History at CMD 2002

In an effort to promote the diffusion of studies in the history of dermatology and venereology, we are pleased to reproduce here the abstracts of the communications with a historical interest presented at the Twentieth World Congress of Dermatology (Paris, 1-5 July, 2002).
All the Congress abstracts can be found on two web sites :
Masson publisher : www.e2med.com/ad
and the Congress web site www.derm-wcd-2002.com

I - History of Dermatology Symposium

SY0810
Where does the knowledge come from in history of dermatology and venereology?
D Wallach, Société Française d'Histoire de la Dermatologie, Paris, France.

For some years, an increasing number of academic and private dermatologists have expressed interest in the history of their medical specialty. As a result, historical dermatological societies are active in the US, in France and in Europe, and history meetings are a regular part of the most important dermatological meetings. In some cases, especially in the field of venereology where social issues are prominent, collaborative work involves dermatologists and non-dermatologists, or non-physician historians.

Like all historians, dermatology historians face the problem of the sources. It is of paramount importance to critically evaluate all available sources and to precisely know all their characteristics, including drawbacks.

This symposium is intended to critically review the main sources of the studies in the history of dermatology. Experienced speakers will answer to the following questions: Where does the knowledge come from in our field? How do we gather the information for our historical works? How can we find original sources? What is the degree of confidence of primary and secondary sources? How do we criticize and appreciate them?

Classic sources, such as books, periodicals, as well as works of art, personal souvenirs and other types of sources, will be considered. Attendees will gain an in-depth knowledge of the intellectual processes in the history of dermatology

SY0811
Tools of knowledge in history of dermatology and venereology: books
M. Valentine, University of Washington, USA.

From Antiquity until the ascendance of medical journals in the late 19th century, textbooks provide the most substantial resource for the historian of dermatology. The number of dermatology books published increased steadily through the 19th and 20th centuries. The style and content of these texts parallel the concepts of the physicians who wrote them, evolving gradually from a framework that was mainly philosophical, through empiricism, culminating in the experimental approach that dominates contemporary dermatology. Selected examples will be used to illustrate these trends. How the modern historian of dermatology can access historical texts will also be briefly discussed.

SY0812
The periodicals of dermatology
L. Parish, Jefferson Medical College, Philadelphia, USA.

The periodical emerged on the medical scene during the mid-eighteenth century. In 1845, the first dermatology journal appeared as the Archiv für Syphilis und Hautkrankheiten mit nicht-syphilitschen. Two decades later, Giornale Italiano delle Malattie Veneree e delle Pelle began publication and continues as the oldest dermatology journal in existence. In 1867, Sir Erasmus Wilson created the first English language publication, the Journal of Cutaneous Medicine.

The journal remains the most powerful tool for the dissemination of dermatologic information, despite incursions from audiotapes, videocassettes, and the internet

SY0813
Atlases as a teaching tool in dermatovenerology: from Alibert to Dohi
S. Fatovic-Ferencic (1), K. Holubar (2)

(1) Department for the History of Medicine, Croatian Academy of Sciences and Arts, Zagreb, Croatia. (2) University of Vienna, Institute for the History of Medicine, Vienna, Austria.

The educational reforms of early 19th century emphasised practical instructions in both theoretical and clinical subjects, thus, knowledge was to be transmitted through an ever-wider range of teaching and learning aids. In the second half of 19th century and increasingly towards the end (as a result of the decreasing printing costs and avaibility of new technologies such as colored lithography), there was a growing interest in the publication and use of printed illustrated works, atlases in particular. In this paper we shall focus on several dermatological atlases throughout this period and analyze their role as teaching tools in the field.

SY0814
Discovering the historical patient: moulages as sources in the history of dermatology
T. Schnalke (1)

(1) Berliner Medizinhistorisches Museum der Charité, Berlin, Germany.

Moulages are pictures of diseases in wax. They are in color. They are lifesize. They are stunningly realistic. Around the middle of the 19th century they made their debut as medical documents and teaching tools in the most eminent metropolitan hospitals of Vienna, London and Paris. They proved to be specially suited for representing afflictions that produced visible marks on the human skin. For that reason it is no wonder that dermatologists and venerologists made the vastest use of these objects among their medical colleagues. Between 1890 and 1950 large moulage collections were built up throughout Europe, in the US and in Japan. Aside from being presented directly to a medical audience, moulages were also reproduced in color in dermatological atlases and handbooks. As shocking objects they even found there way into health museums and public health exhibitions, as well as into the lurid showrooms of stationary and mobile panoptica.

