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Background: Head injuries are a common reason for hospitalisation, and patients often arrive via accident and emergency departments. This study aimed to investigate changes in accident and emergency consultations due to head injuries for patients ≥ 50 years., Material and Method: Electronic reimbursement claims by accident and emergency doctors for., Results: In the age group ≥ 50 years, the overall consultation rate in accident and emergency departments increased from 21 674 per 100 000 inhabitants in 2006 to 22 444 in 2023. The consultation rate for head injuries increased from 92 to 270 per 100 000 inhabitants. For the age group 50-66 years, the increase was from 83 to 166, for the age group 67-79 years from 86 to 269, for the age group 80-89 years from 138 to 698, and for the age group ≥ 90 years from 277 to 1420., Interpretation: Accident and emergency consultations due to head injuries increased in all age groups ≥ 50 years. Among patients ≥ 90 years, the consultation rate was more than five times higher in 2023 compared to 2006.

Background: Doctors generally enjoy good health, but often refrain from seeking help when they are ill. Self-treatment is widespread, and this can be an inappropriate and risky practice., Material and Method: This is a registry study that compares GPs' own use of the primary and specialist health services in 2018 with a control group consisting of all others in the same age group with the same sex, level of education and health as the GPs. Morbidity in both groups was surveyed with the aid of two validated morbidity indexes in the period 2015-17. Only those who scored zero on both indexes were included., Results: While only 21.7 % of the GPs had sought help from a GP and 3.3 % had attended the emergency department, the corresponding figures for the control group were 61.6 % and 11.8 %. Of the GPs, 17.5 % consulted a contract specialist, compared to 15.5 % of the control group. Measured as a proportion of all specialist consultations, consultations with a psychiatrist constituted 35 % for GPs and 13 % for others. There were small differences in the use of somatic outpatient clinics (25.9 % of GPs and 25.7 % of the control group) and acute admission in somatic hospitals (3.8 % of GPs and 3.3 % of the control group)., Interpretation: This study indicates that GPs receive medical assistance from other than their own GP.

Background: Primary care doctors put diagnostic codes on all reimbursement cards. The objective of this study was to map out the use of non-specific diagnostic codes that can undermine the validity of statistics and disease surveillance., Material and Method: The material consists of data from all electronic reimbursement cards from out-of-hours services in the period 2008-2019. We registered consultations and telephone contacts and the proportion of these that were supplied with diagnostic codes for respiratory infections and three non-specific diagnostic codes., Results: The number of consultations per year increased from 1 402 452 in 2008 to 1 417 395 in 2019, a relative increase of 1 %. The number of telephone contacts per year increased from 286 515 in 2008 to 684 773 in 2019, a relative increase of 139 %. Out-of-hours contacts coded with non-specific diagnoses increased nearly thirteenfold, from 40 280 to 514 715. The use of non-specific diagnoses increased by a factor of 19 for telephone contacts and 2.7 for consultations. The total number of out-of-hours contacts for respiratory infections decreased from 240 037 to 176 909 (a 26 % reduction)., Interpretation: There is a strong tendency for general, non-specific diagnostic codes to replace specific diagnoses of disease on reimbursement cards from out-of-hours services. This undermines the evidence base for statistics and research based on reported ICPC-2 diagnoses, and this is especially of concern when these diagnoses are to be used for monitoring of the COVID-19 pandemic.

