Health Care in the Past - Sweden

Childbirth and Midwifery

In the past, all babies were born at home with the help of a skilled local woman. In Sweden, she was called a “jordemor” and was the midwife of the time. A “jordemor” had no formal medical training, but was an elderly 'wise woman' with experience and knowledge of childbirth, often passed on from mother to daughter. The modern term in Sweden for midwife is “barnmorska”. Childbirth and childhood illnesses were not without problems, especially when medical care was not available. It was not uncommon for pregnant women to die in childbirth (“död i barnsäng”). One reason for this was pre-eclampsia (Swe: havandeskapsförgiftning), which led to high blood pressure and often a significant amount of protein in the urine (Swe: äggvita i urinen), which was serious. Other complications were cephalopelvic disproportion, CPD, (Swe: bäckenförträngning) and exsanguination (Swe: förblödning). After delivery, infections such as puerperal fever (Swe: barnsängsfeber) were a problem. In 1750, about 1% of women delivered died, while in 1850 the figure was down to 0.5%. As early as 1708, a form of midwifery training (barnmorskeutbildning) was started in Stockholm by the physician Johan von Hoorn, and around 1711 a midwives' guild was formed. However, before the opening of the Seraphim Hospital in 1752, a midwife could only graduate as an apprentice to a professional colleague. According to the Stockholm regulations of 1711, the prospective midwife had to spend at least two years as an apprentice, then report to a physician and be evaluated by him to find out whether she was "tenable and capable". After the apprenticeship, she was graduated from the Collegium Medicum (A designation for medical societies with the purpose of supervising the medical profession). Towns and cities were urged in 1750 to keep at least 1 trained midwife. The training was to take place in Stockholm. However, the licensing requirement for rural midwives was abolished at the request of the peasantry just three years later because the rural parishes did not want to pay for their midwives to travel to Stockholm. In Gothenburg and Lund, midwifery training was introduced at the end of the 18th century. In Stockholm, the Pro Patria Maternity Hospital opened in 1774 and the General Maternity Hospital (Allmänna Barnbördshuset) in 1775, while in Gothenburg, the Sahlgrenska Hospital opened in 1782 with a maternity ward. The maternity hospitals (BB) also functioned as training units for both physicians and midwives. After childbirth, the mother had to rest and the Churching of the woman delivered could only take place until after 6 weeks. Then she was considered "pure" after childbirth and could be readmitted to the congregation. Puerperal fever or childbed fever (barnsängsfeber) was a bacterial infection that could affect newly delivered women, usually caused by poor hygiene during delivery, such as unclean hands and instruments. The affected woman developed sepsis (blodförgiftning ) with high fever and rapidly deteriorating general condition. The mortality rate was high. When it was realized that higher hygiene in childbirth was of paramount importance, the risk of childbed fever decreased significantly. In the mid-19th century, several discoveries pointed to the importance of cleanliness in childbirth, for example in Austria. In Sweden, in 1870, physician Wilhelm Netzel at the General Maternity Hospital (Allmänna Barnbördshuset) in Stockholm confirmed that fever was spread by midwives and doctors carrying unclean instruments with organic substances. The hygienic procedures he introduced had a good effect. In 1879, procedures were tightened and midwives were required to wash their hands in a solution of carbolic acid (Phenol) before performing procedures. For most of the 19th century, science was aware that bacteria caused many diseases. Despite this, anti-bacterial treatments were not available. In 1867, Englishman Joseph Lister published an article on antiseptic wound treatment in The Lancet. Infant mortality was high. In the mid-17th century, about one-third of all children died before the age of 5. By the mid-19th century, however, the figure was down to a quarter, but that must still be considered high. An overriding cause was a nutritional deficiency and poor nutritional status (often protein deficiency). In years of famine, this was evident. Pneumonia and diarrhea diseases were common causes of death. Diarrhea caused dehydration. Dysentery was a bacterial intestinal infection that caused severe bloody diarrhea. Malnutrition combined with common infections could be devastating for children. Measles is a viral infection that is normally not dangerous but which, combined with malnutrition and poor immunity, could lead to death. Before antibiotics were available, scarlet fever could lead to serious and fatal infections.

