Jim Peters' collapse in the 1954 Vancouver Empire Games marathon

On 7 August 1954, the world 42 km marathon record holder, Jim Peters, collapsed repeatedly during the final 385 metres of the British Empire and Commonwealth Games marathon held in Vancouver, Canada. It has been assumed that Peters collapsed from heatstroke because he ran too fast and did not drink during the race, which was held in windless, cloudless conditions with a dry-bulb temperature of 28 degrees C. Hospital records made available to us indicate that Peters might not have suffered from exertional heatstroke, which classically produces a rectal temperature > 42 degrees C, cerebral effects and, usually, a fatal outcome without vigorous active cooling. Although Peters was unconscious on admission to hospital approximately 60 minutes after he was removed from the race, his rectal temperature was 39.4 degrees C and he recovered fully, even though he was managed conservatively and not actively cooled. We propose that Peters' collapse was more likely due to a combination of hyperthermia-induced fatigue which caused him to stop running; exercise-associated postural hypotension as a result of a low peripheral vascular resistance immediately he stopped running; and combined cerebral effects of hyperthermia, hypertonic hypernatraemia associated with dehydration, and perhaps undiagnosed hypoglycaemia. But none of these conditions should cause prolonged unconsciousness, raising the possibility that Peters might have suffered from a transient encephalopathy, the exact nature of which is not understood.

['Charitable brothers' in charge of hospitals in early modern times: The hospital in Linz/Austria and its patients up to c. 1780]

The article deals with the history of the Hospital of the Brothers of St. John of God (in German: "Barmherzige Brüder"; official name "Ordo Hospitalarius Sancti Joannis a Deo") in the capital of Upper Austria, Linz, from its founding in 1757 to c. 1780. Primarily, the organisational development and the patients of the institute are discussed. The order's hospital already functioned as a medical hospital for the treatment of acute diseases: It was oriented towards the reestablishment of health of its inmates during short time and offered treatment by a staff of learned medical experts, among them academically trained physicians. The accommodation of the patients yet took place in a largely undifferentiated manner, as most of them were situated in a large common hall. This was obviously a consequence of the comparatively little capacity of the organisation, too, which sustained about 12 beds in the beginning, and about 20 around 1780. Nonetheless, the number of patients treated there summed up to nearly 1% of the entire male population of Upper Austria even during the first decade of its existence. In early modern time, only men were admitted to this hospital, the average age of them being only ca. 30 years. As far as social status is concerned, most of them (according to a representative sample out of the admissions of 1757-1767) were handicraftsmen (more than two thirds), labourers and servants. Thus, the organisation was obviously destined to broad social strata, but by no way displays itself as a poorhouse. Average annual mortality was 10 to 13%, which is comparable to that of other hospitals of the order in 18th century Austria. Most of the admitted persons suffered from "fever" or inner diseases and were dismissed as healed already after some weeks of stay.

Zepherina Veitch (1836-94), childbed fever and the registration of midwives

At a time when hospital infections are rarely out of the news, it is important to reflect that the origins of midwifery as a profession owe much to the actions of a group of determined women who, in the face of much opposition from within the medical profession, strove to improve upon standards of hygiene in maternity care to reduce the high levels of maternal and infant mortality associated with some of the most prestigious hospitals in the land.

The isolation hospital in the training of nurses: subject of the BJN over 100 years ago

A Doctor Knyvett Gordon, who was a lecturer on Infectious Diseases at the University of Manchester, wrote a fascinating article on why a period of time spent in an isolation hospital may be of an advantage to a nurse for her future career. Sadly such hospitals no longer exist and the special fever training certificate and registration as a fever nurse (RFN) have disappeared.

Disease and medicine in the armies of British India, 1750-1830: the treatment of fevers and the emergence of tropical therapeutics

The East India Company's extensive medical establishment was noted for innovation and experimentation, it tested economical mass remedies. The service's control of its patients was significant, prefiguring the birth of the clinical anatomical medicine of Paris of the 1790s. The unique environment created a distinctive medical discipline: the medicine of warm climates. This chapter focuses on fever in particular; attention was focused on malfunction of the liver and the favoured treatment was purgation via mercury. The dominance of this method resulted partly from senior military officers imposing their views on the juniors.

['Magdalena fevers': medicine and society in the construction of a Colombian medical notion, 1859-1886]

In this article, I explore the theoretical, social and ideological bases of the emergence and consolidation of the Colombian medical notion of the 'Magdalena fevers'. Firstly I show how, in the late 1850s, the emerging Colombian body of medical doctors elaborated peculiar notions on fevers by articulating the European medical theories (i.e. the miasmatic theory and the climatic determination of diseases) with the negative valuation of the hot climate. Secondly, I explain how free trade policies in the mid-1800s, and the economic and ideological impacts of the agricultural export of tobacco and indigo determined doctors' interest in the epidemics occurring in the production centers and also, therefore, the emergence of the notion of 'Magdalena fevers'. I also show how doctors established a causal association between the productive process of those goods and the fevers.