This paper will give a brief history of the dermatological moulage. It will focus, however, on the main actor who is banned in the moulage: the patient. It will ask, how the patient can be (re-)discovered in this object. Therefore, the moulage will be discussed as an interesting and telling source in the history of dermatology

SY0815
Photographs
G. Tilles, Musée de l'Hôpital Saint-Louis, Paris, France.

Using a photography as a single source for the history of dermatology is an hazardous exercise that can lead to misinterpretations. Its content must be cross-checked with complementary sources. Considering these precautions photography can provide information on the history of :

Evidence-based dermatology

Once photography was accepted as a valuable technique in itself, it became the first tool of evidence-based dermatology. The photos guaranteed the observers to see the real images of their patients.

Teaching of dermatology

The photos underline the importance of sensualism in the teaching of dermatology. Photography became then an essential teaching aid in dermatology. Historically speaking photos can be a truthful indicator of the diseases that had to be taught in priority.
Institutional history of dermatology

Thanks to their portraits dermatologists have constructed their representation as a professional group. The new techniques that allow a larger diffusion of the scientific images may enhance the medical influence.

Social history of patients

The photos allow to set a social topology of the patients in hospital and provide information on their rights.

Science, art and patrimony of dermatology

Photography is a matter of interest with regard to the relations between art and science. The conservation of the collections can reflect part of the patrimonial policy.

Photos can be highly informative on the history of dermatology provided the observer is aware of the context. Other tools remain indispensable for a proper interpretation of historical images.

SY0816
Hospital and historical archives. A case study of Robert Bateman
W.A.D. Griffiths, St Thomas' Hospital, London SE1 7EH, U.K.

Dermatology is well provided with information as a starting point for historical research. Original sources are needed and essential to provide accuracy and reliability. They often lead to a richer vein of material. The main repositories of archival material in the U.K. are:

1. National Archives.

The Public Records Office: www.pro.gov.uk
The British Library : www.bl.uk

2. Medical Libraries.

There are too many to list but these few in London provide a rich source. Scotland, Wales and Ireland have similar establishments.

The Wellcome History of Medicine Library: www.wellcome.ac.uk
The Royal Society of Medicine: www.rsmlibrary.ac.uk
The Royal College of Physicians: www.rcplondon.ac.uk
The Royal College of Surgeons: www.rcseng.ac.uk
The Worshipful Society of Apothecaries: www.apothecaries.org.uk
The British Medical Association: www.library.bma.org.uk
The Medical Society of London. No web site.

3. Non-Medical Scientific Societies.

Medicine was for long a general scientific activity. It was to such societies as these and many other similar that papers of the greatest medical importance were first presented.

The Royal Society: www.royalsoc.ac.uk

 4. Hospital Archives.

Many of the hospitals of the past have become defunct or merged into newer hospitals. Archives maybe difficult to trace but detective work may result in exciting discoveries. As a case study some material relating to Thomas Bateman (1778-1821) is presented.

SY0818
Works of art
M. Faure, Hospital E. Herriot, Lyon, France.

Painters have shown the human body through skin as an obvious condition for the representation of the human being. For more than 2000 years, skin diseases or cutaneous peculiarities have been featured by artists. In fact, this kind of representation is generally rather poor, with, for instance, only some dark spots indicating infectious diseases. They are mere symbols not only of skin disorders, but of all plagues "our flesh is heir to", since painting skin is the only way to evidence the living, and dying flesh.

In a few paintings however we can make a diagnosis by analyzing with our eyes only, for complementary investigations are, of course, not available. As far as portraits are concerned, we may get some information from existing texts indicatings the life and the facts of who was painted, or the history of the artist himself.

These situations can be illustrated with naevus, and other tumours in various italian or nordic paintings (Piero della Francesca, Lotto, Bosch, Van Hemessen, Grünewald, Hogarth, Goya, Ivanov...), with syphilis (Grünewald, Dürer, Goya), plagues and other infectious diseases with skin and/or scalp lesions in numerous religious representations of Job, Lazarus (Hansen's disease) Roch, Sebastian (small pox), Elisabeth (Holbein, Murillo), with inflammatory conditions, especially of the face (Ghirlandaio, Arcimboldo, Hals...). Rarities are piebaldism in a negro child (Portugal, XVIIIth century), alopecias and hirsutism (Ribeira, Memling...), acquired hypertrichosis (the stories of John, Hieronysmus, the egyptian Mary or Magdalen in the desert) or even familial hypertrichosis (Lavinia Fontana, Agostino Carrachi and german painters of the XVIth century).