Physicians

A physician is a person who has graduated from a university medical school after completing a professional program. Thereafter, the graduate can be employed as a doctor. At the beginning of the 19th century, there were about 200 doctors qualified in Sweden. In 1800, the population of Sweden was 2,347,303 (Source: SCB). Physicians existed early in Sweden but they lived in the cities and were for the rich. Furthermore, their knowledge was very limited by today’s standard and no effective medicines such as antibiotics were available. Rural areas were largely lacking competent medical staff. Only in exceptional cases could a town surgeon or field surgeon be persuaded to make an arduous and costly journey to see someone sick in a village. Instead, peasant society had to rely on old household remedies that were often mixed with a large portion of superstition. It was usually the parish minister or his wife who had to respond to the sick call, and in the saddle pocket, the parish minister had suitable medicines alongside the communion vessels, intended for the sick person on his deathbed. The first provincial physicians (provinsialläkare) began their activities at the end of the 17th century. In 1774, these activities were nationalized. There were then 32 provincial physicians, all based in the towns. In 1732, when professor Linnaeus made his Lapland journey, he passed the northernmost dispensary in the city of Gävle and was the last provincial physician in the north. A Provincial physician was a position for medical officers who acted as district physicians. The title has been used since the 17th century for government, especially established medical posts. An instruction for provincial physicians was issued in 1744, but the services were only given a fixed organization by the 1773 Medical Act. The number of provincial physicians was then 32. Such services were then (with some exceptions) available in all the county seats of Sweden. In 1890, there were 211 provincial physicians and 73 district physicians (not government physicians) in Sweden. Provincial physicians thus had a specific station (place of stationing) and district of service, and their task was to assist the public with private medical care. Extra provincial physicians had the same duty as regular provincial physicians but were paid in full or in part by municipalities. In each county, there was also a head provincial physician, paid by the government, with overall responsibility for the county's general health care. In 1973, the term "provincial physician" (provinsialläkare) was replaced by "district physician" (distriktsläkare).

Nurses

Nursing education began in 1884 at Sophiahemmet in Stockholm. Sophiahemmet opened on 1 October 1889 in Östermalm, Stockholm. The construction of the hospital was made possible by a donation from King Oscar II and his consort Queen Sophia, and the hospital was named after Queen Sophia. Sophiahemmet then became Sweden's first private hospital with a total of 60-70 beds. The hospital contained housing for 40-50 nurses. The activities of the Sophiahemmet go back to the foundation of the "Home for Nurses", which was inaugurated by Queen Sophia on 1 January 1884. The aim was to train nurses. The image to the right shows Sophiahemmet (Sophia Hospital) in Stockholm in 2006. Image: Wikipedia. A nurse trained at Sophiahemmet is called a "Sophia sister" and they are well known for maintaining an established uniform, which includes an apron and cap. The length of nursing education has historically varied between one and a half and three years. In Sweden, professional licensing for nurses was introduced in 1960, and the professional title then became certified nurse (legitimerad sjuksköterska). The image to the left shows a so- called Sophia sister (nurse) sometime between 1889 and1915. Image: Wikipedia. One nurse who has made a great impression in history is the English woman Florence Nightingale (1820 - 1910). She is known for her efforts during the Crimean War (1853 - 1856) where she worked at a cottage hospital. She succeeded in reducing the mortality rate in military hospitals in Crimea from around 42% to 2% by improving the unhygienic conditions in the hospitals. In 1860 she founded the Nightingale School of Nursing for nurses in London. Her work was to influence the work of nurses around the world.

