[John Bjorkhem and hypnosis]. / Hypnos i svensk 1900-tals medicin speglad genom John Björkhems liv och verksamhet.

Hypnosis has been recognised for thousands of years and is believed to have originated from shamanic trance methods. It has always been controversial in medical science. The biography of the Swedish physician John Björkhem and the history of hypnosis in Swedish medicine during the 20th century is intimately related to each other. Björkhem devoted most of his professional life to the phenomenon of hypnosis. He had a unique background for his studies as a priest, physician and psychologist. He always regarded hypnosis to have a great potential both as a therapeutical and as a diagnostic tool. He was fascinated by the mysteric undertones in his results from the hypnotic experiments and he devoted great time to parapsychology. In this essay we describe an outsider in medicine, both with respect to person and topic. In the case of Björkhem the situation was particular complicated because of his multidisciplinary activities with three different faculties involved. Finally the essay deals with the condition of a pioneer, and his struggle for acceptance and understanding. Only future can tell if the visions that Björkhem had about hypnosis as an efficient therapeutic tool in medicine will come true.

[Poul Bjerre's practice of psychiatry]. / När man är förfärligt ledsen söker man - tror Ni inte det? Människan.

Poul Bjerre (1876-1964) was one of Swedens most famous psychiatrists and authors in the first part of the 20th century. He had an extensive medical practice. This study is mainly based on letters from patients to Bjerre. These letters are now kept in The Royal Library, Stockholm. The aim of the study was to find out what made Poul Bjerre a successful practitioner. The letters was studied with a phenomenological-hermeneutical approach. The results highlights the importance and need for the physician to be human, to talk with and listen to the patient in a holistic manner, to use words with great care and to touch the patient. This led to understanding, and the physician was regarded a friend and someone who one could tell anything. Bjerre acted in a time of paternalism, but used this to release autonomy for the patient, so that he could be liberated. Follow up was very important, mainly through letters.

Poetry, interpretation and unpredictability: a reply to Neil Pickering.

In his article on poetry in health care education, Neil Pickering puts forward an argument of radical unpredictability: as we can never know in advance how a poem will be interpreted, it can be of no external use.(1) It is, however, exactly this potential to give rise to multiple interpretations that makes the poem valuable. We hold that the poem should be read and discussed with no other intention than to discover and reflect on its possible meanings. Exactly this process, preferably in dialogue with other readers, may very well serve as one of the ends of the poem, and the results of it hence constitute its external use.

[Should we always tell everything? About the difficulties to manage prognosis]. / Ska man alltid berätta allt? Om svårigheten att hantera prognostiken.

Patient autonomy should be respected when information is given about serious and life-threatening disease. The patient must be allowed to choose how much he or she wants to know concerning prognosis, and informed consent should be sought early on with regard to which level of autonomy the patient desires. A number of possible explanations as to why doctors conceal information from patients are discussed. Concealing information may damage the patient's trust in the physician. By not providing full information about a deadly disease, a physician may in turn be forced to bear the affliction of another's fears.

[What is the humanistic medicine?]. / Vad är humanistisk medicin?

At the Karolinska Institute, Stockholm's medical university, a new academic discipline was established in 1998. Humanistic medicine, or medical humanities, is a response to the need in an increasing technological medicine for a humanistic dimension in medical education and clinical practice. The mission of medical humanities is to contribute to the understanding of the scientific and ethical structure of medicine. Medical humanities should focus on clinical practice. At the Karolinska Institute, the discipline has three aspects: medical history, philosophy of medical science, and the "medical meeting", i.e. issues such as: What happens in the relation between patient and caregiver? What is the art of medicine? How is suffering and disease expressed in art and literature? Medical humanities can be a tool for critical reexamination and a radical reorientation of the ethos of medicine. After all, health care is at its very core a moral project.

Prevalence of parvovirus B19 DNA in bone marrow of patients with haematological disorders.

Patients with haematological disorders (n = 100) were examined for prevalence of parvovirus B19 DNA in the bone marrow and serum, irrespective of B19-related symptoms. B19 DNA was studied using 2 nested PCRs and the serum samples were further analysed with B19-specific IgG, IgM and avidity as well as seroreactivity against linear and conformational epitopes of the B19 VP2 antigen. The latter assays specify whether the IgG antibody response represents acute or past B19 infection. B19 DNA was detected in 4 of the 100 bone marrow samples, whereas all the serum samples were B19 DNA negative. None of the 4 B19 DNA positive patients had symptoms typical of B19 infection and serology showed past infection. Furthermore, 2 were still B19 DNA positive in bone marrow more than 1 y after the first sample indicating virus persistence. The seroprevalence for B19 IgG was 59% and 2 patients were B19 IgM positive. Thus, presence of B19 DNA in bone marrow from patients with haematological disorders is not a general finding in seropositive patients. B19 DNA can persist in bone marrow, but in our material this finding showed no clear correlation with symptomatic B19 infection.

[Moniz, lobotomy and the Nobel Price 1949]. / Moniz, lobotomin och 1949 ars Nobelpris.

This paper is an analysis of the decision to award the Nobel Price to Egas Moniz 1949. His method prefrontal leucotomy was introduced in 1936. Before that he made an important contribution to medicine by introducing angiography of the brain vessels. He was suggested to the Nobel Price several times: 1928, 1933, 1937, 1944 and finally 1949. In the judgement of his scientific work the neurosurgeon Herbert Olivecrona 1937 avoided to discuss leucotomy. In 1944 Essen-Moller had critical comments to the orginal work of leucotomy by Moniz, especially the short follow-up and the poorly defined patient-material. When Olivecrona 1949 made a new review, he suggested that Moniz should be awarded the Nobel Price. What had changed from 1944? In front of all: the experience of the method all over the world had increased significant, and therefore Olivecrona now found it suitable to give the price to Moniz. He did not at all discuss the philosophical and ethical perspectives of the method.