SY0819
Electronic media
E. Del Río , Dept. of Dermatology, Complexo Hospitalario Universitario, Santiago de Compostela, Spain.

The dramatic development of new technologies in the past decades has provided new instruments for the knowledge of dermatology. In fact, electronic media are daily present in our lives: audiotapes, videotapes, CDROM, diskettes, DVD, etc.

The fast increase of internet is also a powerful tool. Texts, voice, images and video can be moved from pole to pole in few seconds. Regarding the history of dermatology, several sites and servers are of particular interest. Perhaps the National Library of Medicine in USA is the gold standard, although non-English and ancient literature are not completely represented. Electronic dermatological journals, universitary libraries, hospitals, academies and departments of dermatology around the world are extensive providers of primary and secondary sources for the history of dermatology. Of particular interest are those related to the history of dermatology itself, such as the French Society of the History of Dermatology.

Nevertheless, new dangers are also related to electronic media: the changing media, informatics viruses, safety of transmissions and different laws are some of them.

Scientific information is expanding day by day and the development of electronic media is necessary to record all these data. However, the emotion of reading an old dermatologic texbook in our hands shall not be replaced by the best of the computers in short.

II - Other communications of interest from a historical, artistic or cultural point of view

CO0184
The spectrum of dermatological surgery today and in the future
E. Haneke, Inst Dermatol Klinikk Buns, Sandvika, Norway.

Dermatology is an organ speciality and its therapeutic arsenal contains both medical and surgical treatments. When it became an independent speciality, a considerable portion of the chairs were assigned to clinicians who came from surgery (which 150 years ago treated most skin patients). In the late 18s and early 19s, dermatologists invented or refined many surgical techniques still used today: acne surgery, dermabrasion, chemical peels, vein surgery with special consideration of functional aspects and cosmesis, cutaneous laser surgery, tumescent local anaesthesia and many more. Today, dermatologic surgery comprises all diagnostic biopsies, cutaneous tumour surgery including sentinel lymph node biopsy, defect repair with primary wound closure, all different types of grafts, flaps and their combinations, but also with guided second-intention healing, acne and sweat gland surgery, hair transplantation, cryo-, electro- and laser-surgery, dermabrasion and chemical peeling, nail surgery and in many countries also surgical treatment of varicose veins and haemorrhoid treatment. In the future, this spectrum might well expand to free flap transfer. The impact of cosmetic and aesthetic procedure will become even more evident. Dermatologic tumour surgery will become more and more important due to the continuing rise in the incidence of melanoma, basal and squamous cell carcinoma, but also other rare neoplasms. Patient have become more and more aware of the quality of skin surgery both in terms of long-term, recurrence-free healing as well as good functional and cosmetic results.

CO0186
The concept of nevus in history and folklore, including pigmentary mosaicism
C. Gelmetti, Istituto di Scienze Dermatologiche de l'Università di Milano,
I.R.C.C.S. "Ospedale Maggiore" di Milano, Milano, Italy.

The term of "nevus" is derived from the same latin words which is derived from a greek root: "gen", which is the root of "generate". This explains the popular term of "birthmark" to indicate various patterns of nevi. The story of birthmarks is intermingled with the story of the different civilizations. So, in Germany a nevus could be named as "muttermal" (the sign of the mother) while in Italy and in France the same lesion could be indicated respectively as "voglia" and "envie" (will). Still, at present, the term nevus is curiously absent in standard dictionaries of European languages except the italian language. Indeed, if we indicate the common melanocytic nevi, the terms used in English are: "mole" and "beauty spot", while in French is: "grain de beauté" (grain of beauty), in Spanish is: "lunar" ([the sign] of the moon). Very interestingly, the bivalent meaning of nevus can be found in Cicero's works. In the Renaissance and in Baroque era, the equivalence "nevus = beauty spot" reached its zenit. The intrusion of the genetics and the knowledge of the embryology has explained the appearance of some nevi. If a nevus can be considered a mosaic, the type of mutation, the time of mutation and the position in the embryo of the first mutated cell are the factors influencing the clinical pattern of a nevus. To date we do not have a satisfactory definition of the word "nevus" even in medical dictionaries in which the confusion between "nevus" and "birthmark" is still alive. The definition proposed by Happle is very interesting and will focus the discussion in the following years.

