[Some aspects of the history of tuberculosis with special reference to Finland]. / Några aspekt på tuberkulosens historia med speciell hänsyn till förhållandena i Finland.

A popular theory has been that Mycobacterium (M) tuberculosis evolved from M. bovis after cattle domestication. The evidence of M. tuberculosis complex in the Western Hemisphere before Columbus and the paleopathological evidence from the Near East indicate that this relationship between cattle domestication and evolution of tuberculosis might not have been so straightforward. Tuberculosis was already familiar in Scandinavia during the Middle Ages. In Finland consumption was firmly established in both towns and countryside at the end of the 1700s and the epidemic peaked during the following century. Tuberculosis infection must have been an almost universal feature of childhood in many areas of Finland, even in the early decades of the 20th century. After the Second World War, specific and effective chemotherapy and preventive measures rapidly diminished the number of new cases of tuberculosis.

[Historiography of diseases in Finland]. / "Ovatko taudit itsenäisiä, eläväisiä olentoja?" - eli voimmeko kirjoittaa niiden historian.

The 19th century was a period of comprehensive, "big" histories of diseases. German historiographers of diseases were especially prominent. World-famous is August Hirsch's Handbuch der historisch-geographischen Pathologie (the second edition appeared in three volumes in 1881-1886). The first volume of the Finn Immanuel Ilmoni's (1797-1856) Bidrag till Nordens sjukdoms-historia (A History of Diseases in the Nordic Countries) was published in 1846, the second volume in 1849 and the third in 1853. In this book Ilmoni treated the history of disease up to the year 1800. He planned a fourth volume, dealing with the 19th century, but this book was never published. Ilmoni was strongly influenced by the ideas of Thomas Sydenham and the German exponents of Naturphilosophie. Ilmoni's "ontological" concept of disease was rejected by Erik Alexander Ingman, a contemporary Finnish representative of "modern" medical ideas. After Ilmoni, nobody has attempted to write a comprehensive history of diseases in Finland, but histories of cholera (Carl Qvist, 1872) lepra (Lars Fagerlund, 1886), malaria (Richard Sievers, 1891) and pulmonary tuberculosis (Woldemar Backman and Severi Savonen, 1934) have been published. Diseases in Finland received very little attention in the "world histories" of diseases. After Hirsch only one comprehensive "world history" of diseases has been published (1993).

[Diseases in the ancient world]. / Taudeista antiikin aikana.

Antiquity has been considered the cradle of western civilization, including medicine. The role of diseases in the course of history has been stressed by several authors during the last few decades. The aim of this study is to survey the occurrence of diseases in antiquity. There are many obstacles to the study of the occurrence of diseases during antiquity. The most serious problem is the lack of reliable sources. Mostly we have to rely on written sources. Sometimes it is possible to supplement them with archaeological findings (e.g. bones and mummies). The defective sources give an unrealistically static picture of the occurence of diseases. Diseases must be seen as a dynamic relationship between populations and their environment. There is evidence suggesting great secular and regional variations in the occurrence of diseases during antiquity. Micro-organisms were by far the most serious threat to human health. We can be convinced that some diseases such as malaria, tuberculosis, mumps, cancer, trauma, etc, occurred during antiquity. Available sources do not, however, permit estimation of the frequency of these conditions in different populations and time periods. We have information of the occurrence of large-scale epidemics during antiquity, e.g. the plague of Athens (431-426 B.C.), the plague of Antonines (about 165-180 A.D.) and the plague of Cyprian (about 251-266 A.D.). However, the first definitely identified large epidemic (bubonic plague) was the plague of Justinian (starting in 542 A.D.).

Trace and heavy metal analyses of a skeletal population representing the town people in Turku (Abo), Finland in the 16th-17th centuries: with special reference to gender, age and social background.

