Sanatoria revisited: sunlight and health.

Since the 18th century tuberculosis has been a major cause of death throughout the world. It is a highly infectious disease that spreads by droplet infection and finding effective treatment to combat tuberculosis took a great deal of time. One of the first treatments to have some real success was a stay in a sanatorium. Sanatoria were homes that provided patients with good food and fresh air (and therefore sunlight). The first sanatorium to use sunlight therapy (heliotherapy) seriously was founded in Leysin, Switzerland, by Auguste Rollier. Patients built up their sun exposure gradually to prevent sunburn or skin damage. We suggest that heliotherapy was more successful in treating tuberculosis than was appreciated once chemotherapy became available. The birth of heliotherapy coincided with an increased appreciation of the association of sunlight and health among the general public. The secret of its success is the combined effects of sunlight on the skin inducing the production of nitric oxide and vitamin. Nitric oxide is not only a messenger in the cardiovascular system and responsible for relaxation of vascular muscle but is also involved in the innate immune system. Vitamin D is responsible for immune system functions and multiple studies have found an association between tuberculosis immunity and high vitamin D levels. Therefore, it is understandable that providing tuberculosis patients with sunlight may have boosted their immune system and aided them in the fight against tuberculosis. In view of the high level of resistance to all drug regimens in some patients, perhaps it is time to revive the use of sanatoria in the fight against tuberculosis.

A brief report on the history of phototherapy.

From ancient times, light has played a significant role in the treatment of diseases. The modern discoveries (eg, ultraviolet radiation) and modern inventions (eg, the electric generator or the electric lightbulb), as well as balneologic experiences of the treatment with sunlight, contributed to the transition from heliotherapy to artificial light phototherapy at the end of the 19th century. Nils Ryberg Finsen (1860-1904) was the founder of modern phototherapy. He is famous for applying an electric carbon arc torch in treating patients with lupus vulgaris using ultraviolet radiation. Subsequently, phototherapy using artificial light sources gained importance in the treatment of skin diseases with a noninfectious etiology. William Henry Goeckerman (1884-1954) chose an ultraviolet B light to treat psoriasis. Improvement in the effectiveness of dermatologic phototherapy occurred in 1947, when methoxypsoralen was isolated. During the 20th century, phototherapy was applied to new therapeutic areas, such as neonatology, psychiatry, and ophthalmology.

The medicalization of sunlight in the early twentieth century.

This paper traces the emergence of the therapeutic use of sunlight in medicine during the first half of the twentieth century. This was a period of considerable flux in medicine with various strands of practice and theory competing. Drawing on two case studies of sunlight therapy, both artificial (actinotherapy) and natural (heliotherapy), in the treatment of rickets and tuberculosis this paper will explore how medicine was constituted within these regimes. The paper will argue that therapeutic and clinical applications of sunlight helped establish an association between sunlight and health but also defined a particular and specific performance of medicine.

[Vincenzo Cuomo, pioneer in thalassotherapy]. / Vincenzo Cuomo, un pioniere della Talassoterapia.

Thermal Medicine is now well integrated with other therapies such as pharmacotherapy, surgery, physiotherapy, radiotherapy and so on, in the prevention, cure and rehabilitation of many diseases. The methodology of thermal treatments, now recognized as bona fide therapies with their specific indications, adverse side effects, dosages, applications and administration times, are classified into mineral baths, mudcures and grotto treatments. Thalassotherapy is a therapy that is linked to the sea and is one of the most important of the climatotherapeutic methods. It constitutes a complex of therapeutic effects derived from the meteorological and telluric factors characterising a given climate. Thalassotherapy deals with the therapeutic effects conferred by periods of time spent by the sea, including the modes of action of marine agents, and strives to determine their limitations and in what circumstances a sojourn by the sea can provide effective health benefits. Thalassotherapy is affected by three kinds of main factors: climatotherapeutic factors, eliotherapeutic factors and balneotherapeutic factors. Refraining from normal daily activities and a rigorous observance of general hygiene, and diet in particular must also always be observed.

"My flying machine was out of order".

Why did the founders of this organization-which was established in 1884 as the American Climatological Association-want to study climatology and respiratory diseases? In particular, where did the idea of treating tuberculosis with pure air and sunlight come from? How effective was this treatment for a disease that in 1880 afflicted a third of the population of Colorado? Why did this Association not acknowledge technological advances such as weather forecasting or large 20(th) century population movements? This paper seeks to answer those questions in order to inform the Association's possible study of the effects of global climate change on human health, an issue that is arguably comparable to what the founders faced. Recent governmental reports suggest that the medical and health care communities have not yet become engaged. If the ACCA does not, then who will?

[Brief history of rickets and of the discovery of vitamin D]. / Breve história do raquitismo e da descoberta da vitamina D.

Almost eighteen centuries mediated between the first cases of rickets, reported by Soranus and Galeno, and the clarification of the disease aetiology. Due to the outbreak of rickets verified in the 17th century in England, the situation was known as the 'English disease', being its first detailed description presented by Francis Glisson. The growing incidence of rickets with the Industrial Revolution raised speculations about its origin and treatment. The characterization of solar light and luminous spectrum led to the identification of the biological effects of ultraviolet radiation, and to the discovery of phototherapy as an alternative therapeutic process to the solar irradiation. The experimental rickets achieved by Mellanby and McCollum gave support to the concept that this situation could have an origin in a dietary defect. It was also referred an inverse relationship between sun exposure and the incidence of rickets. The identification of the chemical nature of an essential dietary factor with anti-rickets effect (ergocalciferol or vitamin D2), together with another factor with identical properties, but more potent, produced in the skin exposed to sunlight (cholecalciferol or vitamin D3), was essential to the elucidation, prevention and therapy of the disease. The present revision summarizes the history of rickets, the characterization and anti-rickets properties of the light and dietary supplements of lipid nature, and the identification of the major biological forms of vitamin D.