CC0471
The rhinophyma of Andy Warhol: a case report reflecting the artist's work and his biography
K. Krämer-Schultheiss (1), R. Stadler (1), D. Schultheiss (2)

(1) Department of Dermatology, Klinikum Minden, Minden, Germany. (2) Department of Urology, Hannover, Germany.

Throughout his creative life the artistic work of Andy Warhol (1928-1987) represents different aspects dealing with plastic surgery especially of the nasal area. The young artist was already characterized by a very prominent nose and "The nosepicker", his first successful painting from 1948, was also entitled "The broad gave me my face, but I can pick my own nose" thus indicating it as a self-portrait. Later Warhol was increasingly suffering from his red-coloured nose and finally decided to undergo surgical intervention: "At one time the way my nose looked really bothered me - it´s always red - and I decided that I wanted to have it sanded. Even the people in my family called me Andy the Red-Nosed Warhola". Without any doubt this nasal skin lesion has to be diagnosed as a rhinophyma on the basis of the available biographical literature and the surgical procedure performed in 1957 can clearly be identified as dermabrasion: "Then they take a sandpaperer and spin it around all over your face". One of the important milestones in Andy Warhols work, an icon of Pop Art, is the acrylic painting "Before and After" from 1962 imitating a newspaper advertisement for plastic surgery of the nose. Even two years before his death Warhol outlined a series of surgical drawings including illustrations of pedicled grafts for plastic surgery of the nose. As one of the founders of Pop Art Andy Warhol left essential marks on the modern society and influenced some of our standards of aesthetic shapes.

P0908
Leprosy in philately 2002
L. Sehtman , C. Iovanniti , R. Negroni , A.B. Sehtman, Depto Microbiologia, Centre Micologia, Facultad de Medicina UBA, Argentina.

Very few are the countries who have stamps issues regarding fight against Leprosy. Here are exposed stamps from those countries. The aim of this presentation is to emphasize Philately as an useful tool of communication and education on this disease

P2282
AIDS: philately and mycoses skin lesions
L. Sehtman, C. Iovannitti, R. Negroni , M.R. Elias Costa, Depto Microbiología, Facultad de Medicina UBA, Centro Micologia, Buenos Aires, Argentina.

Philately is the activity devoted to study the origins and graphic characteristics of letter stamps. The subjects used to print the stamps are numerous and intend to show historical, geographical, religious, social or medical events ocurring all over the world. We want to display some of the stamps from a private collection, refering to AIDS, emitted by different countries. This contribution will be show for the first time at the World Congress of Dermatology. The acquired immunodeficiency syndrome (AIDS), due to HIV retrovirus, is characterized by a marked depression of cellular immunity, produces by the reduction and destruction of CD4 positive lymphocytes and some macrophages by the virus. Retrospective studies of AIDS, all over the world, showed that 58-81% of all patients contract a fungal infection at some time during HIV disease and 10-20% have died as a direct consequence of fungal infections. This situation leads to multiple opportunistics infections, including fungal infections such as oropharyngeal candidiasis, candida esophagitis, cryptococcosis, disseminated histoplasmosis, disseminated coccidioidomycosis, Pneumocysti carinii pneumonia, penicilliosis due to Penicillium marneffei. The fungal diseases in AIDS patients are often more severe and widely disseminated, the mayority of them present pleomorphic skin lesions such as papules, nodules, ulcers or granulomatous lesions on the face, the trunk and the limbs. These cutaneous manifestations are very important from the clinical point of view and turn the diagnosis of these mycoses easier. The aim of this presentation is to show 50 stamps from many countries about AIDS and photos of AIDS related histoplasmosis and cryptococcosis with skin lesions.

P0454
Women destiny in medicine from ancientry to new millennium
C. Rigoni (1), G. Spinelli (1), R. Serri (1), S. Sesti (2)

(1) University of Milan. Institute of Dermatological Sciences, I.R.C.C.S. "Ospedale Maggiore" Milan, Italy. (2) Eleusi-Pristem, Università Bocconi, Milan, Italy.