Background: The rotavirus is the most frequent cause of severe diarrhoea in small children. The purpose of this study was to map emergency primary health care consultations due to gastroenteritis in small children before and after the introduction of the rotavirus vaccine on 1 October 2014., Material and Method: The material consists of data from all electronic reimbursement claims from emergency primary health care doctors in the period 2010-18. Quarterly consultation rates at the emergency primary health care units for children aged 0-4 years with gastroenteritis were calculated. The consultation rate ratio for the years 2015-18 was calculated by dividing the consultation rate by the corresponding mean for the years 2010-13., Results: The consultation rate was highest in the first quarter of the year. In the years 2010-13 (prior to the introduction of the vaccine), infants had a mean consultation rate of 9.7 per 1000 inhabitants, one-year-olds 14.3 and two-year-olds 7.3. In 2016 (after the introduction of the vaccine), the consultation rate ratio in the first quarter was 0.5 for infants, 0.3 for one-year-olds and 0.4 for two-year-olds. In 2017 and 2018, the corresponding consultation rate ratio was 0.5 for infants, 0.4 for one-year-olds and 0.5 for two-year-olds. Three-year-olds and four-year-olds had lower consultation rates and fewer changes over time., Interpretation: The strong decline in gastroenteritis-related consultation rates may be related to the introduction of the rotavirus vaccine as part of the Childhood Immunisation Programme.

Background: Otitis is a frequently occurring condition in young children and involves considerable use of antibiotics. The most common bacterial cause is pneumococci. The pneumococcal vaccine was introduced as part of the Childhood Immunisation Programme in Norway in 2006. The purpose of the study was to investigate whether this vaccination may have reduced the number of otitis cases presenting at emergency primary health care units., Material and Method: The material consists of data from all electronic reimbursement claims from emergency primary health care doctors in the period 2006-18. Annual consultation rates were calculated for children aged 0-5 years attending an emergency primary health care unit, both in total and due to otitis. Registration of vaccination coverage in this age group began in 2006., Results: The total consultation rate fell from 674 per 1000 inhabitants in 2006 to 502 in 2018 (a relative reduction of 26 %). The consultation rate for otitis fell from 44 per 1000 inhabitants to 21 (a relative reduction of 52 %). While the total rate fell steadily throughout the period, the reduction in consultation rates for otitis began to fall in 2011, when vaccination coverage in this group was over 90 %., Interpretation: The pneumococcal vaccine may have reduced the number of children presenting with otitis at an emergency primary health care unit.

Background: The objective was to compare the use of emergency primary health care services on Christmas Eve and New Year's Eve to a normal Saturday., Material and Method: The material comprises data obtained from reimbursement claims from all doctors on out-of-hours duty in Norway in the period 2008-18. The number of consultations and home visits, and the diagnoses set, were recorded for Christmas Eve, New Year's Eve and the last Saturday of January. Comparisons were differentiated between daytime, evening and night-time consultations., Results: On the last Saturday of January there was a total of 45 088 consultations. On Christmas Eve the total number was 36 045 (80 % of Saturday) and on New Year's Eve the total was 50 377 (112 % of Saturday). Overnight on Saturday there was a total of 1 007 consultations concerning injuries. On the night of Christmas Eve, the figure was 453 (45 % of Saturday), while on the night of New Year's Eve it was 2 447 (243 % of Saturday). On New Year's Eve there were 246 night-time consultations associated with burns. The corresponding figure was 13 for Christmas Eve (5 % of New Year's Eve night-time) and 11 for Saturday (4 % of New Year's Eve night-time). On New Year's Eve there were 120 night-time consultations due to eye injuries. The corresponding figure for Christmas Eve was 16 (13 % of New Year's Eve night-time) and 23 for Saturday (19 % of New Year's Eve night-time). On New Year's Eve there were 513 night-time consultations due to acute alcohol intoxication. The corresponding figure for Christmas Eve was 53 (10 % of New Year's Eve night-time), and 260 for Saturday (51 % of New Year's Eve night-time)., Interpretation: Christmas Eve is peaceful in emergency primary care units, while New Year's Eve is probably the busiest night of the year. A ban on private firework displays may reduce the extent of injuries on New Year's Eve.