Reintroduction of a classic vitamin D ultraviolet source.

As early as 1930 sunlamps claiming to provide ultraviolet (UV) exposure to make vitamin D were sold to the public in the US and Canada for home use. Today even with dietary supplementation of vitamin D many people do not get enough solar UV exposure to maintain sufficient vitamin D levels. There is growing interest in the availability of sunlamps for this purpose. The original Sperti Sunlamp, with label claiming vitamin D benefit was approved by the American Medical Association in 1940 as a sunlamp. This intermediate pressure mercury lamps ultraviolet B emission lines, at 297, 302, and 313 nm are able to convert 7-dehydrocholesterol in the skin to vitamin pre-D3 initiating the natural process of vitamin D formation. Today's KBD Vitamin D lamp, an updated model of the earlier type source. In order to comply with modern safety guidance, the source is filtered to remove unnecessary UVC radiation and is equipped with a timer to control the dose administered. The 5 min timer provides an exposure, at 20 in. from the user's skin, of one standard erythemal dose (SED). The SED represents a suberythemal dose for even the most sensitive skin type I individual.

[Docter François Miramond de Laroquette (1871-1927). Second part]. / Docteur François Miramond de Laroquette (1871-1927). 2eme partie.

In the last issue ofVesalius, vol. XIII, No 1 p 34-39, we considered the life and work of Dr Miramond de Laroquette up to 1911. This second part takes up the story in Algeria, where he continued his military and research careers. In Algeria, country of the sun, Dr Miramond de Laroquette continued, naturally, with his work on heliotherapy. During the First World War he was at the front in Picardy and in Lorraine, where he took care of the wounded and wrote an Atlas of electro-diagnosis and therapeutics, published in 1918 and translated 2 years later by an English nurse. He left the army in 1922 and became a radiologist in Algiers, writing articles on radiology and radiotherapy. In 1923 the Ministry of the Armed Forces brought out a collection of the numerous publications on heliotherapy that he had published previously.

[The historical-scientific foundations of thalassotherapy: state of the art]. / Le basi storico-scientifiche della talassoterapia: stato dell'arte.

Throughout the ages the interest in the use of sea water in medicine has fluctuated from century to century and from nation to nation. In this paper, the historical development of sea medicine from the ancient Egyptians until the 20th century is given. The medical world has viewed it with different opinions, from very enthusiastic to extremely critical, and from beneficial to harmful. In the last decades, thalassotherapy is receiving renewed attention from many medical specialties and health tourists. The aim of this review is that of offer an update on the real therapeutic possibility of the thalassotherapy. However, the exact therapeutic potential of thalassotherapy still remains largely unknown. Better and more profound scientific evidence for its efficacy is therefore warranted, in particular for its effects on the musculoskeletal system and skin. The main researches belong to the activity of thalassotherapy and the clinic outcomes, namely in osteoarthritis patients, were referred.

[Maximilian Mehl and the treatment with concentrated sunlight]. / Maximilian Mehl und die Behandlung mit konzentriertem Sonnenlicht.

In 1889, a chance observation made by Maximilian Mehl, an officer of the Berlin police force, lead him to develop a new method of treating Lupus Vulgaris with concentrated sunlight. Although first therapies proved the efficacy of this method, scientific medicine showed little interest. But Mehl found recognition among supporters of natural healing methods who saw their principles confirmed by his discovery. Mehl's tentative therapy was superseded by technological methods of sunlight treatment, as developed by the Danish doctor Niels Ryberg Finsen. In 1903 Finsen was awarded the Nobel Prize for his work while Mehl's discovery remained practically unknown. This episode in the history of medicine demonstrates how the recognition of a new method not only depends on criteria of its efficacy, but equally so on the degree of its conformity with preconceived notions and accepted standards.

[The fight against tuberculosis and developments in public health from 1890 to 1930 in Italy]. / La nascita dei sanatori e lo sviluppo socio-sanitario in Europa ed in Italia. La lotta alla tubercolosi dal periodo post-risorgimentale al 1930.

The author presents the developments in society and public health that paved the way, thanks to the birth of social and scientific associations and later to state intervention, for the establishment of hospitals for tuberculosis in Italy at the beginning of the 20th century. From 1890 onwards many fruitful meetings, conferences and debates ultimately led to the passing of a specific law on public health care; in 1927 this law covered about half the population. The First World War was undoubtedly the prime cause that stopped the downward trend in mortality and morbidity from the tuberculosis epidemic in the early 20th century. Early on, Bologna, together with other cities in Tuscany and Lombardy, developed plans for therapy (i.e. hospitals for tuberculosis) and prevention (i.e. holiday camps). However, in Italy in the 1930s tuberculosis continued to be a major problem despite such improvements in public health. In Europe, Germany was the nation that pioneered the fight against tuberculosis by social, scientific and legislative means. Since 1883 there had been a specific law for insurance against illnesses and a network of sanatoria had been established.