We describe the biography of a few women of Science, who have distinguished themselves meritoriously in medical fields. We discovered that we are contemporary students of an 11th century "medichesse" (women doctor) as was Trotula de Ruggiero of the Salerno Medical School.

Trotula had already perceived in those days that skin shouldn't be cured only in the case of disease, but she recognized the importance of cleansers, the appreciation of creams massages ecc. These challenges represented the additional qualities that women of science had over the history: intuition, imagination, fantasy and an holistic and complete vision in the approach of health and well-being.

P0510
From the roots of cell culture techniques to modern tissue engineering of the skin
K. Krämer-Schultheiss (1), R. Stadler (1), D. Schultheiss (2)

(1)Department of Dermatology, Klinikum Minden, Minden, Germany. (2) Department of Urology, Hannover, Germany.

R. Virchow established his "Cellularpathologie" in 1858, confirming that tissue regeneration is dependent on cell proliferation ("omnis cellula a cellula"). This led to an increased interest in histological findings for example of wound healing and tissue transplantation as for example early studies of K. Thiersch from 1874 revealing the important interaction of granulation tissue and overgrowing epithelium for wound closure. In 1895 F. von Mangoldt performed autotransplantation of a matrix with cell clusters of epithelium and blood to close skin wounds. Cultivation of cells and small units of tissue outside the body was introduced by L. Loeb (1897), C.A. Ljunggren (1898) and J. Jolly (1903) but the landmark experiment of cell culture with proliferation of nerve cells from a cultivated frogs medullary tube was performed by R.G. Harrison in Baltimore in 1907.

After 1910, the surgeon and nobel laureate A. Carrel became one of the main tissue culture protagonist for many years. During the following years many of the pioneering studies on epithelial cell cultures were undertaken in Europe, especially Germany. The surgeon S. Hadda from Breslau documented proliferation of spindle cells in culture originating from small tissue parts of chicken embryos. 2 years later K. Kreibich from Prague could see the same effect in tissue cultures of human skin and in 1923 the dermatologist W. Friboes at the Charité Hospital in Berlin discovered a growing system of epithelial fibers in his skin cultures of guinea pigs. K. Börnstein at the famous dermatology department of J. Jadassohn in Breslau could proof that the growth of pieces of human skin was really due to migration of keratinocytes in 1930 and these works were continued by her colleague H. Pinkus who in 1932 published the most extensive article on this topic at this period. With the upcoming regime of the Nazis these works, mainly perfomed by Jewish scientists, came to a sudden end. The topic of cell cultures from skin was reintroduced about a decade later by P.B. Medawar in England. His first article from 1941 already suggested one important principle of skin cell cultures: the enzymatic separation of the epidermis from the dermis induced by trypsine. During the next years Medawar designed sophisticated methods of tissue incubation and cultivation and finally became nobel laureate for his achievements in transplantation immunology. The doors into modern tissue engineering of the skin was finally opened by J.G. Rheinwald and H. Green from Cambridge, Massachusetts, in the mid 1970´s.

P0614
Dermatological diseases in the freak show
A.I. Bernal-Ruíz (1), F. Allegue (1), G. Blanco-Eguren (2), J.L. Zambrana (1), M. De Traja (1)

(1) Hospital Alto Guadalquivir, Spain. (2) H Carlos Haya, Spain.

During the end of the 19th and the beginning of the 20th centuries circus owners used their ambulant carnivals not only to provide sober melodramas but also to show off crippled bodies, thus offering entertainment, and horror to spectators from many different parts of the world. This sordid, grotesque parade in ambulant carnivals was in fact the freak show, a sort of strange coexistence with men and women who had been destroyed by their diseases. Many of these persons had dermatological diseases, including Proteus syndrome, hereditary lanuginous hypertrichosis, lamellar ichthyosis, Madelung's adenolipomatosis, Alibert's dermatolysis, hirsutism, or Ehlers-Danlos syndrome. These persons were publicized and exhibited as "The Bearded Lady", "The Elephant Man", or "The Alligator-Skin Man", "The Lion-Faced Man", "The Man with Iron Skin" among many others. With this study, we wish to pay a small homage to these fairground characters who, because of their severe dermatological disorders, suffered applause and insults in a world laden with passion, and morbidity, and at the same time with tenderness. We wish especially to remember with all our respect and consideration Clementine Delait, Joseph Merrick, Julia Pastrana, Jo-Jo and many others, in the hope that the story of their lives not horror or compassion, but rather our respect. Let their stories, not their diseased skin, mark their true identify

P0636
Influence of meteorological data on the occurrence of erysipelas
A. Macario-Barrel (1), K. Zeghnoun (1), P. Young (1), A. Hautemaniere (1), L. Froment (1), H. Levesque (1), F. Caron (1), P. Musette (1), P. Joly (1)

(1) Rouen University hospital, France.

