Hospital for venereal and dermatological diseases "Andreas Sygros" and the late
professor John Stratigos
Panagiota Emmanouil. Pentelis Children Hospital, Athens, Greece
In Athens, at the beginning of the year 1910, the first specialized hospital for venereal and dermatologic diseases was established. It was the only one of its kind in Europe. It was built on the left bank of the river Ilissos as a legacy of Andreas Sygros, who had been a rich businessman and later was named a "national benefactor", under the supervision of his widow Iphigeneia Sygros. A. Sygros had the idea of founding a hospital specialized in treating those who had venereal diseases and particularly the prostitutes, who were until then treated in the most horrible way and in complete misery. The hospital was soon attached to the University of Athens, housing the Dermatologic and Venereal Clinic of it. The first professor, who was also the head of the department, was G. Photinos, an individual with strong personality, who organized the hospital in accordance with the European standards and established the training program for the specialization of Dermatology - Venerealogy. He also founded and ran the Skin and Venereal Museum of Moulages inside the hospital. Visiting the hospital in 1930, the famous professor Gouzerot claimed that: "The Andreas Sygros Hospital is a modern, original hospital both in its architectural design and in its scientific equipment".In 1981 John Startigos became Chairman of the Department of Dermatology in the University of Athens and Director of A. Sygros Hospital. Among his many contributions, professor Stratigos re- organized the educational system as far as dermatology is concerned, revitalized the role of dermatologists in the management of STD's and AIDS and transformed A. Sygros Hospital into a modern medical institute with specialized units.
Skin manifestations depicted by the Greek moulages
A.M. Worm. Specialist Center, Peter Bangs Vej 3, Copenhagen F, Denmark
Wax moulages were produced all over Europe in the beginning of the last century. Moulages were produced for teaching as unique tree-dimensional coloured images of visible diseases and thus particularly popular when teaching about abnormal skin manifestations. The �A Sygros Hospital� in Athens was founded as a dermato-venerological hospital in 1910. Already two years later, Professor G. Photinos, the first hospital director, started to build up a museum with wax moulages after having captured the technique in Paris and especially in Berlin. The first moulages are said to have been prepared by the founder himself, but otherwise the vast majority of the moulages are signed K.X. Mitropoulos and dated between 1914 and 1954. In contrast to many other collections almost all moulages at this museum seems to have been produced on location at their own �ergastirion� (workshop) at the hospital. In 1912, at the VII International Dermatological Conference in Rome, Photinos presented a collection of 24 moulages from the �A Sygros� Hospital visualising the results of arsenic treatment. In 1987, at the XVII World Conference of Dermatology in Berlin, Professor JD Stratigos presented a collection of 30 moulages from the �A Sygros Hospital�. The latter collection focused upon skin manifestations before the use of antibiotics and corticosteroids, skin manifestations typical for the Mediterranean area together with certain moulages collected for their artistic quality. The museum contains about 1.600 wax figures many of which are well preserved but other are quite faded and battered. The moulage collection at the 'A Sygros' museum in Athens is one of the biggest preserved collections in the world. The moulages have been evaluated as to the diagnosis and quality in order to present a best possible photographic overview of the various skin manifestations together with the history and technique of the art of moulaging.
Evangelismos general hospital and Professor A. Vareltzidis
C. S. Naoum, P.Em. Emmanouil, Ch.D. Pavlidou, I.P. Michelaki,. 1Dermatology, Evangelismos Hospital, Athens, Attiki, Greece, 11251 and 2Dermatology, Pentelis Children Hospital, Athens, Attiki, Greece
Introduction: At the beginning a foundation of Infirmary called EVANGELISMOS, announciation, is considered as the effort from sixty two Ladies in 1872. On 27th of April 1872, with the consensous of Queen Olga and an approval by Royal Decree, this foundation was placed under her protection. The aims of Association were: charitable, beneficial to the public as well as the education of Nurses.
In 1881, at the Governments Newspaper was published, (No 39// 4-5-81), an approval of the foundation of Infirmary which it became as a charitable institution called EYAGGELISMOS. On 25 March 1881 was deposited the first stone for the construction of Hospital by King George A.
On 16 April 1884 the Infirmary initially functioned with two Clinics that have 48 beds and the first patient was entered in the Surgical clinic. In 1903 begun to function the first outpatients services:Internal Pathology, Surgical and Obstetrician. During the World War, 1912-13, Evangelismos gave again the present in the care of wooded soldiers.
