These abstracts have been published in a CD-ROM supplement of the Journal of the European Academy of Dermatology and Venereology, 2005, volume 19, supplement 2
St John’s Hospital for diseases of the skin – tales of the founder to the present day
M.M. Black, St John’s Institute of Dermatology St Thomas’ Hospital, London
St John’s Hospital for diseases of the skin was originally founded in 1863 in the Leicester Square area of central London. The founder, John Laws Milton (1820–1898), was in fact a surgeon and it is still somewhat of a mystery until the present day why he should have funded a specialist hospital for skin diseases. At that time there were a number of other smaller skin hospitals in London and as a newcomer in 1863, it received quite a hostile reception in some quarters. The
following year there was a minor scandal of the medical staff, which threatened its very existence. 25 years later a major crisis occurred when staff were dismissed and a libel action by the secretary against the proprietors brought its reputation to low ebb. A period of slow recovery followed but between 1911 and 1913 there were further staff disputes and dismissals. It was not until 1923, in its sixty-first year that St John’s Hospital for Diseases of the Skin, was put firmly on its feet. This
was due to the untiring efforts of Dr James Herberts-Stowers and others who brought about the appointment of staff of a number of dermatologists who were attached to undergraduate teaching hospitals.
The inauguration of the London School of Dermatology followed and in 1956 this became the Institute of Dermatology of which the first Dean was Dr Geoffrey Dowling (1891–1976). The Postgraduate Institute of Dermatology became one of fifteen institutes, which made up the British Postgraduate Medical Federation of the medical faculty of the University of London. The first Professor of Dermatology at The St John’s Institute of Dermatology was Professor Charles Calnan and he was followed by Professor Malcolm Greaves. Both had International reputations, which enhanced the further development of the Institute. In 1990 the St John’s Hospital for Diseases of the Skin closed in the Leicester Square area and moved to St Thomas’ Hospital on the south bank of the river Thames opposite the Houses of Parliament. Here it has continued to flourish and develop. This Alibert Oration charts the progress of these developments with a series of anecdotal stories about the founder and others who contributed to the history of the growth of St John’s Hospital for Diseases of the Skin.
Skrljevo disease – 19th century dermatovenerological endemic phenomenon
Z.Z. Slavec, Institute for the History of Medicine, Medical Faculty, University of Ljubljana, Slovenia
During the first decades of the 19th century a disease appeared in the region of Inner Carniola and Carst which was, due to its unusual course, at first considered a new entity. It spread among the population in an asexual, extra genital and endemic way and was conditioned by poor economic and hygienic circumstances. Since the clinical picture of the disease resembled sporadic syphilis, some doctors thought that it was a combination of syphilis and some other contagious disease, while others likened it to sporadic syphilis. The government in Vienna responded to the epidemic by the introduction of extensive social and health measures. Compulsory medical examination of all the inhabitants in the affected areas was decreed, treatment of patients was initiated and preventive measures recommended. The action was organized by Baron Stifft. In the summer of 1818 a new specialized hospital for Skrljevo’s patients was opened in Postojna (Adelsberg). When the epidemic declined a decade later the hospital was closed down. Extensive preventive and curative actions, and the efforts of local authorities and clergy to improve living conditions of the Slovenian peasant population and make them more aware of the seriousness and causes of the disease contributed to the decline of the epidemic The examples set by organization of the official measures taken in the case of Skrljevo disease can serve as a basis for a comparative medico-historical study regarding new epidemic diseases (AIDS, and diseases caused by slow viruses).