(Note : this is not a historical poster but it is so close to the hippocratic thinking that it deserves being presented here).

Objective
The aim of this study was to determinate the responsibility of external temperature on the onset of erysipelas in a French region. This notion is controversial in the literature.

Methods
All cases of erysipelas hospitalized in the departments of Dermatology, Internal Medicine and Infectious Disease of the Rouen University Hospital in France from jan 1995 to dec 1998 were daily recorded. The local maximal air temperature was daily measured and a relation between each hospitalization for erysipelas and the weather during the 2 previous days was studied with a Poisson regression controlling for times trend and days of week.

Results
Eight hundred and ninety-eight cases of erysipelas [342 men (38%), 556 women (62%)] were hospitalized during the study period. The mean age of patients was 66.1 years old. The daily mean number of erysipelas was 0.60 (0-5). The daily maximal atmosphere temperature measurement was 14.6°C (-9.2 to +34.1). A positive association was observed with t test=1.79.

Conclusion
There is a relationship between frequency of erysipelas and the meteorological temperature. The number of hospitalized erysipelas increases when the air atmosphere is heater.

P2187
African nosomorphic masks and dermatology
F. Simon (1), M.L. Dordain-Bigot (1), S. Perez (1), H. Darie (1)

(1) Department of Dermatology, Military Hospital Bégin, Saint Mandé, France.

As part of African artistic heritage, nosomorphic masks (greek nosos disease) can be set aside and studied separately. The term nosomorphic masks is a neologism attributed to masks whose pecular and suggestive shapes are meant to represent a disease, the manifestation of which is a deformation of the face. Most of these masks were produced in the 19th century by various ethnic groups located in the Gulf of Benin. This study is based on the comparison of five masks belonging to a private collection. The observation of these masks from live different ethnic groups (the Iholis, the Igbos, the Senoufos, the Ibibios and an unknown ethnic group), shows endemic diseases typical of Africa and allows us to form several diagnosis such as: the collapse of the nasal pyramid as the treponic or leprous "gangosa"; the signs of necrosis on the soft tissues of the face suggesting the noma; the distortion of the mouth and paralysis of hall of the face due to leprosy; the subcutaneous nodules suggesting the onchocercosis.

The interest in these works of art cannot be limited to their description, location and historical background. Their ethnological and traditional therapeutic value are almost unheard of and yet, they express the perception of a disease by a people.

These masks are sometimes exhibited by the elders to warn to a threat to the village or to exorcise a curse that brought about a disease.

P2191
History of syphilis in Bosnia and Herzegovina
F. Alendar (1), A. Temeida (1)

(1) Faculty of Medicine, Dermatovenerological Clinic, Sarajevo, Bosnia and Herzegovina.

The bad social and economic conditions at the regions of Bosnia and Herzegovina as well as constant ears which have been led on these regions were the great stimulii for the occurrence of many skin disease. The Dermatovenerology on these regions was as the symbol for the venereal diseases, fungoid diseases and leprosy and less for the rest skin diseases.

The problem of syphilis on the regions of Bosnia and Herzegovina occupies the visual place from the oldest time so that in 1866 in the new built property of religious community hospital the priority has been given to the treatment of the syphilis.

In the state hospital which was built in 1894 year, was built a department for syphilis and the skin diseases. It was located in to two storied buildings with about 90 beds.

The great contribution to the studying, treatment and eradication of syphilis gave the Austrian physicians Leopold Gluck and R. Neiman.

P2193
A gallery of dermatological diseases in the Prado Museum
A.I. Bernal-Ruíz (1), F. Allegue-Gallego (1), G. Blanco-Eguren (2), J.L. Zambrana (1), M.J. Velasco (1), F. Rosa (1), C. Gutierrez (3), M. De Traja (1)

(1) EP Hospital Alto Guadalquivir, Spain. (2) CH Carlos Haya, Spain. (3) Hospital Clínico, Spain.