From 1884 up totoday, the historical course of EVANGELISMOS is a result of multifaceted contribution and collaboration between State and Public. The creative, dynamic and effective effort of this factors linked for various predicaments. A history that was written with the sweat and the efforts of all Greeks. Each one of them eponymous and anonymous linked with effort in order to become a Hospital as today is, the First Hospital of Greece. The announcement of Infirmary in 1983 created new perspectives for growth and development in the health sector.
The department of Dermatology was founded in 1923. Up to today, many famous Dermatologists have worked there, Professor Vareltzidis gave a modern orientation in scientific work. Nowadays, the department is well known in Greece for its contribution in Dermatology-Venereology. There are working six senior Dermatologists and ten trainees, who are specializing in Dermatology. Monthly 1200 patients are examined and more than 220 biopsies are performed. The department of Dermatology still follows the development of this general hospital.
Sabouraud and the trichophytons: A new era in dermatological mycology
G. Tilles. Musee de l'hopital Saint-Louis, Paris, France
Sabouraud was born November 24th 1864. Interne des Hopitaux de Paris in 1890, he attended the course of technical microbiology lectured by Emile Roux at the Pasteur Institute were he could acquire the methods of the bacteriological research. Interne in the department headed by Besnier in Saint-Louis hospital, Sabouraud used his abilities in microbiological research to clear up the complex relationships between trichophytons and cutaneous mycoses. Despite David Gruby's pioneering works in the 1840's, the connexions still remained questionable. For the majority of dermatologists, the clinical forms of cutaneous mycoses were all caused by a single trichophyton. Thanks to thorough clinical and microscopical descriptions Sabouraud and a glucose peptone medium he named "milieu d'epreuve" -still used worldwide as Sabouraud medium- he could prove the plurality of trichophytons. The presentation of his works he gave in 1892 in Saint-Louis hospital, the textbook he published in 1894 (Les trichophyties humaines) and the talk he gave at the world congress London 1897, contributed to his worldwide definite reputation. In 1897, Sabouraud was appointed as a director of the municipal laboratory housed in the Lailler School (Saint-Louis hospital) for the children afflicted with tinea. From the first years of the 20th century, he use X rays -invented in 1895- to improve epilation, traditional treatment of tinea. Sabouraud and his assistant, Noire, invented a special device, called radiometer X used in France over the next 15 years. Sabouraud remained in Saint-Louis until his retirement in 1929, welcoming a lot of foreign students coming from all around the world attracted by the reputation of the dermatologists who learned microbiology under Pasteur's pupils. Sabouraud was elected as a President of the French Society Dermatology in 1925-1926. He died in Paris February 4th 1938.
Isidor Neumann 1832-1906. Centenary of his death.
K. Holubar. Institute for the History of Medicine, M&M Wolf Library for the History of Dermatology, Medical University of Vienna, Vienna, Austria
Isidor Neumann was educated in Ferdinand Hebra/s department in Vienna, as much as Moriz Kaposi was educated in Carl Ludwig Sigmund/s (sister)department of syphilis. Upon retirement and death of the former professors they switched sides to become heads of the respective departments in Vienna, Kaposi in dermatology, Neumann in venereology. Neumann pioneered in skin pathology (first histopathology of LE; first description of pemphigus vegetans). Moreover he served as government advisor on many occasions especially in the Balkans. Eventually he succeded to have dermatology and venereology become one mandatory subject for teaching and examination in the Austrian medical school curriculum. He was awarded many Austrian and foreign distinctions. He is buried in the Jewish section of the Central Cemetery in Vienna.
Ethics of medical imaging
S. Fatovic-Ferencic. Department for the History of Medicine, Croatian Academy of Arts and Science, Croatia
The history of syphilis and other venerea, leprosy, vitiligo, lupus vulgaris, reveals examples of stigmatization and ostracision, by ignorant and powerful authorities and by a bigot society. Such examples are evident also in the sphere of iconography. This paper aims to analyze the picture- a copper print, from late 18th or early 19th century, which presents the head of a syphilitic woman cut of and displayed on the plate, from the ethical point of view. Furthermore it will inquire the borders between didactic medical imaging, and voyeuristic perversity, scientific idealism and sensationalism of the lay world.
The history of a forgotten dermatological wax museum
Alexandru D. Tataru, M.D.. Dermatology, University of Medicine "I. Hatieganu", Cluj-Napoca, Cluj, Romania
Introduction: From the late XIXth century to the early XXth century, many collections showing dermatoses made in wax appeared all across Europe. We want to present the history of the last dermatological wax collection made in Europe.
Methods: We explored the archives of our clinic, the archives of our University of Medicine and the State Public Archives with the purpose to add more informations about the history of our dermatological wax museum, quite ignored until now.