Hospitals

A hospital (Swe: sjukhus) is an establishment for primarily inpatient care. An older Swedish term is “lasarett” (General hospital). Sweden's earliest monastic hospitals were called “helgeandshus” or “hospital” and were usually a common gathering place for the poor and crippled as well as the mentally and somatically ill of all kinds. Royal decrees in 1765 and 1776 ordained that county hospitals (länslasarett) should be established throughout the realm in combination with special “kurhus” wards (treatment of venereal diseases). The image to the right shows a hospital ward in the past. Photo Hans Högman, 1998. Medicinhistoriska museet, Stockholm (Medical History Museum). The first hospital in Scandinavia, the Akademiska sjukhuset (the Uppsala University Hospital), was opened in Uppsala in 1708. In the 1750s there were 6 beds, and by the turn of the 1800s, the hospital was able to take 10 patients for clinical care. In 1752, the Serafimerlasarettet (the Seraphim Hospital) was inaugurated on Kungsholmen in Stockholm. The hospital was the first proper institution in Sweden, dedicated exclusively to the cure of diseases. It was also the first teaching hospital in the country. The hospital initially had only eight beds, but by 1765 the number of beds had grown to 44. In Stockholm, Allmänna Barnbördshuset (the General Maternity Hospital) opened in 1775. At the time of its opening, it had 17 beds. The maternity hospitals (abbreviated BB in Swedish) also served as training units for both doctors and midwives. In Gothenburg, the Sahlgrenska Hospital opened in 1782 (founded in 1772 but only opened in 1782). In Sweden, county hospitals have been called "länslasarett", while other health care institutions were called "sjukhus", such as Sabbatsberg Hospital in Stockholm, Uppsala University Hospital, Sahlgrenska Hospital in Gothenburg, and Malmö General Hospital. The 1808 Army Field Medical Regulations refer to the army's hospitals as "sjukhus", not "lasarett". In 1907, there were 75 hospitals in Sweden with a total of 8,631 beds. In 1907, 79,372 patients had been treated at these hospitals. Furthermore, at the same time, there were 73 smaller hospitals and infirmaries in towns and in countryside with a total of 999 beds. In 1907, no county lacked hospitals, most of them had several. The population of Sweden in 1900 was 5,136,441. The image to the left shows an ongoing treatment of a patient at the Seraphim Hospital (Serafimerlasarettet) in Stockholm in 1898. Because effective treatment was often lacking, diseases that are now easily treatable could often lead to death. Many diseases were due to poor hygiene often combined with large crowds. When soldiers were gathered into armies, more soldiers usually died from disease than from battles. This was because it was not known how diseases were transmitted and in what environment they thrived. See also History of the Swedish Hospitals

Pharmacies (Apotek)

King Gustav Vasa (1496 - 1560) made the first attempt to establish an orderly medical system in Sweden. He acquired physicians and pharmacists from abroad. The first pharmacy was licensed in Stockholm in 1575. In 1675 there were 6 pharmacies in the city. In Swede, names of pharmacies have traditionally been taken from the fauna. The image to the right shows the interior of a pharmacy in Linköping at the beginning of the 1900s. Photo Hans Högman, 2004. The following chart shows the growth of pharmacies (Apotek) in Sweden between 1700 and 1900.