Aim
To describe the main pathological findings of the different dermatological diseases seen in the paintings, whether depicted on purpose or otherwise, during a trip through the halls of the Prado Museum, as though it were a real dermatological visit.

Material and methods
An exhaustive study of the main works of art in the Prado Museum was undertaken to reveal different dermatological diseases, highlighting those whose compositions consciously represent the subject.

Results
Among the classical works of art in the Prado Museum we discovered an important number of different dermatological diseases, including female androgenetic alopecia, rosacea, tinea capitis, actinic keratosis, hyperthyroidism with generalized myxedema, malignant lentigo, and connective tissue diseases. This study shows that numerous painters have been especially sensitive in their representations of persons with dermatological diseases, mainly during the 17th and 18th centuries, with Goya and Velasquez being among the most important.

P2201
The Philippine Dermatological Society at 50: defining dermatology in the Philippines
M.L.A. Nebrida (1), C. Rosete (1), N. Tan (1), A. Mendoza (1), J. Que (1)

(1) Philippine Dermatological Society, St. Luke's Medical Center, E. Rodriguez Avenue, Quezon City, Philippines.

Purpose
To present the history of Dermatology in the Philippines from the view point of the Philippine Dermatological Society (PDS) as it commemorates its Golden Anniversary in 2002.

Method
Descriptive.

Summary
The first indication of the recognition of Dermatology as a distinct branch of medicine was registered only after 1910 as shown in the progress of Philippine Dermatology. The history of the PDS chronicles the development of the Dermatology in the Philippines.

Conclusion
Half-century of dedication and progress brought the PDS to its rightful place in the local and international arena as the oldest and premier organization of medical practitioners who continue to lead the path in defining the specialty of Dermatology in the Philippines.

P2208
Dermatology in France: a collective endeavour
D. Wallach, G. Tilles, Société française d'Histoire de la Dermatologie, Musée de l'hôpital Saint-Louis, 75010 Paris, France.

The purpose of this poster is to introduce Dermatology in France, a textbook on historical and current aspects of French dermatology, presented to all CMD 2002 attendees as the official gift from the Organizing Committee and Pierre Fabre Dermo-Cosmetique laboratories.

The first section of the book presents the main works of French dermatologists, including the precursors (by Jacques Chevallier, MD), the main doctrines, and vintage articles. Many sub-specialities are described by prominent actors of the relevant fields. The Investigative Dermatology section is edited by Daniel Schmitt, PhD. Michel Janier, MD, edited the STD section, which contains a detailed history of the French schools of Venereology in the 19th and 20th centuries. The history of the main institutions of French Dermatology is fully described, including chapters by Professor Jean Civatte, MD, on the French Society and its activities.

In a second section, most of the academic departments have written the history of their development and current activity. An important part is devoted to the Hôpital Saint-Louis in Paris, the birthplace of French Dermatology.

The third section of the book explores the cultural aspects of cutaneous medicine, including literature and painting.

More than eighty authors contributed to this illustrated textbook, the first complete history of French Dermatology, hopefully an appreciated souvenir of CMD2002 and a basis for future research on the history of our specialty.

P2247
M.N. Devergie and the Clinique de la Maladie Syphilitique of 1826
N. Kuner, W. Hartschuh, Department of Dermatology, University of Heidelberg, Germany.

Target of the project was to present the life data of the author, who is almost unknown today. Further, the rare syphilographic colour Atlas had to be discussed under today's context. After examination of the current available sources of syphilographic research as well as the reviews of the Atlas, some case reports and illustrations were discussed. In addition, we began an extensive research of the author and his main work.

Contemporary biographers describe M. N. Devergie (1784-1842), professor of anatomy and surgery at the hospital Val de Grace in Paris, as one of the most important syphilographers and experts in his field. Nevertheless, he hardly finds mention in medical history. So far, we only find vague biographic notes in relevant literature. The similarity in names with the well-known Alphonse Devergie (1798-1879), who was the first to describe Pityriasis rubra Pilaris, later led to uncertainty concerning who was who.

The most outstanding work of Marie Nicolas Devergie ainé is certainly the "Clinique de la maladie Syphilitique" of 1826. Besides several Casuistics of syphilitic affections of the skin, this Atlas work also contains individual illustrations of gangrenous ulcers, which almost undoubtedly are suggested to be Pyoderma gangraenosum, a depiction over one hundred years prior to being first described.