Background: Poisonings constitute a serious health problem in Norway. The objective of the study was to analyse cases of poisoning reported to out-of-hours services and any changes that may have occurred over a ten-year period., Material and Method: The material consists of reimbursement claims from all doctors on out-of-hours duty in Norway in the period 2006 – 15. Poisonings were defined as ICPC diagnostic codes A84 (poisoning by medical agent), A86 (toxic effect non-medicinal substance) or P16 (acute alcohol abuse)., Results: The contact rate due to poisonings increased from 221 per 100 000 inhabitants in 2006 to 297 per 100 000 inhabitants in 2015. For the age group 1 – 2 years, the contact rate per 100 000 inhabitants dropped from 469 to 223, for the age group 15 – 25 it rose from 523 to 719, and for the age group 53 – 59 it rose from 178 to 339. The highest contact rate was found among women aged 15 – 25 (785 per 100 000 inhabitants). This group also had the highest contact rate caused by poisoning by a medical agent (238 per 100 000 inhabitants). In the age group 15 – 25 years, altogether 63% of the poisonings occurred during the night., Interpretation: The frequency of contact with out-of-hours services because of poisoning is generally increasing, although a strong decline is observed among small children. Adolescents, and young women in particular, stand out in suffering frequent cases of poisoning.

Background: Approximately half of all accident and emergency medical (A&E) services are provided by regular general practitioners (RGPs). We wished to find out which RGPs staff the A&E services., Material and Method: The material comprises billing cards from all A&E doctors in 2008, linked to information from Statistics Norway and the Regular GP database. We estimated the proportion of various RGPs who staff the A&E roster and how many patient contacts they had while on duty. The same variables describing the RGPs were used in a multivariate logistic regression analysis, in which the dependent variable was whether the RGPs were on the emergency service roster or not., Results: Altogether 53% of the RGPs were on the emergency service roster, and accounted for 47% of all patient contacts. The RGPs were older than other emergency doctors (44 years as opposed to 34 years), and included a smaller proportion of women (33% as opposed to 44%). Immigrants accounted for 23% of the RGPs and 21% of the other emergency doctors. Women RGPs were on A&E duty less frequently than their male counterparts in all age groups, and they also had fewer patient contacts (206 and 374). The participation rate decreased in proportion to the doctors' age, increasing list length and increasing centrality. Immigrant RGPs with a short time of residence in Norway had the highest frequency of on-call duty (81%)., Interpretation: The number of women RGPs is increasing, and it is therefore likely that the frequency of on-call duty among RGPs will decrease further. However, the immigrants are providing a significant contribution to maintaining the A&E scheme.

Background: Norwegian emergency medical services are used with frequency, often in relation to conditions that could wait until the next day to be handled by the patient's regular GP (RGP). We investigated whether there are characteristics of particular GPs that may help explain why patients on their list use the emergency medical services., Material and Methods: We used data from the billing cards for 2008 from all emergency doctors, linked to information from the Regular GP database and Statistics Norway, for a total of 4,097 RGPs. For each RGP we estimated a contact rate: The total number of contacts reported for their list patients (identified by their personal ID numbers), divided by the length of the RGP's list. This rate was subsequently analysed with regard to characteristics of the RGP (bivariate analyses and multiple logistic regression)., Results: The average contact rate amounted to 27.4 contacts per 100 list patients, with significant variation between the RGPs (the 25th percentile was 17.8 contacts and the 75th percentile 33.1). Patients of male RGPs, young RGPs and immigrant RGPs used the emergency medical services more frequently than patients of female RGPs, older RGPs and Norwegian RGPs. Patients from long lists, single-doctor practices and open lists used the emergency medical services less frequently than patients from short lists, group practices and closed lists. The contact rate was higher in rural municipalities than in urban areas., Interpretation: The large variations in the use of emergency medical services indicate that more RGPs should take measures to improve accessibility for emergency calls during the daytime.