Medical History - Medelpad

Medelpad is a province in central Sweden and its the major city is Sundsvall. There was no qualified medical care in Medelpad before 1726, when Dietrich Theodorus Reineck, a field surgeon, was employed as city surgeon in Sundsvall. He was also skilled in the art of midwifery. However, Reineck left already in 1731, dissatisfied with the salary. It was not until 12 years later, in 1743, that Sundsvall's next city surgeon, Addeus Adde, who was previously employed as a regimental field surgeon with the Björneborg Regiment. He held this post until 1766 when his son Fredrik Adde took over as city surgeon. Fredrik Adde held this post until 1775 when he was appointed to a similar post in Hudiksvall town. In the city of Gävle, there had been a city surgeon since the end of the 17th century. This post was held by Carl Pelt between 1709 and 1743. At this time, Adde and Pelt were the only trained physicians in the northern half of Sweden, from Gävle and north and down to Åbo on the Finnish side of the Baltic Sea. After 1775, when Adde retired, Gävle was again the nearest town where physicians were available for the people in Medelpad province. Carl Pelt settled down after 1743 as a mill owner at Åvike mill in Medelpad. He had partly inherited the mill from his father-in-law. He may well be regarded as the first resident doctor in Medelpad. Already in the "Medical Order" of 1668, it had been decided that there should be a provincial physician in every county of the realm. The shortage of physicians in Norrland (northern half of Sweden) had been raised during the Parliament meeting in 1743 and it was then decided that the "Senior Master at Härnösand Upper Secondary School should always be a qualified physician". In 1744 physician Nils Gissler was appointed to this post as "Provincial-Medicus for the Northern part of Västernorrland County" which until 1762 included provinces Gästrikland, Hälsingland, Jämtland, Härjedalen, Medelpad, and Ångermanland. Gissler was born in Torp parish in Medelpad. Gissler organized a corps of assistants by teaching the parish clerks (Swe: klockare) simple medical care and bloodletting. It was also common at this time for priests to have some medical training. Carl Pelt is said to have been helpful to Gissler in organizing the medical service in the county. A few years after Gissler took office, Härnösand got its first pharmacy. Sundsvall's first pharmacy was established in 1763. This first pharmacy was called "Gripen" (The Griffin). A second pharmacy was opened in 1891 in Sundsvall, "Lejonet" (The Lion). In 1839, a pharmacy branch was established in Fränsta to serve the population of western Medelpad. When Västernorrland county was divided in 1762, the county consisted of the provinces Medelpad, Ångermanland, and Jämtland. Gissler was now officially authorized as a provincial physician in Medelpad and Ångermanland. The city of Sundsvall hired Dr. J Sahlberg as city physician in 1770, and the following year he was appointed provincial physician for the whole of Västernorrland when Gissler died.

Hospitals in Sundsvall

In 1776, during Sahlberg's time, a small hospital was established in Sundsvall with 2 - 3 beds. However, the hospital was closed in 1783 when Sahlberg received Gissler's old lectureship at Härnösand Upper Secondary School. The movable assets were moved to Härnösand where a new hospital was opened in 1788. During the years of war 1808 - 1809, Sundsvall was ordered to establish a field hospital. All available space was used for the hospital. The situation in Sundsvall was difficult as half the town had burnt down a few years earlier (1803) and the town was far from being rebuilt. The field hospital had the most patients in the autumn of 1809 when over 800 wounded soldiers arrived from Västerbotten County. Large numbers of soldiers were also stationed in Sundsvall due to the city's strategic location. Among these soldiers, field diseases were also rampant. Some units were reduced by half. The image to the right shows a hospital ward in the past. Photo Hans Högman, 1998. Medicinhistoriska museet, Stockholm (Medical History Museum). It was not until 1 January 1844 that a permanent hospital was opened in Sundsvall. The hospital was located on Holmgatan and was a two-story wooden building. The hospital was also an infirmary for the venereal ill. Between 1861 and 1875, the number of beds varied between 12 and 28, with a total of about 80 patients treated per year. During the 1800s, lumbering expanded considerably. An exceptionally large amount of people migrated to Sundsvall to look for jobs with the many lumber firms in the region; sawmill laborers, loggers, log drivers, and charcoal makers. The Sundsvall region became a lumbering Klondike. Sundsvall became the center of the world’s largest lumber industry district. The flourishing of the sawmill industry in Sundsvall during the second half of the 1800s increased the pressure on the hospital and thus the need for greater medical resources. A new hospital was built in Norrmalm district in Sundsvall in 1875. There was a capacity for 90 beds. This three-story building was built of timber on a stone base, contrary to the regulations of the National Board of Health. The hospital now became a county hospital. In the 1880s, there were about 400 patients per year and one physician. By 1890, the number of patients had increased to 650 per year and an additional physician's post was created. The Chief Physician at this time was Adolf Christierin. In 1890-1891 extensive improvements and repairs were made to the hospital. The number of beds was increased to 120 and electricity was installed in 1902. In a 1902 inspection by the National Board of Health, the hospital was described as: "a large wooden building, poorly sound insulated, inflammable, difficult to evacuate, and with bedbugs that could not be eradicated." In 1905, the construction of a new hospital began. It was inaugurated on 6 March 1908 and was located just east of the old operating theatre from the beginning of the 20th century. The new hospital had 200 beds, 15 of which were for venereal diseases. By 1920 the number of beds had risen to 255. A new maternity ward with 20 beds was opened in 1927. In 1956, the number of beds in the hospital reached 714. The hospital remained here until 1975 when a new hospital was completed in the Bosvedjan district of Sundsvall. Sundsvall's municipal administration then moved to the old hospital buildings. Since 1853, Sundsvall also had a water spa, located approximately where the current Badhusparken is. The town field surgeon's office from 1726 was withdrawn in 1900 and the last "barber" in Sundsvall was Bror Ulric Andersson. He is also said to have been the last in Sweden.

