscript collections above all by uroscopic and hematoscopic treatises from the medical compendium of an unknown Franciscan. The works are a translation of the so called Arzneibuch by Ortolf von Bayerland from the first half of the 15th century, coming from canonic Latin diagnostic procedure (Issac Iudaeus, Aegidius). The Old-Czech doctrine about urine examination and pulse measurement relied on the Latin school tradition. In therapeutically oriented texts, minimal attention is devoted to the description of the signs of diseases. Leprosy is an exception. The signs of diseases correspond to medieval convention, as do diagnostic methods of an experimental character. These Old-Czech collections differ rather fundamentally from the tradition of school medicine in the case of a complication (disease) described as “a nightmare,” which is perceived not as a medical problem but as magic one and as a question of faith. The reason for difficulties is sought not in humoral pathology but in an external aggressor, either a demon (incubus) or a person able to practise sorcery. Only analysis of recommended ritualistic therapies (apotropaic amulets, ritual taboos, inverse courses) brings to light the background of the Old- Czech diagnosis.
history of medicine • Middle Ages • Czech lands • diagnostics • nightmare • leprosy • uroscopy
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Description of Dissection of Melchior’s from Redern Body in Havlíčkův Brod According to Funeral Preachment on September 20, 1600
Popis pitvy a balzamace Melchiora z Redernu v Havlíčkově Brodě 20. září 1600 podle pohřebního kázání
Priest Martin Nussler wrote an extensive German funeral preachment, Zwo Christliche Leich-Predigten (Görlitz 1601), over Protestant Aristocrat, Freiherr (baron) Melchior von Redern (1555–1600). One chapter of the preachment, Kurtze Beschreibung des Proceß, wie es mit der gottseeligen Leiche in Ihrem Leichgang und Begräbniß gehalten worden, presents the results of the dissection together with a short description of the embalment of the deceased, whose funeral took place four months after his death. Besides the fact that it was not usual to add a „postmortem record“ to the funeral preachments delivered and later printed about nobles and townsmen in the Early Modern Times, the yet unknown (in the Czech context) text opens various possibilities of interpretation in different scientific branches. Among answers to other questions, the author seeks a possible diagnosis that could be specified both then and today.
history of medicine • 1600 • Bohemia • funeral preachment • autopsy • diagnosis • postmortem record
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The Level of Diagnostics in the 17th and 19th Century Based on Patients’ Reports of Prague Brothers’ of Charity and “Alžbětinky” Hospitals
Úroveň diagnostiky v 17. až 19. století na základě protokolů nemocných pražských nemocnic milosrdných bratří a alžbětinek
During the 17th century and especially in the 18th century, medical care in the Czech lands changed dramatically. The changes were closely connected with the arrival of the Brothers of Charity in the beginning of the 17th century, first to Valtice (1605) and shortly after to Prague (1620). They founded the hospital for men in the Old Town in Prague (at the site of the medieval hospital of Bohuslav). A hospital specializing in the care of women patients was founded in Prague hundred years later, in 1719, by the “alžbětinky” (catholic religious order of St. Elisabeth) in the Prague New Town in Na Slupi street. The mission of both houses was not charity or the care of the poor and infirm people any more. Rather, ill people (mainly from lower social classes) were professionally treated by trained staff.
The books listing accepted patients have been preserved in the archival records of both medical houses. They provide information about the morbidity and mortality of the Prague population since the 17th (and the 18th – in case of “alžbětinky”) centuries, about patients’ ages, and, to a certain extent, about the social condition of patients. However, above all, recorded diagnoses bring information about the level of medical knowledge and about the development of new knowledge. Single illnesses, for the treatment of which patients were taken to hospital, were not diagnosed exactly. Instead of a „name“ of the illnesses or a cause of death, the place of sickness or accident were given and the symptoms were described. Those descriptions were the same for several illnesses. One illness could be named in different ways, while names for some sicknesses did not need to be (and mostly were not) precise because of the low level of diagnostics. We can find among the most mentioned illnesses unspecified fever and sicknesses of the digestive organs, respiratory and circulation organs. Infectious illnesses were widespread, caused mainly by the poor hygienic conditions of lower social classes. Unusual events, such as epidemics and wars, can be studied in the books of patients as well. The number of patients fluctuated (it was quite low in the period of plague because of hygienic measures, and it increased in the war times) as did the type of illnesses.