Background: Prompted by the H1N1 influenza epidemic in autumn 2009, Norwegian health authorities launched a campaign for better hygiene. We wanted to investigate whether there was any change in the out-of-hours contact rate for infectious diseases during this campaign., Material and Methods: The material consisted of remuneration claims from all doctors doing out-of-hours work during the years 2006-2009. The contact rates for nine diagnoses of infectious illness in autumn 2009 were compared with a corresponding mean from the years 2006-2008., Results: The contact rate for influenza was ten times higher in autumn 2009 than in the three preceding years. During the same period there was a significant reduction in conjunctivitis (contact rate ratio 0.74), otitis (0.73), sinusitis (0.70), throat infections (0.79), pneumonia (0.70) and intestinal infections (0.82). There were small changes in the contact rates for acute upper respiratory tract infections and urinary tract infections, but in December there was also a clear reduction in acute upper respiratory tract infections (0.61)., Interpretation: The reduced contact rates for infectious diseases may be ascribed to an effect of the campaign, but other factors may also have contributed to this result.

Background: RGPs (regular general practitioners) are obliged to take on duties in the out-of-hours services in Norway, but they actually perform less than half of this work. We wished to compare remuneration claims for out-of-hours work from RGPs with those from other doctors., Material and Methods: The Norwegian Labour and Welfare administration provided information about all doctors working in the out-of-hours services in Norway in 2006 (4 729 of whom 2 220 were RGPs) and coupled this with the remuneration they had claimed in this period., Results: RGPs had 46.6 % of all patient contacts in the out-of-hours services, but more telephone contacts (57.4 %) and simple/short contacts (50.7 %) than other doctors. Other doctors had most contacts in the largest (59.8 %) and most central (56.7 %) municipalities and used general and unspecific diagnoses more often than the RGPs (12.6 % of all consultations vs. 11.0 %). Older doctors used fewer fees than younger doctors, but otherwise the total number of fees only differed slightly between various groups of doctors. Newly qualified doctors serving their compulsory practice period claimed extra remuneration for long consultations in 41.2 % of the cases, RGPs who are also general practice specialists in 20.2 % of cases, and other doctors in 35.7 % of the consultations. RGPs wrote sick notes more often (7.1 % of consultations) than newly qualified doctors (5.7 %) and other doctors (6.6 %). General practice specialists wrote sick notes most often (7.4 %)., Interpretation: Experienced RGPs and general practice specialists spend less time per patient than other doctors in the out-of-hours services.

Background: Out-of-hours work is often perceived as burdensome and there is an inherent increased risk of making mistakes. The aim of the study was to examine Regular General Practitioners' (RGPs') experiences with and attitudes to out-of-hours work., Material and Methods: A questionnaire was sent to all RGPs in Norway. Participation in out-of-hours work was analysed against characteristics of the physician, list, and municipality., Results: 2,913 RGPs responded (78%). 50% participated fully, 15% partly, and 35% did not participate in out-of-hours work. 28% were formally exempted, and 13% had a regular locum. Women and elderly RGPs participated less, as did RGPs in large and central municipalities. Out-of-hours cooperatives covering several municipalities reduced the amount of work, but did not increase the RGPs' participation rate. List characteristics had little influence on the participation rate. 60% of the RGPs tried to give away most of their duties, 16% wanted more out-of-hours work than their regular duties and 16% of those below 55 years who were still doing out-of-hours work wanted to continue after 55 years. RGPs in small and remote municipalities considered out-of-hours work more challenging, but less remunerating, and more often wanted to move from the municipality., Interpretation: Many RGPs do not participate in out-of-hours work. As Norwegian RGPs constitute an aging cohort, this may become an increasing problem.

Background: Norwegian regular general practitioners (RGPs) are required to participate in out-of-hours duty. The aim of this study was to determine their actual participation rate., Material and Methods: Information was collected from the RGP Database, the Municipality Database and from physicians' bills to the National Insurance in 2004. The material consists of 3,751 RGPs and 2,317 other physicians claiming reimbursement for out-of-hours work., Results: RGPs received 51.8% of the total reimbursement for out-of-hours work, and 35.6% of them did not have any such income. Male RGPs received almost twice as much reimbursement for out-of-hours duty as their female colleagues, and there was a strong tendency for older RGPs to receive less. Among all physicians, young men were those who generally worked most frequently out-of-hours. RGPs' reimbursement dropped with poorer coverage of doctors, increasing list size, if their list was full or overcrowded, and with increasing size and central localization of the municipality., Interpretation: A large proportion of RGPs do not work out-of-hours in emergency services.