Mental Health Care

In a detached building next to the hospital built in 1875, there was a care institution for the insane. From the beginning, there were only two beds, in the 1890s six beds, and 1912 eight beds. In 1918, this building was converted into a maternity ward, and the mentally ill patients had to be transferred to other places, including Frösö Mental Hospital. In a news item in the Sundsvall newspaper, Nya Samhället in 1910, a consultant from the Swedish Poor-Law Association tells about a visit to Skön's poor house. There 11 "fools" were kept, for whom no more suitable place of residence could be prepared. Gösta Sundqvist writes in his book "Everything was not better formerly....." (page 32) "...have seen with my own eyes these pitiful creatures in their wooden cages on several occasions ....". In 1943, the Sidsjön Mental Hospital was opened in Sundsvall. From 1930, the government had taken responsibility for the care of the mentally ill. The city of Sundsvall also ran a municipal mental asylum from 1916 at Västhagen Hospital. After 1967 it was transferred to the county council to be used as a nursing home.

Epidemics in Medelpad

Sundsvall is a seaport town and in maritime towns, there was in the past always a risk of epidemics breaking out. In 1812, Sundsvall also obtained the right of staple towns (the right to trade directly with foreign countries). This also increased the risk of epidemics. But it was not only via ships arriving in Sundsvall that disease could spread but also via the Norwegian Atlantic coast. In the late 18th century, peasants from Jämtland province transmitted venereal diseases from Norwegian seaports. Jämtland is a Swedish province located west of Medelpad, by the Norwegian border. Smallpox arrived in Sweden at the end of the Middle Ages and an epidemic is known from 1528. Large outbreaks occurred on and off in Sweden and throughout Europe during the 18th and 19th centuries. During an epidemic in 1753, three of Dr. Gissler's children died. The first smallpox inoculation in Västernorrland was carried out by Dr. Gissler in 1761 on 20 children with successful results. In 1785, a severe epidemic of dysentery ravaged the whole of Norrland. In 1825, 1833, and 1858, smallpox epidemics struck Medelpad. Protective vaccination became compulsory in 1816. It became a task mainly for parish clerks (klockare) and midwives. In 1862 Sundsvall was hit by a diphtheria epidemic. In 1831 a cholera epidemic was feared and a quarantine master was appointed in Sundsvall. At the end of the 1830s, a temporary quarantine station was built on Tjuvholmen, an islet. The epidemic did not occur in Sundsvall at that time, but in 1850s cholera came in several rounds. In this epidemic, about 50 people died. In 1893, a decree was written that special infirmaries were to be established in certain parishes as a precaution against cholera. In Skön parish in northern Sundsvall, a cholera barrack was set up at Kabben along the old coastal road. In Granloholm was Sundsvall's official cholera infirmary. In the so-called. Petersén's house, west of the small Büsowska woodland lake, Sundsvall's first epidemic hospital was established in 1873. This house was subsequently called the Smallpox House (Kopphuset). The hospital remained here until 1909 when a new epidemic hospital was completed on Ludvigbergsvägen (the Ludvigberg road). In 1908, when the new hospital was completed, it was decided that the old hospital would be used by the Medelpad Tuberculosis Society for the care of tuberculosis patients. This wooden building was moved in 1911 to the sanatorium area at Balders Hage on the North Mountain (Norra Berget). The building became a school much later. The tuberculosis hospital had 100 beds. A children's pavilion was opened in 1931. According to statistics from the period 1895 - 1900, various diseases of the respiratory organs were the most common cause of death in Sundsvall. In 1918, a severe influenza epidemic spread throughout the world. It was the Spanish flu (The Great Influenza epidemic). At the turn of June and July 1918, it arrived in Sweden. In 1919, 200,000 people fell ill, but the death toll dropped to 9,000. Sundsvall was also affected and in September 1918 it reached its peak when 727 cases were reported. Deaths occurred every day. There was no direct cure. Food shortages during the Great War, malnutrition (especially among the urban population), and consequently low resistance contributed to the rapid progression of the disease. Symptoms of the Spanish flu included lower back pain, high fever, sore throat, severe and rapidly developing pneumonia, and even heart paralysis. Many of the epidemics that struck the population were largely due to poor hygiene and lack of cleanliness. From 1874 onwards, street sweeping was organized in Sundsvall. Initially, this task was carried out by the town bailiff’s office, but from 1881 it was contracted out to a haulage contractor. The removal of rubbish and latrine from the yards was arranged so that the hauler was responsible for the transport at the expense of the property owners. A water barrel on wheels was also purchased for watering the streets when the streets were swept. By 1879, Sundsvall's water and sewage disposal system had been developed. A few years later, in 1887, the first private water closets came into use.