The Julin site in the city of Turku, Finland, was excavated in 1964, 1983-1985 and 1987. On this site are the remains of the church of the Holy Spirit with its cemetery. The burial period of the excavated skeletons lasted most probably from the 1580s to the 1650s. Sodium, phosphorus, calcium, manganese, iron, copper, zinc, bromine, strontium and lead concentrations of ribs from skeletal remains of 141 individuals were analyzed. The main finding is that the concentrations of Sr and Zn in younger women tend to be lower than that in men of a corresponding age, and in older people both the strontium and zinc values tend to be higher in women than men. On the basis of this study the Pb exposure in the early modern population in Finland was at a very low level. We conclude that the role of migration and the source of grain supply on the variation of the elemental values are more difficult to evaluate than the role of diagenesis.

Public health and children's well-being and health during antiquity.

The health and well-being of children depends on many factors. These factors may include: 1) geographic location, 2) genetic composition of the population, 3) existence of parasites and their hosts, 4) previous history of diseases (e.g. immunity) and 5) socio-economic structure (Grmek 1989). During the last two centuries, industrialized societies have successfully manipulated several of these factors for the benefit of children. But what were the possibilities in pre-industrial societies to improve public health and to promote the health of children? The aim of this study was to examine the relationship between public health and the health and well-being of children during Antiquity (roughly 500 B.C.-500 A.D.). To realize this aim, both written and archeological evidence was considered. Unfortunately both types of sources are biased, their data being defective with regard to children. Public health was not a major topic of interest for ancient authors (medical or others). There are few archaeological studies which have concentrated on public health aspects (e.g. water supply, sewers, housing conditions) of ancient societies.

[Water and public health during antiquity]. / Veden kansanterveydellinen merkitys antikin aikana.

"Thales of Miletus, one of the Seven Wise Men, affirmed that the principle of all things is water; ..." The importance of water for people's health was a widely held opinion of ancient writers. The purpose of the present study was to examine: 1) ideas of the salubrity of water, 2) the organization of water supply in towns, 3) the role of water in agriculture and transport, and 4) the influence of water on public health during antiquity. The written sources indicate that ideas of the salubrity of water are connected with the general scientific level of the society. The quality of water was examined using the senses; taste, smell, appearance and temperature. In addition the health of people and animals using a water source was examined. Tasty, cool, odorless and colourless water was considered best. Stagnant, marshy water was avoided. Settling tanks, sieves, filters and boiling of water were methods used to improve the quality of water during antiquity. The available sources do not permit estimation of the effect of these methods on public health. The relatively extensive urbanization during antiquity may be attributable to the importance dedicated to the transportation of sufficient amounts of water of good quality to the towns, Baths were probably beneficial for public health in towns where an abundance of water was available. In towns where water was scarce the role of baths was probably negative for public health....

[Lead and health during antiquity]. / Lyijy ja terveys antiikin aikana.

The possibility of widespread lead exposure during antiquity has awakened interest during the last few decades. The purpose of this study was to examine: 1) possible sources of lead exposure, 2) ideas concerning the health hazards of lead, 3) the extent of lead exposure, and 4) the influence of lead on public health during antiquity. Both written and archaeological data seem to prove that part of the population was exposed to lead during antiquity. Occupational exposure was most probably most important, but food and wine also played a part. The role of water in this context is hard to evaluate. Lead exposure by medical and cosmetic use was most probably epidemiologically unimportant. Evidently some population groups occasionally suffered from lead poisoning. There is, however, no reason to suppose that lead had something to do with the fate of the Roman aristocracy or the collapse of the Roman Empire.

Social variation in infant mortality in a core city of Finland during the 19th and early 20th centuries. Positive effect of industrialization?

The aim of this study was to examine social variation (social class, legitimacy) in infant mortality in a core municipality (Viipuri) in Finland from 1819 to 1918. Data were obtained from the Population Change Tables of Finnish, Swedish and German parishes of the town of Viipuri. During the 19th and early 20th centuries the German parish socially had the highest rank and the Finnish one the lowest while the Swedish parish held an in-between position. The study period was divided into the preindustrial period (until 1868) and the period of industrialization (from 1868 onwards). Results of the study indicated a clear association between social class and infant mortality in the preindustrial period; in the period of industrialization the association was also clear but smaller. Legitimacy as a determinant of infant mortality became more marked towards the early 20th century. Industrialization brought with it some factors, such as numerous public health measures, which benefited the legitimate infants and narrowed their social group differences.

