Saras blogg: Professor Malmstens patientjournaler

Augusta spent the summer of 1852 at Loddby. She was ill with tuberculosis. Adolf Nordvall (who she would later marry) was studying in Uppsala and they wrote long letters to each other. He worried and inquired about her health. She tried to sound upbeat about it, but didn’t like her local doctor: Loddby 31 August 18,52 …My health and my strength are improving in big…

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Professor Malmsten’s Patient Journals

The Sick Child by Edvard Munch 1885. The painting is of Munch’s sister who died from TB.

Augusta spent the summer of 1852 at Loddby. She was ill with tuberculosis. Adolf Nordvall (who she would later marry) was studying in Uppsala and they wrote long letters to each other. He worried and inquired about her health. She tried to sound upbeat about it, but didn’t like her local doctor:

Loddby 31 August 18,52

…My health and my strength are improving in big leaps. Doctor Almqvist is often out to see me and each time he becomes more complacent. Yesterday, he likened me to Hebe [the Greek goddess of eternal youth], so you can imagine how I have improved since you last saw me…”

But what she really wanted was to see Adolf again. And the doctor was getting on her nerves:

Loddby, 14 September 1852

…I was just interrupted by the doctor  who has been sitting here for 5 hours and talked so much nonsense that I am really tired, as if I had walked several miles. He is unsatisfied with my plan to travel to Stockholm and, to be truthful, I also think it might be unnecessary. One doctor is exactly like another; they don’t have any interest in their patients – or know what they should prescribe – and I am really averse to having to start explaining my misery to yet another [doctor].

Pehr Henrik Malmsten
Pehr Henrik Malmsten. Efter teckning av F. Hallman 1854.

In the beginning of October, Augusta finally traveled to Stockholm and stayed with her old friends, the family Hjort. She now got a new doctor, and not just any doctor, but a professor and also the royal family’s private doctor: Pehr Henrik Malmsten.

Stockholm, 3 October 1852

…The Professor visits me every day and always has a gracious disposition….

Stockholm, 12 October 1852

…I am completely taken in by Professor Malmsten. He is the most kind, wise, and pleasant doctor one can encounter; always happy and nice, never grumpy or careless like other Sons of Aesculapius [the Roman god of healing and medicine]. What I least admire in him is his terrible stubbornness to coax me into taking fish oil, and he will most likely succeed in the end, even though I fight for the longest time….

Augusta writes that she lies about taking the fish oil and has qualms about lying to the doctor. She tells Adolf in her letter that she only takes one table spoon of fish oil every day instead of two, but “it’s so terrible, so terrible…”

In addition to the terrible fish oil, she is not supposed to “liven up or encourage her numb feelings”. Professor Malmsten thinks that she is too lively. She has to stop laughing, speaking, and debating; sing or play the piano, and to write – and if  writing is necessary, then only a few lines. Also, no reading for the time being. She is not supposed to do anything that will liven up her imagination or make her emotional. This, she is supposed to do for 6 months: a life of “muteness and lifelessness”.

Despite the harsh restrictions and the horrible fish oil, Augusta still likes Professor Malmsten, and the feeling is probably mutual. One day when he visits her, he is coming straight from the death bed of a young woman and he shares his feeling with her: “..I saw that my Professor had shed some compassionate tears over the young woman.”

What Professor Malmsten didn’t know was that tuberculosis was caused by a bacterium. It would take another 30 years until Robert Koch discovered the bacterium in 1882. The only thing he could prescribe was fish oil and rest – and later, sea air at the spa town of Varberg, where Augusta died in 1855.

But in the correspondence between Adolf and Augusta’s mother, following Augusta’s death, Professor Malmsten is implicated – did a prescription contribute to Augusta’s death?  There are no details, just hints. So could we find out if she received any other medications besides fish oil?

I contacted the Swedish National Archives who confirmed that they had Professor Malmsten’s patient journals for the time period during which he treated Augusta. They also had a considerable amount of his correspondence. Could any of this material shed any light on Augusta’s treatment and cause of death?

Kerstin and Sara reading Pehr Henrik Malmsten’s journals and letters at the Swedish National Archives

Today, Kerstin and I visited the archives in Stockholm. It is a serious place. And very quiet. An archivist delivered the brown paper boxes that contained the journals and letters. With cotton gloves, we untied the strings and opened the boxes.

The patient journals were small note books. When I opened the first one, it was not what I had expected. For each patient, there was a row, and the columns represented the days of the month. In this matrix, the doctor had made an X on the day he had seen the patient.

We knew which days Professor Malmsten had visited Augusta, but her name was not listed on any pages in the journals. Why? Was she a special patient? A private patient, paid for by someone else – like her brother-in-law? Was this book a record for billing? No clues.

Malmsten’s Patient Journals

Then there were actual patient journals – called Disease History, but they seemed to be sorted by diseases and possibly for the sake of research. There were journals for patients with Chlorosis [anemia], Bright’s Disease [nephritis], and Syphilis. Those were some of the diseases that Professor Malmsten was interested in. I forgot to check if there were any patients with Phthisis (the Greek name for tuberculosis).