Background: We wanted to chart telephone accessibility in 100 randomly selected general practices in Norway and to define a standard against which others could compare themselves., Material and Methods: During one week, the telephone company recorded all calls to each practice and how many were answered, unanswered, or blocked. Mean waiting time for answer and mean conversation time were also registered. Each practice received a report, comparing its own results to those of other practices. An accessibility index was calculated by dividing the percentage of answered calls with mean holding time on the line (waiting time plus conversation time). Background variables about the practices were collected by questionnaires., Results: There were 266 calls (95 % confidence interval 219 - 312) per week per 1000 patients on the list. 66 % (61 - 71) were answered. Mean waiting time was 25 seconds (20 - 30), conversation time 119 seconds (111 - 127). It is estimated that 7.0 calls (6.4 - 7.5) are answered per patient on a list per year. The accessibility index showed large variations, mostly independent of background variables., Interpretation: Compared with earlier registrations, telephone accessibility has improved despite a strong increase in traffic. Structural aspects of the practices do not explain the variation in telephone accessibility; interest and attitudes are probably just as important.

Background: The most heavily discussed subject on Eyr, the Norwegian mailing list for general practitioners, has been the introduction of a general practice list system (GPLS)., Material and Methods: All messages in the GPLS debate were recorded from its start in August 1996 up until the GPLS was introduced nationwide in June 2001., Results: During this period, 243 different persons posted 2,153 messages about the GPLS, 232 of the participants were physicians, 203 of them GPs. Mean age was 46 years; males were strongly overrepresented (87%). 80% of the participants posted ten or fewer messages, 10% posted 11-20 messages, and 10% posted more than 20 messages. GPs sent most of their messages in the evenings, academics and public health officers sent most of their messages during work hours. Mean length of the messages was 179 words, 72% were responses to earlier messages. Most of the messages were neutral regarding the GPLS, 207 (9.6%) were negative, and 181 (8.4%) positive. Academics, public health officers, and participants in a GPLS trial were heavily overrepresented with positive messages., Interpretation: It is concluded that this debate has been fairly balanced. Participation greatly exceeded what would have been possible in traditional media.

In 1836, a system of district physicians was established in Norway. In addition to providing individual medical services, the district physicians supervised other health care providers and looked after vulnerable groups of patients. They were also chairmen of the local boards of health, and were supposed to engage in anything that might improve local health conditions. The first district physicians were given responsibility for enormous areas, and would rarely get in close contact with the people in their districts. When the districts were divided into smaller units, they came closer to the local people, but they had to struggle hard for recognition. Over the years, however, they succeeded by means of health information and increasingly effective medical remedies. In the late 1950s, local health services were in a deep crisis, but towards the end of the 1960s new and radical political trends initiated a revitalisation. Primary health care became increasingly popular among young doctors, and a large number of new positions were established. However, in 1984, at the height of this boom, the government chose to close down the district physician service.

We wanted to test the specific theory behind foot reflexology. Three reflexotherapists examined 76 patients of whom they had no previous knowledge. They were to localize the patients' problems and complaints by examination of the foot soles only; they had no other information about the patients. Each patient and the therapist graded problems related to 13 different parts of the body. Interrater agreement, measured by weighted Kappa, ranged from 0.04 to 0.22, and was significantly better than chance (p < 0.05) for six parts of the body. The overall Kappa was 0.11 (95% CI: 0.08-0.14). A score based on a detailed examination of the "colon zone" showed no significant difference between patients with many or few distal intestinal complaints. Generally, the therapists tended to score higher than the patients, thus overdiagnosing problems. The statistical agreement may be better than pure chance, but is too low to be of any clinical significance.