Not just malaria: Mary Slessor (1848-1915) and other Victorian missionaries in West Africa

Fear of 'fever' was uppermost in the minds of many travellers to West Africa in Victorian times. 'Not just malaria...' chronicles attitudes, treatments and discoveries regarding malaria from the time of David Livingstone through the early 20th century. Missionaries often found themselves in the position of serving as untrained doctors and nurses among the people they went to evangelize. In addition, they suffered from the same maladies as the people did, and many died from malaria or other afflictions. Mary Slessor arrived in Calabar, in what is now southeastern Nigeria, to serve with the Scottish Presbyterian Mission in 1876. With only a few furloughs, she remained there until her death in 1915. The article relates instances of the illnesses and injuries she treated as well as those she suffered herself. She is remembered in Nigeria with statues and, along with David Livingstone, is one of Scotland's best-known missionary figures.

From Fahrenheit to cytokines: fever, inflammation and the kidney

People have used the words inflammation and fever for millennia, but the meaning of inflammation has gradually changed whereas that of fever has remained reasonably constant. Whereas inflammation originally referred to the combination of heat, redness, swelling and pain in a local area, it has gradually evolved to focus upon cellular and humoral processes that occur in tissues when external or internal agents cause damage to them. The classical manifestations are no longer obligatory. Diseases that affect internal organs such as the kidneys are nowadays commonly described as inflammatory despite entirely lacking those classical manifestations, but possessing evidence of cellular proliferation and/or involvement of factors such as cytokines. These conceptual changes have resulted from the application of progressively improved investigational techniques such as microscopy, thermometry, experimental pathology, and tissue culture. The consequence of them has been largely to extinguish the fire that previously epitomised inflammation.

Robert Robertson, FRS (1742-1829): physician to the Royal Hospital, Greenwich, 18th-century authority on 'fever', and early practitioner in care of the elderly

Robert Robertson was born in Scotland and trained to be a surgeon. In 1760, he served briefly on a whaling ship and then entered the Royal Navy. He subsequently had many postings, several of them to the tropics. He recorded his observations on fevers, scurvy and other illnesses. After 23 years of active service, he retired to private practice in Hampshire. However, later he rejoined the service and was appointed physician to the Royal Hospital, Greenwich, where later he was made a Director. During this period, he addressed the problems of illness after the days of active service. Robertson was thus an early practitioner in the care of the elderly. He retired in 1807 and died at Greenwich at the age of 87.

The identification of medieval fevers according to Al-Isra'ili, Avenzoar and Bernard Gordon

In this work, which derives from a study into the prevention of illness in medieval Spain, and which forms part of a larger work on medieval fevers in all their aspects, we concern ourselves with their causes, symptoms, prognostications and treatment. We are grateful for the support of the British Academy and The Wellcome Trust in funding this study. Through this work we aim to establish a certain order in the fevers which figure in medical texts of the Middle Ages which we have analysed. We have grouped them, following the example of Galen, according to their point of origin: spirits, humours and solid matter. Then, within each of these categories, we have classified them by the spirit or humour affected. The basic elements of each fever are described in order to differentiate them. We offer, finally, over one hundred names by which the different fevers can be known.

Hempelian and Kuhnian approaches in the philosophy of medicine: the Semmelweis case

Semmelweis's investigations of puerperal fever are some of the most interesting in the history of medicine. This paper considers analysis of the Semmelweis case. It argues that this analysis is inadequate and needs to be supplemented by some Kuhnian ideas. Kuhn's notion of paradigm needs to be modified to apply to medicine in order to take account of the classification schemes involved in medical theorising. However with a suitable modification it provides an explanation of Semmelweis's failure which is argued to be superior to some of the external reasons often given. Despite this success in applying Kuhn's ideas to medicine, it is argued that these ideas must be further modified to take account of the fact that medicine is not a natural science but primarily a practice designed to prevent and cure diseases.

Hippocrates in the context of Galen: Galen's commentary on the classification of fevers in Epidemics VI

This paper elucidates the relationship between Hippocrates and Galen concerning the classification of fever and illustrates Galen's use and abuse of Hippocrates. Galen used Epidemics VI in order to justify his own arguments on the classification of fever, based on the three forms of matter. A close examination of Galen's use of Epidemics VI does not support his justification. It turns out that it was Galen's theory-laden eyes that made Epidemics VI a founding ground for his fever theory.