And finally there were the letters. Lots of handwritten, old letters from patients but none from Augusta’s family.

So we removed our cotton glows, wrapped up the boxes, tied the strings, and carted the material back to the archivist. The visit had only taken an hour as there was nothing to be found.

What should we do for the rest of the day?

”Let’s check out the Military Archives,” said Kerstin. ”Maybe we can find out more about Augusta’s dad!”

And off we went.


The Meissen Souvenir

Ever heard of Meissen porcelain? It is one of the most famous porcelain manufacturer in Europe – since 1710.

Augusta visited Meissen on her journey in 1847. Meissen is not far from the city of Dresden and Augusta stopped there on her return trip from Prague. She didn’t write much about her visit:

”We only stayed in Dresden for one day and visited the large porcelain factory where we bought a few small things.”

A contemporary Swedish writer, Sophie von Knorring, visited the porcelain factory the year before and wrote a little bit more in her letter home:

”In the afternoon, we first went to the Catholic Church, the first one I have ever visited, and then to the porcelain factory. From all the many magnificent objects, I would not be able to bring home many, but the little I chose were so much more beautiful and expensive. You will see, when I return home ….”

Kerstin and I visited the Meissen porcelain factory on our journey last fall. We got to see the various steps in making porcelain dishes and figurines. And then we ended up in the gift shop. What should we buy?

Augusta bought a few small things to take home to Loddby, and Sophie von Knorring bought a few, beautiful and expensive things. But what were the things they bought?

Some of the refrigerator magnets from our journey last fall. Small, inexpensive souvenirs that will brighten your day.

We walked around and looked at some of the things we had seen being made during the factory tour. The prices were astronomical. There was really nothing in the gift shop that we could afford and also want….except for the usual souvenir – the refrigerator magnet.

We each bought one.

What would Augusta have thought of that?

A little painting that would stick onto a cold-cabinet in the kitchen – a cabinet where you could store milk and cheese and other things so you wouldn’t need to go to the cellar. If someone got hungry in the middle of the night, they could just go and grab something. Or you could pour yourself a glass of cold, white wine. What luxury! And why not decorate this cold cabinet with a little piece of art that would remind you of what you had seen on your exotic journey.

Augusta would never have believed it!

Att fylla ”minnets rosengård” för mörka vinterkvällar

Vinter och mörka kvällar. Idag läste jag åter Augustas Tysklandsberättelse i dagboken och fastnade på några rader i slutet.  I en enda mening sammanfattar hon sin resa. Väldigt träffande beskrivning av städerna hon besökte. Efter vår Tysklandsresa i höstas kan jag hålla med Augusta helt och hållet, utom Hamburg.

”Minnet af de dagar då jag vandrade bland Rubens och Rafaels mästerstycken i det herrliga Sachsiska Schweitz, det gamla minnesrika Prag, det ståtliga Berlin, det vackra Hamburg och framför allt det trefliga, gästvänliga Lübeck, skall förljuva mången vinterafton vid Bråvikens strand.”

Jag kan just se för mig hur en vinterafton såg ut på Loddby. När solen gick ner redan på eftermiddagen blev det dåligt med ljus. Brasor i kakelugnarna och några stearinljus var det enda som lyste upp vintermörkret inomhus. Men inte var det mycket ljus för att kunna läsa böcker eller brodera. Så förmodligen satt de och samtalade. Och visst måste det varit roligt att Augusta och hennes mamma Anna gjort Tysklandsresan tillsammans. Så många roliga minnen de hade att skratta åt där i vintermörkret.

Precis likadant gjorde Sara och jag i november när vi kommit hem från vår Augustaresa i Tyskland. Vi pratade och skrattade åt alla tokigheter och roliga situationer vi varit med om. Som när jag tappade underkjolen, när vi skulle checka in på hotellet i Bad Schandau. Plötsligt kände jag hur något stort slafsigt hasade runt fötterna och det gällde att snabbt kliva ur det vita tyget och smussla det bakom ryggen till Sara, medan jag konverserade med hotellägaren.

Det är så mycket roligare när man har någon att dela sina minnen med. I dagboken skriver hon inte om tokigheter. Det var ju första kapitlet i dagboken och det verkar som om hon skrev den för en bredare läsekrets och därför utelämnade det tokiga och roliga. Den är lite för korrekt för att vara hennes egna tankar och funderingar.

”Skulle jag alldrig mera återse det trefliga, vackra, Tyskland och dess glada, artiga innevånare, som tycka att allting är ”ganz wunderschön” så skall likväl alltid de stunder jag der tillbringat, blifva de käraste platserna i minnets rosengård, dem på hvilka jag helst ser tillbaka.”

Det blev inte några fler resor till Tyskland för Augusta. Hennes ”minnets rosengård” fylldes med mycket annat de få år hon hade kvar att leva.
Nu när vårsolen smälter bort lite snö, börjar Sara och jag en ny säsong upplevelser i Augustas fotspår att fylla våra ”rosengårdar” med.

Min underkjol på golvet