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The aim of this paper is twofold: to defend the validity of the manic-depressive psychosis as a disease entity and to make an incursion into the history of psychiatry. The two intentions meet as far as the recognition of a clinical case straight through space and time supports the ontological status of a disease entity. An autobiographical work from 1801 "My insanity in the year 1783" written by the Danish vicar C.S. Andresen, who lived from 1760 to 1832 is briefly summed up. Andresen tells that he as a young student of divinity made a journey from the small town Rørvig in Zeeland to his then place in Copenhagen. The weather was intolerably hot, the coach was uncomfortable, the landscape deserted and empty-and just in the hardships the most unhappy and deplorable event happened: He faced the gruesome truth that he was deprived of the most precious gift of his Creator, his reason and faculties. A fellow passenger brought him to an inn where he literally ran up the walls alternately in high spirits and in deep dispair. When he arrived in Copenhagen he was blead, probably by a surgeon, but later that day admitted to King Frederik's Hospital where he was treated with bleds and leechs and baths. However, as the illness dragged on he was according to his own will accompanied by his custodian to his parental home in the Isle of Bornholm where he recovered while nursed by his mother and mother's mother who themselves had suffered from periodical melancholy when they were young. He completed his academic studies and became a highly respected scholar and vicar in the isle of Funen - but almost twenty years after his recovery he was made to suffer the humiliation that he - a true representative of the Age of Enlightment and rationalistic theologician - was suspected to have invoted his insanity by a sinful life in his youth. Thus his work may be regarded as a defensive pamphlet written at a time when a neutral and clinical view of mental diseases had given place to a moralistic and religious concept. The case serves as a modification of the general assumption that psychotic patients in "the classic age of confinement" under all circumstances were brutally treated and locked up. Even the fluent and subjective style is charming and reminds the Danes of Johannes Ewald (1743-81) and perhaps - were it to be translated - the English of Lawrence Sterne (1713-68). Maybe the booklet of just 75 pages is worthy of a translation?

Hospital monographs frequently describe the buildings and the leading staff but rarely the patients. However, the 1980s and 1990s called attention to the importance of the perspective of patients of the past. The chapter reports an examination of the quality and extent of information retrieved through a systematic search of patient records from the Copenhagen General Hospital, extending back to 1855. The charts illuminated the social conditions of the patients in addition to their illnesses and the treatments characteristic of the day. Analyzing the state of medical practice revealed in the records, the author tested whether hospitals in reality were no more than gateways to the afterlife. Comparisons among hospitals showed the extent to which treatments varied across institutions. Correlations between the evidence of the patient charts and the ideals of the professional literature at the time revealed the differences between theory and practice. The records yielded important insights into the daily lives of patients admitted 150 years ago. They generally were younger and of lower social class. For reasons of poor hygiene, poor housing, and poor nutrition, they fell victim to the classical diseases of the crowded urban environment, including lung, skin and venereal diseases. Of these, tuberculosis killed most patients admitted to hospital.

The gates of the Kommunehospital in Copenhagen opened for the first time on September 19th, 1863. It is recorded that on this day 89 patients were admitted to the hospital. These patients have been subdivided according to occupation, their own or that of the family, as it was recorded on admission. The occupational groups are: journeymen, workers, seamen, servants, self-supporting and paupers. Most of the patients are men, reflecting the fact that on the opening day only male patients were moved from Almindelig Hospital that the new Kommunehospital was to replace. Most of the patients came from the working class, a few belonged to the middle-class. That was the general trend at Danish hospitals in the 1860s. The case records provide information about hospital life and about social conditions in 1863, as regards work and family life. According to an article in the 125 year's Anniversary publication of the hospital, the first patient admitted was a widow Mrs. Popp, who suffered from eczema. This study has shown that probably the first patient was a mate by the name of Frits Nygaard. He suffered from smallpox and was admitted already on the 9th of August to the isolation-house, which was taken into use before the official opening of the hospital.

Treatment of acute myocardial infarction (AMI) with streptokinase in Fredericia from 1967 to 1977. During these years 184 patients with AMI were treated with trombolytic therapy. At that time such treatment was not used anywhere else in Denmark, and only in relatively few places in other countries. The patient population, the treatment, the survival rate of the patients are described, and also other measures taken to better the prognosis of patients with acute heart diseases. These measures comprised the introduction of cardiac defibrillation in 1961, the establishment of an intensive care unit in 1965, and in 1970 ambulances with equipment for ECG monitoring transmitted to the hospital (telemetry) and defibrillators to be used by paramedical personnel in the ambulances. Trombolytic treatment of AMI was not generally used in Denmark before the late eighties. The reason for this delay is discussed.

In April 1924 a 13 year old Greenlander died of tuberculosis in the hospital in Egedesminde. The boy had been transported on dog sled by the district doctor from the outpost Ikamiut two months earlier. Not because healing was considered possible, but because the conditions for nursing in his family's turf hut was too bad. The crowded living conditions in Greenland and the frequent hunger periods were the reason for the spread of TB, which in the nineteen twenties was the cause of 1/3 of all deaths. At the present moment it is psychiatric patients who take up most beds in the Greenlandic hospitals. The reason for so many patients with behaviour disorder is still--among other things--due to crowded living conditions but also to the sudden change in recent years of the way of living. The doctors living and working conditions in Greenland in 1924 were very different from conditions in Denmark which made it difficult to fill the vacancies. Nowadays doctors salaries are on the same level in Greenland and in Denmark, but a period in a Greenlandic hospital does not count very much for a doctor's special training, and when schools for children are not as good as in Denmark it is still difficult to get Danish doctors to stay in Greenland for a long time.