Carl Liebermeister (1833-1901): a pioneer of the investigation and treatment of fever and the developer of a statistical test

In the second half of the nineteenth century, when the typical course of various febrile clinical phenomena was found to be specific to particular infectious diseases, Carl Liebermeister successfully pioneered the investigation of the patho physiology of fever and the regulation of body temperature. He applied biophysical and pharmacological antipyresis, especially for the treatment of typhoid fever, and developed new statistical tools for the evaluation of therapeutic results.

"It is wisest here, as always, to maintain a balance": the medical dissertations of Friedrich Schiller

Johann Christoph Friedrich Schiller (1759-1805) is remembered today for his contributions to literature and aesthetic theory-it is less well known that his first career was in medicine (an army appointment). Scholars have generally held that his primary interest lay in psychology and the psychological aspects of medicine, and that his commitment to other aspects of medicine was perfunctory at best. The present paper argues that a study of Schiller's three medical dissertations-two on psychological aspects of medicine and one on fevers-reveals his attempt "to maintain a balance" between the mind and the body in his approach to medicine.

The evolution of the concept of ‘fever’ in the history of medicine: from pathological picture per se to clinical epiphenomenon (and vice versa)

The medical concept of 'fever' has undergone profound changes throughout the centuries. Galen of Pergamon considered fever as a systemic disease in itself, and it was only between 17th and 18th century that Hermann Boerhaave provided a more careful evaluation of the clinical phenomena related to fever. Apart from incorrect theories, a major obstacle to the development of a rational study of fever has been the lack of appropriate instruments of measurement; in effect, the clinical thermometer was not diffusely used in everyday medical practice until the mid 19th century. During this same period Ignaz Semmelweiss postulated that the pathological-anatomical changes recorded in women who had died because of puerperal fever represented a pathological reality clinically suggested by a whole cohort of symptoms and signs, among them fever. Even if enormous progress has been made in the 20th century with regard to fever, which is currently considered a clinical sign of many different diseases, its etiologic assessment remains a challenge. In fact, in 1961 the clinical picture of 'Fever of Unknown Origin' was officially defined. Since such diagnostic labelling is in effect a cover for our inability to discover the real causes of fever, in this case, paradoxically, fever goes back to being the whole pathological picture, just as it was retained to be many centuries ago.

[Japanese nonprescription drugs (1) "Pediatric Formulas" for five kinds of "Gan"]

The genealogy of children's sedatives such as Kio-gan and Kyumei-gan, which remain in use even today for pediatric conditions including convulsions and nocturnal crying, was traced and the significance of these formulas was investigated. In the Edo Era, pediatric formulas for five kinds of gan (infantile malnutrition) combined four prescriptions to treat individual symptoms of "re (heat) gan," "leng (cool) gan," "hui (helminth parasite) gan," and "ji (spinal) gan" into one prescription. In contrast, during and after the Meiji Era, pediatric formulas for these five kinds of gan have used only one prescription to treat "re (heat) gan". Moreover, these formulas have tended to use a greater proportion of components that are used to treat "re gan". From this information, it readily became apparent that : 1) Edo Era pediatric formulas for the five kinds of gan were intended to improve the physical condition of the children prone to the illness; and, 2) modern (Meiji Era) prescriptions were intended to alleviate the acute symptoms of gan.

[Febres paulistas and the São Paulo society of medicine and surgery: a controversy among spokespeople from different arenas of knowledge]

At the close of the nineteenth century, São Paulo physicians were debating a disease they classified as "febres paulistas" (São Paulo fevers). The article present a brief overview of the role of fevers within Brazilian nosology at that time and describes how science then explained febres paulistas, malaria, and typhoid fever. Changes in the medical field meant febres paulistas were no longer classified as forms of malaria but instead considered cases of typhoid fever. Following the Society's debates surrounding this shift, the article analyzes the scientific lines that tended to identify febres paulistas with malaria or typhoid fever and also the line that believed these fevers were an independent nosological entity.

Dr William Coley and tumour regression: a place in history or in the future

Spontaneous tumour regression has followed bacterial, fungal, viral, and protozoal infections. This phenomenon inspired the development of numerous rudimentary cancer immunotherapies, with a history spanning thousands of years. Coley took advantage of this natural phenomenon, developing a killed bacterial vaccine for cancer in the late 1800s. He observed that inducing a fever was crucial for tumour regression. Unfortunately, at the present time little credence is given to the febrile response in fighting infections-no less cancer. Rapidly growing tumours contain large numbers of leucocytes. These cells play a part in both defence and repair; however, reparative functions can also support tumour growth. Intratumoural infections may reactivate defensive functions, causing tumour regression. Can it be a coincidence that this method of immunotherapy has been "rediscovered" repeatedly throughout the centuries? Clearly, Coley's approach to cancer treatment has a place in the past, present, and future. It offers a rare opportunity for the development of a broadly applicable, relatively inexpensive, yet effective treatment for cancer. Even in cases beyond the reach of conventional therapy, there is hope.