Schleisner’s treatment
We know quite a lot about Schleisner’s treatment of newborn babies. The main sources are the Health Board’s records for the period from 1847 – 48 (23, 24, 33, 34) which we have compared with a fuller report published by Schleisner in German in 1855 (35) . Schleisner focused particularly on the umbilicus «insisting – in accordance with the advice of American physicians – that the umbilical stump be dressed with balsamum copaivae as a preventive measure until it fell off» (24, 35) . The copaiba balsam was obtained by making incisions in the trunk of different species of the Copaiba genus which belongs to the Fabaceae family that grows in South and Central America (36) (fig 7). The preparation had been used medicinally from the 17th century onwards and is found in all Norwegian pharmacopoeias. In Europe it was originally used as a remedy to heal wounds but later good effects were also attained for a number of other conditions such as coughs, scurvy, venereal diseases and diarrhoea (37) . It was said to be particularly effective against urinary tract diseases, especially gonorrhoea (38, 39) . We have not found other descriptions of the use of copaiba balsam in the preventive treatment of neonatal tetanus, but Schleisner apparently knew of the preparation’s wound healing properties (40) . Until the first half of the 20th century, copaiba balsam was described in pharmacology textbooks as a possible remedy but became superfluous with the introduction of anti-bacterial preparations such as sulfonamides in the 1930s (41, 42) . Some more recent studies suggest that the preparation may in fact have anti-inflammatory and antiseptic properties (43, 44) .
Figure 7 Copaifera officinalis Medical botany www.classicnatureprints.com)
It has been claimed that Schleisner did not use copaiba balsam but rather peru balsam (6, 7) but in all probability this is not correct. Schleisner writes to the Health Board and also in the German report that he used copaiba balsam. However, these remedies were not very different from each other and the indications were fairly similar. Interestingly, several books published at the beginning of the 19th century discuss the good results achieved by using peru balsam against tetanus (39, 45) . In 1831, it was asserted that «Lately […] it has required some reputation in tetanus, on the authority of a most respectable practitioner» (46) . This probably refers to the American physician Lemuel Kollock (1766 – 1823), who had practised as a doctor in Savannah, Georgia since the 1790s (47) . Neonatal tetanus was known to be prevalent in warm regions such as America’s southern states (13) . According to one of the first American pharmacopoeias, Kollock had even cured several cases (48) . But as early as the 1840s it seemed that the enthusiasm had subsided and some were of the opinion that peru balsam for this indication was obsolete (39) .
In both reports Schleisner also gave an account of other medical initiatives vis-à-vis newborn babies (25, 35) . At the slightest sign of symptoms, he wrote, he would apply a lukewarm preparation of herbs (Kräuterbäder ) and dress the umbilical stump once or twice daily with a linen compress (Charpie) that was moistened in opium tincture with saffron. At the next phase he applied an oatmeal poultice with mercurial ointment on the lower part of the abdomen. These were well-established remedies. Opium tincture with saffron, which Schleisner referred to as «Laud. liq. Syd.», was an old preparation named after the famous English physician Thomas Sydenham (1624 – 89): Laudanum liquidum Sydenhami . These drops were originally made of opium, saffron, cloves, cinammon and Spanish wine, but both the recipe and the name varied over time (37) . In Norwegian pharmacopeias the preparation was known as tinctura (or essentia ) opii crocata .
Mercurial ointment was the last remedy Schleisner mentioned. He referred to it as «Ugt. Neapolitanum», named after the town of Neapolis (Naples): unguentum neapolitanum otherwise known as Naples ointment, a reminder of the outbreak of syphilis there in 1495 (37) . Mercurial ointment had been used as a remedy against syphilis for many centuries.
We can say with certainty that Schleisner did not approach the task lightly. He used all means at his disposition and there is little doubt that these succeeded. Some have asserted that the copaiba balsam was the decisive factor because this was the only remedy the midwife continued to use after Schleisner had returned to Copenhagen (5) . In retrospect it is difficult to decide which remedy or remedies led to the gratifying development. Perhaps of greatest importance was that Schleisner improved hygiene in the postnatal period.