Besnier was the leading dermatologist of the French School of Dermatology at the turn of the 19th century. Born in Honfleur (Normandy) April 21st 1831, Besnier was named as doctor in medicine 1857. Appointed as Me´decin des Hoˆpitaux de Paris in 1863, he published many articles on internal medicineunderlining his ability in many fields of medicine. He became Médecin de l’hoˆ pital Saint-Louis in 1873, succeeding Bazin. As a head newly appointed, he had to learn dermatology, which he did in taking advantage of his colleague Lailler’s great diagnostic skills. Following the 1870s political troubles, Besnier was particularly attentive to the teaching of dermatology abroad and notably in Vienna, place of excellence, which attracted more and more students. Besnier and Doyon -founder of the Annales de Dermatologie translated Kaposi’s textbook and extensively commented on it making known the French opinions in dermatology. They examined the dermatological education in Vienna and championed the necessity of a deep reform of medical education in Paris. Besnier completed brilliantly the description of the Pityriasis Rubra Pilaris previously described by Devergie. Besnier created the term biopsy in 1879 and described the lupus pernio in 1889, the first stage of sarcoidosis which knowledge was enriched by Cesar Boeck and Jorgen Schaumann and later named Besnier-Boeck-Schaumann disease by L. Pautrier. In 1892, Besnier published the first observations of what he called diathetic prurigo (Besnier’s prurigo) now recognized as atopic dermatitis. For 15 years Besnier produced writing every third month innovative works in epidemiology a complete analysis of the contagious diseases in the Paris hospitals. Interested in the microbiological discoveries headed by Pasteur and his pupils, Besnier set up the first laboratory in Saint-Louis and encouraged his pupil, Sabouraud to research mycology. Besnier was elected as a member of the Academy of Medicine in the hygiene section. President of the International Congress of Dermatology in Paris 1900, the same year Besnier and his colleagues Brocq and Jacquet edited, La Pratique Dermatologique, a massive textbook and first collective work of the French School of Dermatology. Besnier died in Paris May 15th 1909. Besnier can be regarded as the first modern master of French dermatology combining great skills in medical dermatology, attention to the developing biological research, attentive observation of the foreign schools and endeavours to improve dermatological education.
Albert Neisser (1855–1916): his contribution to the development of dermatology
R.B. Birula, E. Baran and T. Szymczak, Department of Dermatology, Wroclaw Medical University, Wroclaw, Poland
Professor Albert Neisser (1855–1916) was one of the greatest creators of a high position of the Wroclaw (Breslauer) Department of Dermatology. He studied medicine in Breslau and received his medical degree in 1877 with a thesis on echinococcosis. He was the first full-time assistant physician of this clinic directed by Oskar Simon. In 1879 he discovered Neisseria gonorrhoeae, usually called gonococcus, the bacterium that causes gonorrhoea. Neisser was trained in dermatology in Leipzig in 1880. In 1882 was called to Breslau to become a head of the department and a title of an extraordinary professor of skin and venereal diseases. He was engaged in organization of a new building for the department which was opened in 1892 and became internationally famous research and teaching center. Many of his assistants became famous dermatologists. Neisser made the research trips to Norway and Spain (studies on lepra) and Java (studies on the contagion of syphilis in man and animals). A Neisser-Hansen controversy over discovery of the Leprosy bacillus is well known. Hansen first discovered the L. bacillus, but Neisser was the first to identify it as the etiological agent of the disease. Neisser also worked with August P. von Wassermann in developing the Wassermann test for syphilis. With him and with Carl Bruck he developed the serological test. He was nominated together with Wassermann, for the Nobel Prize in Physiology and Medicine in 1910. Neisser founded the Deutsche Dermatologische Gesellschaft in 1898 (with Pick) and the Deutsche Gesellschaft zur Beka¨mpfung der Geschlechtskrankheiten in 1902 (with Blaschko). In 1907 Neisser was nominated the first full-time professor of dermatology in Germany. He suffered from diabetes and after surgical operation died due to a sepsis on the July 30, 1916. He did not have a children and donated one thousand volumes of scientific books and journals from his private collection to the library of his department. His villa, which was full of artistic works and of interesting architecture, was written to the city of Breslau as a museum.