Over a period of two months in 1988 and 1989 general practitioners in the Norwegian county of Møre and Romsdal recorded all contacts with their patients. Participation was close to 100%. We report data from 10,850 surgery consultations with elderly patients (65 years and older). 60% of the consultations involved female patients, and 58% of the patients were 65-74 years old. New diagnoses were made in one-third of the cases; two-thirds were follow-ups. The most common groups of diagnoses were cardiovascular (28%), musculoskeletal (13%), psychiatric (8%) and respiratory diseases (8%). Almost 10% of all consultations were for hypertension. Drugs were prescribed in 45% of all cases. 27% of all prescriptions were for cardiovascular drugs, and 25% were for drugs for the nervous system. The 20 most common diagnoses made up more than half of the total number of diagnoses. Almost 70% of all prescriptions were for the ten most common therapeutic groups.

Over a period of two months in 1988 and 1989 all general practitioners in the Norwegian county of Møre and Romsdal recorded all contacts with their patients. We report data from 1,384 house calls to elderly patients (65 years and older). House calls made up 11.3% of all face-to-face contacts between general practitioners and elderly patients. 59% of the visits were to female patients, and 60% were to patients 75 years and older. 23% of the house calls took place during weekends, and new diagnoses were made in 58% of the cases. The most common groups of diagnoses were cardiovascular (21%), respiratory (16%), and musculoskeletal diseases (13%). Drugs were prescribed for 42% of the house calls. 28% of all drugs prescribed were for the nervous system, while 26% were antibiotics for systemic use. Most house calls were made because of acute illnesses. Our results suggest that preventive home visits to the elderly are rarely, if ever, performed in general practice.

According to reports in the Norwegian lay press, a lot of illness can be ascribed to "earth rays". Earth rays are presumed to form a square pattern, but can only be demonstrated by dowsing. No documentation has been reported which supports their existence. However, many patients have experienced considerable relief after a protecting copper net has been placed under their beds. Four dowsers participated in an experiment where, independently of each other, they were to demonstrate the pattern of earth rays in a gymnasium. Four supervisors ensured that the dowsers could not communicate with each other during the experiment. As it turned out, they came up with four totally different patterns. Thus, any protective treatment prescribed by the dowsers seems to be based on pure chance.

In 1988 and 1989 all general practitioners (GPs) in Møre & Romsdal recorded all encounters with patients over a period of two months. The participation rate was close to 100% and a total of 90,458 encounters were recorded. Of all encounters 61% involved female patients. Female GPs had more female patients than their male colleagues (71% versus 59%). The discrepancy was most pronounced for sex-specific diagnoses. Home visits accounted for 9% of all direct encounters, an increase from the 5-6% reported in the 1970s. 37% of all contacts occurred by phone or messenger. The diagnostic distribution compares well with Olav Rutle's findings in 1978. Cardiovascular diseases, however, seem to have become less prominent since that time. The most frequent ICPC diagnoses were musculoskeletal (17%), respiratory (14%), cardiovascular (12%), and psychiatric (12%). Respiratory diseases dominated among children, musculoskeletal diseases among adults, and cardiovascular diseases among the elderly.

Group sequential experiments are terminated when an interim statistical test turns out to be "significant", or when maximum study size is attained. To ensure a stipulated total level of significance the interim tests have to be performed at a stricter level of significance determined by the maximum number of interim tests. As for fixed size studies, it is possible to determine a study size leading to a stipulated power. This study size depends on expected effect of intervention, number of interim tests and level of significance. Tables and computer simulation programs have been developed to facilitate the design of such plans. If the intervention turns out to be about as effective as expected, a saving in study size of about 30% can be expected in the long run, relative to studies of fixed size. If the intervention is much more effective than expected, larger savings can be achieved.

The barber-surgeons' guild in Bergen was founded on 17 January 1597. For nearly 250 years this was the only "medical association" in Norway. The guild disappeared with the death of its latest master, Christian Wilhelm Wisbech (1740-1822). However, only nine years later his son, Christian Wisbech (1801-69), founded the Medical Association in Bergen. The barber-surgeons were craftsmen who got their education by apprenticeship. They were the medical practitioners of their times. Their empirical knowledge was more in touch with real life than was the medicine taught by the professors. This paper describes the barber-surgeons' education and work, including their conflicts with other craftsmen and doctors. During the 18th century the barber-surgeons' education was improved, and eventually was given full academic status.