Related Links

• Diseases in the past • Swedish names of diseases in earlier times • History of the Swedish Hospitals • Poor Relief in the Past • Churching

Source References

• "Svenska sjukdomsnamn i gångna tider" av Gunnar Lagerkrantz, tredje upplagan 1988, utgiven av Sveriges släktforskarförbund. • "Vår Svenska Historia" av Alf Åberg, fjärde upplagan, 1978 (sid 319-321). • "Hembygdsforska! steg för steg" av Per Clemensson och Per Andersson, 1990, (sid 123). • "Allt var inte bättre förr .....", Om hälsovård och sjukvård i Medelpad efter 1700 av Gösta Sundqvist, 1994 • Skriften "Sundsvallsbygden" nr 15, årgång 14/97, artikel "Historiska fakta och berättad familjehistoria i Sundsvallsområdet" sid 21 av Barbro Andersson. • Skräckens tid, farsoternas historia av Berndt Tallerud, Prisma 1999. • Gamla tiders sjukdomsnamn, Olof Cronberg, 2018. • Wikipedia • NE, encyclopedia Top of Page

Until 1970, Swedish pharmacies were run by individual pharmacists, who had special privileges from the Crown (so-called apoteksprivilegium), which were hereditary but used to be transferred by purchase (privilege trade). In 1970, the entire pharmacy business was nationalized and Apoteksbolaget (now Apoteket AB) took over the business. The pharmacy monopoly ended in autumn 2009, and at the end of January 2010, most of the pharmacies that were deregulated began to rebrand.