José Sanchez Couisa (1881–1944)
R. M. Diaz Diaz, La Paz Dermatology Department, Madrid, Spain
Abstract not available
Jose Eugenio De Olavide, a dermatological maestro of the 19th century
J.C. Calatayud, Spain
Jose Eugenio de Olavide y Landazabal was born in Madrid in 1837. He studied medicine in Madrid. His teachers were Sanchez de Toca, Martin de Pedro and Fourquet. He was a resident student of dermatology in the second year of his medical studies. In the Revalida he achieved the highest qualification. In 1859, Olavide moved to Paris for his dermatological postgraduate studies. In Paris he worked in the Hospital Saint Louis with Cazenave, Devergie, Bazin and Hardy. In 1860, he got the post of dermatologist in the Skin Disease Hospital of San Juan de Dios (Madrid). This hospital was the first nucleus of dermatology as a speciality in Spain. So we consider Olvide as the founder of Spanish dermatology. Alvarez Sierra described Olavide as follows ‘He was thin, with a penetrating look and used few words. He was generally reserved but very effusive and affectionate with his friends’ Olavide was one of the first in Spain to apply laboratory data in the clinic. He was an excellent clinical observer and a great believer in parasitological studies. He also attached great importance to dermatopathology. His first histopathological work was on a submuscular lipoma (1859). In 1881, he created an anatomopathological and microbiological laboratory in the Hospital of San Juan de Dios and put in charge Don Antonio de mendoza. With the assistance of Dr. Castelo he set up a museum with an important collection of wax reproductions carried out by the sculptor Don Enrique Zafio and representing more than 1500 cases of skin diseases. Durign the time Olavide was the director of the San Juan de Dios Hospital there were 120 beds for skin disease patients. In 1960, 500 beds were available. Unfortunately in 1970 the San Juan de Dios Hospital was destroyed to build a new hospital (Now called Hospital Gregorio Maran˜on). Olavide showed a big interest not only in dermatology but also in general medicine, as well as philosophy and art (sculpture and painting). The latter enabled him to complete his important work Atlas de la Clinica Inconografica de Enfermedades de la piel o dermatosis (1873) which contains 165 masterly watercolors of skin diseases.
Dermatology in Louisiana
L.E. Millikan, USA
Louisiana is a fitting an example, for it is the most European state of the USA, starting in 1699 with the French influence from Pierre Lemoine Sieur d’Iberville, which developed this colony over a 35-year period, and Pierre Card was the first person in authority. This was a time of illness, fevers, and particularly malaria, yellow fever, bacterial fevers and scurvy in the swamps and lower regions of the Mississippi. The lush green foliage became the source of many medicaments, as the Europeans learned from the natives. Ilex vomitorium was a particularly useful called upon holly which was used as tea substitute, or as a purgative. The Charity Hospitals are a unique institution in the southern USA. The first in 1736, followed by the next hospital in 1773, then in 1785 the third Charity Hospital was put in the turnaround basin (now Basin St.) on the Mississippi, and the fourth Charity Hospital built in 1815 on Canal Street in Downtown New Orleans. In 1832 the fifth Charity Hospital was built, and the current Charity Hospital still standing and in use was constructed in 1939. The French influence was succeeded by that of Spain, in 1763–1803. Slowly the gentile and aristocratic French were being replaced by the garrulous Americans, and the elegant Spanish. Medicine in this area of the Gulf South continued to reflect the French roots, paralleling Europe. Few reputable drugs and many products of quackery. It was estimated in 1754, 40,000 deaths were caused in France by excessive withdrawal of blood. Hospital overcrowding resulting in 2–5 patients per bed prompted rampant spread of infectious disease, parasites. In 1803, Jefferson’s Louisiana Purchase made a great change in the Americanization of Louisiana. It then became a major port for commerce, After the revolution and the Louisiana Purchase was the War of 1812, and Andrew Jackson’s victory over the British in the Battle of New Orleans. Subsequently the Civil War had a major impact on life, commerce and medicine in Louisiana, and at the turn of the 20th century, Louisiana was a leader in commerce, banking, agriculture and the unique Charity Hospital systems continued to be a pioneer in delivery of public health.