To calculate the minimum size of sample required for clinical trials it is first necessary to decide the expected difference between the groups, and then the acceptable risk of wrongly declaring a significant result (alpha) or wrongly declaring a non-significant result (beta). Once these three parameters are set, simple tables can show the necessary sample sizes. Such tables are presented for classical comparative studies, survival studies, and group sequential plans. Sequential plans often entail large savings in sample size compared with fixed group plans.

The authors performed a questionnaire survey to investigate the current routines for screening applicants for asylum for hepatitis B virus, HIV and intestinal parasites, and for vaccination against hepatitis B. The response rate was 82% (n = 80). Of the respondents, 58% were physicians, 23% public health nurses and 18% nurses. Without regard to country of origin of the applicant 71% of the health personnel usually offer an HIV-test and 77% an HBsAg-test. Few differentiated their testing routines according to country of origin. Many agreed that an HIV-test (49%) and an HBsAg-test (65%) ought to be made compulsory. 26% usually offer vaccination against hepatitis B, while 54% do so if the person concerned is an infant. Routine screening for intestinal parasites was reported by 27% of the health personnel, but more than half (54%) take only one sample from each patient. Health control of applicants for asylum provides a good opportunity to give information about the transmission of hepatitis B and HIV, preventive measures, and testing.

Vampires are feared everywhere, but the Balkan region has been especially haunted. Garlic has been regarded as an effective prophylactic against vampires. We wanted to explore this alleged effect experimentally. Owing to the lack of vampires, we used leeches instead. In strictly standardized research surroundings, the leeches were to attach themselves to either a hand smeared with garlic or to a clean hand. The garlic-smeared hand was preferred in two out of three cases (95% confidence interval 50.4% to 80.4%). When they preferred the garlic the leeches used only 14.9 seconds to attach themselves, compared with 44.9 seconds when going to the non-garlic hand (p < 0.05). The traditional belief that garlic has prophylactic properties is probably wrong. The reverse may in fact be true. This study indicates that garlic possibly attracts vampires. Therefore to avoid a Balkan-like development in Norway, restrictions on the use of garlic should be considered.

The first Norwegian medical school was founded in 1814. Niels Berner Sørenssen (1774-1857), one of three professors, was responsible for teaching pathology and therapy, and for clinical education. Together with his student and successor, Andreas Christian Conradi (1809-68), he made his mark on Norwegian physicians for a period of 50 years. A few years ago a small handwritten book by a medical student, dated 1828, turned up in a second-hand market. This book, which contains notes from Professor Sørenssen's lectures on therapy, demonstrates that his teaching was heavily influenced by the speculative theories of John Brown (1735-88). Similar influence is traceable in the annual reports from Norwegian physicians during the second half of the 19th century. Sørenssen urged his students to thoroughly investigate the medical history and make a detailed clinical examination, and his attitude to therapy was careful, almost reluctant. This personal clinical attitude was probably more important than the theoretical foundation upon which he based his lectures.

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.

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.

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.

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.

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.

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.

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.

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".

139 general practitioners and 190 gynaecologists responded to a case-history questionnaire about female urinary incontinence. More gynaecologists than general practitioners reported more frequent use of leakage provocation test, neurological examination, frequency-volume chart, and measurement of residual urine. Among the less relevant procedures, use of blood tests was reported more frequently by general practitioners, and use of x-rays and ultrasonography by gynaecologists. General practitioners preferred urine microscopy to urine culture. The opposite was true for the gynaecologists. 50% of the gynaecologists would prescribe oestrogens for the postmenopausal women, as against 25% of the general practitioners. Young women were instructed in pelvic floor exercises, incontinence pads were prescribed for elderly women.

Radøy, 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 Radøy. 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.