Core-periphery differences in children's health and use of general practitioner services in Finland from 1964 to 1987.

Finland is a modern welfare state in Northern Europe especially proud of its development of programs for children's health. The aim of this study was to investigate the development of core-periphery differences in children's health and use of health services. The study material was obtained from the national health and social security interview survey carried out in 1964, 1968, 1976 and 1987. Age standardized prevalence of chronic diseases, number of restricted-activity days and physician contacts were presented for two age groups: 0-6-year-olds and 7-14-year-olds. The prevalence of chronic diseases was quite similar in the core and periphery in 1976 and 1987, but the number of restricted-activity days throughout the study period (1964-1987) was significantly higher in the core than in the periphery. The consistently higher frequency of physician contacts in the core in comparison with the periphery was spectacular; the welfare policy of the last decades seems to have had very little or no effect on this difference. The core-periphery division thus continues to have relevance with respect to the health of Finnish children.

Family resources and children's use of primary health care services in Finland in 1979.

The purpose of the study was to determine how children's use of primary health care services was related to family resources (socio-economic status, marital and residential stability of the family, and core/periphery dichotomy). The population consisted of a random sample of 3201 children from 15 municipalities in the province of Uudenmaan lääni in Southern Finland in 1979. Among two-parent families in the core regions total utilization of primary health care services was significantly higher among the children of workers and upper white-collar employees. Children of farmers and lower white-collar employees in the periphery exhibited low primary health care utilization. Children in upper white-collar employees' families (both two- and one-parent) in core regions frequently used private services. Among children of one-parent families, exceptionally high users of private services were children of upper white-collar mothers in core regions, and of municipal health services the children of working-class mothers in the periphery. Non-migrated children had a slight tendency to use health services more than migrated children. Differences in family resources thus cannot be ignored when children's utilization of primary health care services is studied.

Children and core-periphery differences.

This study examines the differences between children's (0-15 yr of age) use of primary care services in core and peripheral municipalities in Uusimaa province in southern Finland following the implementation of the Primary Health Care Act (1972). In the ecological study (municipality-based), children's total use of primary health care services during 1973-1979 was continuously lower in peripheral municipalities than in core areas in spite of the Primary Health Care Act, the express purpose of which was to reduce regional differences. Some equalization of utilization of private practitioners occurred during this period. The individual-based study material collected in 1979 enabled us to control for the influences of (1) distance to the core of the municipality, (2) age of the child, (3) socio-economic status of the family, (4) type of visit and (5) diagnosis. These factors somewhat modified the influence of the core/periphery dichotomy, but the overall picture that children in the core use more primary health care services remained the same. This suggest that health care policy should be quite specific and based on detailed regional analysis, if equalization between core and peripheral municipalities is to be achieved.

Core-periphery differences in infant mortality.

The study aims to describe the development of core-periphery differences in infant mortality trends in Finland from 1950 to 1984. The infant mortality trends in core and in periphery are described at three levels of spatial hierarchy: (1) nation, (2) province and (3) local hospital region. The main findings are: (1) at the national level: (a) the differences between core and periphery in infant mortality trends disappear by the mid 1960s, mainly due to the equalization of postneonatal mortality and (b) the diminishing of postneonatal mortality stops and the diminishing of especially the first-day mortality begins about the middle of 1960s, both in core and periphery; (2) in the province of Uundenmaan lääni there are no differences in infant mortality trends between the metropolitan area of Helsinki (core) and the rest of this province (periphery); (3) in the two local hospital regions the diminishing of infant mortality is significantly slower in periphery than in core. At present there is scarcely any core-periphery variation in the trends of different components of infant mortality. This is a very remarkable fact when the achievements of the health and social policy of Finland are assessed. Several possible methodological, socio-economic, demographic and health care factors that may explain the differences in infant mortality trends between core and periphery at different levels of spatial hierarchy are discussed.