Thus, M.N. Devergie is to be appreciated as an important representative of early dermatological research.

P2350
Josef von Lindwurm - chairman ("ordinarius") of a university department for dermatology in Germany
M. Braun-Falco, J. Ring, Department of Dermatology and Allergology, Technical University Munich, Germany.

Josef Lindwurm, born 1824 in Aschaffenburg near Frankfurt, Germany, studied medicine at the Universities of Würzburg and Heidelberg from 1845-49. His early fascination for the rational medicine was promoted by the well-known anatomist Henle and the internist Pfeuffer, a pupil of Schoenlein. During a two-year education and travelling period to Dublin, Edinburgh, Vienna and Paris, Lindwurm became excellently educated by famous teachers as Limpton, Corigan, Stokes, Hebra and Ricord. Especially in Paris, the zenith school of Dermatology during that time, Lindwurm became intensively interested in syphilology. Contrary to Ricord's opinion, Lindwurm proved by inoculation studies, that secondary syphilis is as contagious as primary. He also proofed the theory of duality between syphilis and gonorrhea as being to different infectious diseases. Lindwurm choose Munich for his professional life. In 1859, he became professor extraordinarius and head of the dermatological division of the "Allgemeine Krankenhaus" in Munich. Not enough satisfied, he worked for an independent department for Dermatology which was founded in 1863. On 19 March 1863, Lindwurm was appointed professor ordinarius for Dermatology and Syphilology at the Ludwig-Maximilians-University in Munich by King Maximilian II of Bavaria. In 1869, he became director of the whole hospital. In 1874, he died of pneumonia at age 50. He was knighted in 1872 for his merits. Taking into account the different names and classifications of university degrees, Lindwurm probably was the first professor ordinarius for dermatology in Europe.

P2354
Knuckle pads in Michelangelo's works
J. De Bersaques, J.M. Naeyaert , M.L. Geerts, Department of Dermatology Ghent, University Hospital, Belgium.

Knuckle pads are asymptomatic circumscribed fibrous and hyperkeratotic thickenings over the dorsal aspect of the interphalangeal articulations of the fingers and/or toes. They are sometimes familial or associated with other fibromatous diseases (Dupuytren's or Peyronie's disease). A traumatic origin has not been confirmed.

Knuckle pads were first described in 1893 as "an unusual form of nodule upon the joint of the fingers".

There are, however, much older typical representations of knuckle pads on works of the Italian renaissance artist Michelangelo Buonarotti. They are very striking on the fingers and/or toes in some of his marble statues: David and Bacchus (Florence), the Madonna and Child (Bruges), Moses (Rome), the Pieta (Rome), etc. But they are also visible on some of his painted works, e.g. in the Sistine Chapel on the fingers of God and of Adam, in the scene of the creation of Adam, on those of the prophet Jeremiah. Similar details are not seen on works of other contemporary Italian artists.

Several explanations have been proposed for these thickenings. That they were technically needed to insure enough strength of the marble does not apply to the fresco's. Or should we suppose that the model(s) used by Michelangelo, or possibly the artist himself, presented with these knuckle pads?

P2364
Dermatological diseases of the ancient Peruvians
L. Flores-Cevallos, E. Flores-Cevallos, Flores Medical Center Av. del Parque 150, Lima 27, Peru.

The ancient Peruvians had no writing but in their ceramic they have left us depicted all the knowledge they had about several millennary dermatological diseases, some of them present only in Peru, due to the especial geographic conditions of this country.

In the northen coast of Peru from 200 to 1,200 years A.C. flourished the Mochica, Vicus and Chimu cultures, which archeologically were discovered in the middle of the last 20th Century. We have carefully studied all the portrait pottery "Huacos Retrato" - specially the ones we call of "Clinical Dermatological Pathology" that we could found in private collections and different museums of Peru. There are Huacos Retrato with typical lesions of syphilis, a millennary disease originated without any doubt in America and taken later to Europe by the Spaniards; Huacos Retrato with lesions of peruvian wart, present only in the Andean valleys; mucocutaneous tuberculosis and others. They did perform amputations of the lower extremities, to treat some of this patients -mycetomas.

From our study, we can conclude that the ancient Peruvians knew and treated several millennary dermatological diseases.