Saint Anthony’s fire (herpes zoster): some remedies of ancient and popular medicine
C. Gelmetti, Istituto di Scienze Dermatologiche dell’Universita` di Milano, _I.R.C.C.S. ‘‘Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena’’ di Milano, Italy
The history of Saint Anthony’s Fire is fascinating but complex. In the majority of the old documents it is depicted as a horrible disease leading to excruciating pain, gangrene and hallucinations. Many diseases including black death and syphilis have been named in this way; however after the Middle Ages, Saint Anthony’s Fire became a synonym of ergotism in France and Germany, of erysipelas in England, of herpes zoster in Italy. While the term of ‘Saint Anthony’s Fire’ is outdated when it refers to ergotism or erysipelas, in Italy herpes zoster is, at present still, more well known by its eponym. It is clear that, before the discovery of acyclovir the treatment of herpes zoster has been empiric for centuries. Some remedies used in the popular medicine are magic or suggestive (e.g., the prayers to Saint Anthony), some have a very subtle rationale (herbal decoctions), some more recent remedies are designed only against the associated pain (e.g., topical cocaine or aspirin preparations). A confused mixture of old remedies can be found also today in holistic medicine which appears frequently in the Web. Therefore the options are numerous and patients can choose according to their inclinations and beliefs. The list starts from simple application of ice and continues with preparations made with essential oils including bergamot, chamomile, eucalyptus, geranium, lavender, lemon and tea tree oil. Vinegar compresses and aloe vera are also advised. Some treatments prescribe food as a topical medicine as raw honey, licorice or yogurt (e.g., ‘place plain yogurt mixed with zinc oxide, if available, along the path of the nerve’), some others are indeed dietetic indications pro (e.g., ‘Pear juice is rich in antiviral caffeic acid. Drink it as a fruit juice and eat lots of pears for shingles’) or con (e.g., ‘‘Avoid foods containing the amino acid arginine, such as chocolate, cereal grains, nuts, and seeds’’). In conclusion, Saint Anthony’s Fire is not yet under control of EBM medicine.
1. Chaumartin H. Le Mal des Ardents et le Feu de Saint Antoine. Grenoble, 1947.
The science of infection began with a fungus
E. Panconesi, Florence, Italy
The hypothetical idea of contagium vivum, that is ‘living animals found inside living animals’ (as stated in a publication by Francesco Redi in Florence in 1684) and that provoke a pathological condition, had been in the air for some time. For example, Girolamo Fracastoro (c.1478–1553) had referred to seminaria morbi (seeds of disease) crassiora et subtiliora (larger and smaller). However, evidencing these agents and proving contagion required more than hypothesis: it depended on the microscope. The first demonstration of an infectious pathogenic agent, a fungus, was the work of an administrative employee of the Lodi prefecture, neither physician nor biologist, who used the microscope to study the disease (muscardine, mal de segno) afflicting his silkworms.
Eugen Galewsky and the introduction of Cignolin (Dithranol) in the psoriasis treatment
S. Albrecht, Germany
Eugen Galewsky (1864–1935) belonged to great group of students of Albert Neisser from Breslau/Wroclaw. He worked as a dermatologic practitioner in Dresden from 1891 to his death 1935 in Dresden. He created a great scientific work with books, articles in textbooks, and 100 papers in the leading dermatologic journals. The skin diseases during childhood and the trichopathies were his main topics. Galewsky’s greatest merit was his combat against venereal diseases. Eugen Galewsky introduced 1,8-dihydroxyanthrone for therapy of psoriasis. He intended to substitute Chrysarobin, a synthetic product, which causes strong discouloring and irritation of skin. In 1916 the firm Farbenfabrik Bayer, Leverkusen, obtained a patent for synthesis of 1,8 dihydroxyanthrone by an inexpensive method. There is a reason to believe that the brother of Eugen Galewsky, the chemist Paul Galewsky, was a coworker of the Farbenfabrik Bayer and that he recommended his brother Eugen test Cignolin. Eugen Galewsky published the first article on the practical experiences by Cignolin in the journal Dermatologische Wochenschrift in 1916. His priority is proved because his paper was published before the article by Paul Gerson Unna on the same topic. Even now Cignolin is still used in the treatment of psoriasis.