Medical Treatments

Bloodletting

Bloodletting is an ancient medical treatment. Using a so-called cup (Swe: “koppa”), blood was drained from the body which would cause the sickness to come out through the blood and thus cure the person. Leeches were also used for bloodletting. In the 1850s, the use of bloodletting as a method of treatment declined sharply. The image to the right shows an ongoing bloodletting in Värmland in 1922. Image: Wikipedia. Nordiska museet. The image to the left shows the instrument (lancet) with which one opened the vein. According to very ancient theories, the body contained four fluids; blood, mucus, yellow bile, and black bile. For good health, these fluids had to be in balance with each other and that disease occurred when any of these were present in too small or large quantities. The theory was based on the properties of drained blood. The fluids were thought to reside in various organs of the body, where they were formed and stored, and added to the blood. The yellow bile resided in the liver, the mucus in the brain, the black bile in the spleen, and the red bile in the blood. All fluids had to be present in the blood in the right quantity and strength. It was mainly the mucus that was thought to cause disease. Regardless of the cause of a disease, bloodletting was considered the best way to cure the sick person by draining the diseased blood with its mucus from the diseased area of the body. Before the body's blood circulation was known, it was thought that blood was locally bound in defined areas and where blood could become bad from mucus accumulation. Chills were thought to be a way for the body to counteract this and that fever prevented the mucus from congealing and so could expel it through sweating. Much superstition has been associated with bloodletting. In ancient almanacs, there could be precise instructions as to which part of the body, ruled by different constellations in the Zodiac, was, therefore, most appropriate, or inappropriate, to draw blood from at a particular time for a particular ailment. Traits of the signature doctrine also came into play. For example, bloodletting on young men would preferably be done when there was a new moon, while older men would be bloodletting when the moon was on the wane. The amount of blood to be drawn was depending on the patient's age, size, health, and illness. According to a medieval instruction: From a strong man should be taken as much blood as a thirsty person can swallow in one gulp. From a weak person, as much blood as would fit in an ordinary egg. It was most common to open veins in the arms. There were three veins from which blood was drawn. From the top vein, they would draw blood partly for prevention and partly to cure headaches. The middle vein was used to cure heart and lung diseases. The lower vein was used to treat pain and diseases of the liver, kidney, and spleen.

The Medical Thermometer

The medical thermometer and fever temperature curves are aids in medical care. It was not until the 1870s that they came into regular use, mainly through the German clinician Carl August Wunderlich (1815 - 1877). By continuously measuring body temperature, he was able to establish that temperature curves had a different appearance depending on the disease. Previously, the fever had been thought to be a disease in its own right. Now it was established that fever was only a symptom, which was a great help in diagnostics. The physician Magnus Huss introduced the practice of regularly measuring the temperatures of the sick in 1838 at the Seraphim Hospital in Stockholm. It is not known when medical thermometers began to be used regularly in Sweden, but eight medical thermometers were purchased in 1870 at the Västerås Hospital. The measurement of body temperature was greatly simplified with the advent of min/max thermometers. In Sweden, this happened in the early 1880s. Swedish production of min/max medical/clinical thermometers began in 1895.

Stethoscope

A stethoscope is an instrument that propagates sound from a mouthpiece to the user's ears and can be used to listen to the heart, lungs, and intestines, among other things. The first stethoscope was invented in 1816 by the French physician René Laënnec and consisted of a monophonic wooden tube. The first version of a stethoscope consisted of a wooden tube about 30 cm long with a diameter of about 3-5 cm. The image to the right shows a wooden stethoscope from the late 19th century. Image: Wikipedia.

Anesthetics

When it comes to anesthetics, there wasn't much available in the past. Ether was one of the first anesthetics and began to be used as an inhaled surgical anesthetic in 1846 in the US, followed the following year by chloroform. Ether is a clear, colorless, highly volatile, flammable liquid with a peculiar aroma and burning taste. Chloroform is one of the oldest anesthetics used in surgery. It was considered to have several advantages over the ether. It was not flammable like ether and also has a more pleasant smell. However, towards the end of the 19th century, it was realized that chloroform tended to cause liver damage, as well as cardiac arrhythmias and ether, became the dominant anesthetic. The effect of chloroform is not immediate; it takes at least five minutes for the person to lose consciousness. Anesthesiology is the study of anesthesia and administering anesthetics. The word anesthesia is not used very often in everyday Swedish, much more common is the word narcosis (Swe: narkos) and an anesthesiologist is usually referred to as a “nakosläkare”. Anesthesia/narcosis means controlled sedation together with painkillers.