history of medicine • 17th to 18th centuries • Prague • hospitals of religious orders • diagnostics in patients’ reports
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Diagnosis in the Diary of Physician Dr. J. Hruš from 1840
Diagnózy v lékařském deníku ronovského lékaře Josefa Hruše z roku 1840
Diagnosis in the Diary of Physician Dr. J. Hruš from 1840 Working diaries of doctors are a very rare source in our country, particularly for the more ancient periods. Hruš’s diary contains data about the number and social origins of patients, the frequency of visits, fees, the monthly income of the doctor, diagnosis, and prescriptions. Of 180 patients, 18 died. The most frequent diagnosis was TBC and typhus. The prescription of remedies could be evaluated only by specialists – doctors and pharmacists.
medicine • 1840s • Czech lands • J. Hruš • diagnosis in diaries
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The Beginning of the Radon Spa, Joachimsthal, Bohemia Part I. Its Organization: impulses and connections
K počátkům radonových lázní v Jáchymově v Čechách 1 Část I. Organizace prvých radonových lázní (impulsy a vazby)
The Beginning of the Radon Spa, Joachimsthal, Bohemia
Part I. Its Organization: impulses and connections
The beginning of the radon spa in Joachimsthal (Jáchymov), Bohemia, is closely connected with research on the radioactivity of spa waters in the Austro-Hungarian Monarchy. As a part of this research, two Austrian physicists, Heinrich Mache and Stefan Meyer, measured radioactivity in samples of water taken from the state-owned Werner mine in Joachimsthal in January 1905. Here, from the mid-nineteenth century, pitchblende (Uraninite) was mined and processed. Using a sample taken from a depth of 375 metres, Mache and Meyer measured the then highest-known concentration of radon in natural waters (185 Mache units of M. u.). Josef Štěp, the director of the mine, continued the measurement of the radioactivity of mine waters in Joachimsthal. In the Werner mine he soon discovered even more active and, what is more important, richer springs. Later named after him, they became the source of naturally radioactive water for the first private radon spa, which was established by Leopold Gottlieb, a district doctor, in Joachimsthal in 1906. The impulse had been provided by the encouraging results of experiments with the medical application of radon baths, which Professor Edmund von Neusser began at Vienna University. Neusser prepared radon baths using radioactive waste material resulting from the manufacture of paint made from Joachimsthal uranium ore. Pierre and Marie Curie were the first to draw attention to these radioactive materials in their paper on the new radioactive element (radium) published in 1898. With the processing of more than twenty tons of the radioactive waste eventually obtained from Joachimsthal, they produced the first concentrated radium preparations.
The radon spa in Joachimsthal aroused great interest amongst the public, far greater than the actual capacity of the first spa. At first, the spa had only two bathtubs. The main obstacle to increasing spa capacity was the limited supply of naturally radioactive water, which was fetched from the Werner mine in buckets in that time. The daily supply of water was enough to prepare only five naturally radioactive baths daily. To satisfy the demand for baths, artificially enriched radon water on Neusser’s model, was also made available. This approach, however, threatened the unique standing of the Joachimsthal spa, which it owed to its natural character.
The possibilities of using the naturally radioactive Joachimsthal waters to establish the state-owned spa in Joachimsthal were discussed at a meeting on 18 January 1907 in the Austrian Ministry of Agriculture, Vienna, which oversaw the administration of the state mines and metalworks until 1908. Professor Sigmund Exner, the chief medical officer, Professor Neusser, the director, and Fritz Dautwitz, an assistant doctor at the Neusser clinic, were invited to the meeting as medical experts.
An important step towards the development of the Joachimsthal radon spa was the laying of four-kilometre-wide water pipe in the Danieli drainage adit, through which the radioactive water from reservoirs at the Štěp Spring in Werner mine was carried out to the surface. Where it emerged from the pipes the water had an activity of about 600 M. u. The pipes discharged the water at a place near the uranium plant. This was used by the state mining and metal works authority (k. k. Berg- und Hüttenverwaltung) to set up a special spa right in the plant. It had four bathing cubicles, which were meant primarily to serve employees of the Joachimsthal mining company. This spa was headed by a doctor at the mines, Adolf Langhans. In 1908, the production of radium also began in Joachimsthal uranium plant. Radium was eventually used to include the other treatments at the state-owned spa. The development of the state spa institute for radium-therapy (k. k. Kuranstalt für Radiumtherapie) at Joachimsthal and the refinement of the medical indications and methods of the spa are considered in detail in the second part of the article.
treatment with radon, beginning of the 20th century, Czech lands – Joachimsthal
© M. Barvík 2008