Antisepsis

In the 1860s, antiseptics, i.e. cleanliness, sterilization of surgical tools, etc., began to be used in health care. An antiseptic is a germicide used on a body surface to kill or inhibit the growth of microorganisms such as bacteria, fungi, parasites, and viruses. Phenol (carbolic acid) was used medically in the past as a disinfectant in dilute solution, carbolic acid solution, or carbolic water. When it was realized that higher hygiene in childbirth was of paramount importance, the risk of childbed fever decreased significantly. In 1870, doctor Wilhelm Netzel at the General Maternity Hospital (Allmänna Barnbördshuset) in Stockholm was able to establish that fever was spread by midwives and doctors carrying organic substances on unclean instruments. The hygienic procedures he introduced had a good effect. In 1879, procedures were tightened and midwives were required to wash their hands in a solution of carbolic acid before performing procedures. In everyday language, antiseptics and disinfectants are often used interchangeably. However, disinfectants also include agents used to kill microorganisms on objects such as tables, floors, buildings, etc. Antisepsis aims to combat pre-existing microorganisms, as opposed to aseptic, which aims to prevent the emergence of microorganisms, for example through cleaning and sterilization.

X-Ray Examinations

An X-ray examination is an examination of the body's bones or internal organs using X-rays. After developing, any lesions or changes appear on the X- ray photograph. In the past, the X-ray was also called radiography and the plates radiogram. Wilhelm Conrad Röntgen (1845 - 1923) was a German physicist and the discoverer of X-rays. X-rays began to be used after 1895.

History of the Penicillin

The Egyptians used mold from bread or porridge as an antibiotic thousand years ago. In the Swedish peasant's practice, poultice (Swe: grötomslag) are listed and if one was left on for a long time, it began to mold. A poultice, also called a cataplasm, is a soft moist mass, often heated and medicated, that is spread on a cloth and placed over the skin to treat an aching, inflamed or painful part of the body. It can be used on wounds such as cuts. The Swedish word “grötomslag” literally means “porridge wrapping”. What the porridge is made of is of no great importance, it can be prepared from ordinary flour, oatmeal, linseed, or something similar, the important thing is that it maintains a suitable temperature to heat without burning or causing any other discomfort. When the porridge is ready, it is placed in a cloth folded into a package so that it does not stick, then the package is placed on the area in question. In 1928, Alexander Fleming (1881-1955) discovered that the mold fungus Penicillium notatum produced a bactericidal substance. He called it penicillin. In 1939, Ernst Boris Chain and Howard Walter Florey began experiments to produce large quantities of penicillin from broth cultures. Its bactericidal effect was confirmed in large clinical tests in 1942. Mass production soon began in the US and saved the lives of tens of thousands of Allied soldiers during World War II. The first treatment with penicillin in Sweden took place at Sabbatsberg Hospital in 1944. Antibiotics: Antibiotic means to biologists substances produced by living organisms for the purpose of keeping other organisms away. For example, both bacteria and fungi live either as parasites or by breaking down dead material. Since both have the same food source, they try to poison each other by secreting substances that the other cannot tolerate. For example, ascomycetous fungi produce penicillin to keep bacteria at bay, while actinobacteria produce amphotericin to keep fungi at bay. The antibiotics that have become known are those that can be used as medicines. When we talk about antibiotics in everyday language, we are referring to drugs against bacteria in general. The drugs can be either bactericidal (killing) or bacteriostatic (inhibiting growth). The first antibacterial drug was mercury, used against syphilis as early as the 16th century. However, this was very dangerous for the patient. In folk medicine, mold has been used since ancient times as a remedy for various diseases. The first scientific observation of antagonism between different microorganisms was made by Louis Pasteur (1822-1895) and Joubert, who already in 1877 observed that certain aerobic bacteria inhibited the growth of anthrax bacteria.

Dental Care

Since 1797, a degree has been a requirement for practicing dentistry in Sweden. Organized dentistry also began to appear in the 19th century. Dental care has been available for a long time through barbers. But now came trained dentists. However, it was expensive to go to the dentist and it was a "pleasure" for the wealthy. The anesthetic used was alcohol. The dental drills used in the late 19th century were treadle-driven. Only after the turn of the century did the first electrically powered drills appear. There were also traveling dentists around the turn of the century. The first Swedish school dental clinic was established in Stockholm in 1907. Folktandvården (Public dental care) is the name given to the public dental care in Sweden that has been run by the county councils (Landsting) since 1938. Initially, Folktandvården only provided dental care for children, but over the years it has expanded to include both adult and specialist dental care.