Results: The innitiative to create this colletion belong to dr. Coriolan Tataru, head of Dermatological Clinic between 1928-1956. The moulageur was dr. Richard Hofmann, with great artistic talent, dermatologist and assistent professor between 1924-1936. During 12 years he created 311 wax pieces, placed in a special room in the clinic, representing syphilis, tuberculosis cutis, skin cancers, psoriasis, genodermatosis, mycoses and pelagra. He developed a good personal technique for his moulages, resembling the state of art of a true painter. The quality of his moulages was recognised with the occasion of the IXth European Dermatological Congress held in Budapest in 1935, where this colletion was awarded by Gold Medal.
Discussion: We presented a short history of the Dermatological Wax Museum from our town, because this collection is not known enough nowadays in Europe. It was ignored and forgotten by political reasons in the last 50 years.This is an important collection of 311 pieces covering almost all dermatology. We think its quality is excellent and for these reasons it should be better known.
The crusader lepers of St Lazarus and their relationship to the Order of St.
George WM Millington, Ph.D., Nick J Levell, M.D.. Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, Norfolk, United Kingdom
Introduction: Perhaps the most remarkable organisations connected with the European occupation of the Holy Land in the Middle Ages, was the order of St. Lazarus, the leper knights.
The Order of St. Lazarus of Jerusalem originated in a leper hospital founded in the twelfth century by the Crusaders of the Latin Kingdom. The first written reference dates from 1142 describing its foundation in the 1130s. The Order of St. Lazarus was, like that of St. John, initially a caring, not a military Order.
It may be that the institution was an extension of the work of the Hospital of St. John. Those cared for by the Order of St. John were transient cases, but the lepers of St. Lazarus were initially isolated in permanent seclusion. In return they were regarded as brothers or sisters of the hospital which sheltered them and they obeyed the common rule which united them with their religious guardians. In these early years, the Order's Grand Master was usually a leper. It is likely that these �lepers� suffered from other diseases too, as an accurate system of categorising skin disorders was not available until Willan's �On Cutaneous Diseases� was published in 1808.
Like many other religious orders in the Levant, the twin problems of endemic leprosy and a shortage of warriors forced the Order, to develop their own fighting force, probably in the thirteenth century. Uniquely though, the disabled were armed and expected to fight. Their heraldic symbol was an eight-pointed cross, similar to the Cross of Malta, but coloured green.
The Knights of Saint Lazarus went back to Europe around 1290, after Islam finally forced the Christians from Palestine and northern Africa. Unlike the Order of St John, the Knights of Saint Lazarus did not found a territorial state of their own. How effective these leper knights were as troops is open to debate. All records available suggest that they were not very successful. For example, the Patriarch of Jerusalem stated that all the leper knights of St Lazarus were killed during the defeat at La Forbie in 1244.
The 100th anniversary of Wassermann-Neisser-Bruck reaction
Rafal K Bialynicki-Birula, Ph.D.. Department of Dermatology, Department of Dermatology, Wroclaw, Poland
Introduction: August Paul von Wassermann (1866-1925), German bacteriologist together with Albert Neisser (1855-1916), Carl Bruck (1879-1944) both German dermatologist-venereologist developed a first serological test for diagnosis of syphilis and published first paper about that on 10th May 1906: von Wassermann AP, Neisser A, Bruck C: Eine serodiagnostische Reaktion bei Syphilis. Deutsche Med. Wochenschr. 1906, 32:745-746. They used the idea of Jules Bordet (1870-1961) and Octave Gengou (1875-1957): a complement-fixation test (their published about their in years: 1898-1901). Therefore sometimes the Wassermann test is called: Bordet-Wasserman test.
Methods: The study was done at the Berlin Institute of Infectious Diseases and at the Breslau (Wroclaw) Department of Dermatology. Wassermann test had been used in the diagnosis of syphilis. The �antigen� was prepared empirically. Originally the �antigen� was an extract of liver from a syphilitic fetus (rich in Treponema pallidum).
Results: Later the active substance, referred to as cardiolipin, was found to be present in normal tissues (non-syphilitic), including heart (usually cow heart). Karl Landsteiner (1868-1943) correctly identified the antigen involved in the Wassermann test, which finally has been identified as a diphosphatidylglycerol. Wassermann antibodies, evoked during syphilitic infections, combine with cardiolipin in the presence of lecithin and cholesterol. Antigen-antibody reactions lead to immune complex formation which produces complement fixation via the classical pathway and this may be exploited to determine the amount of antibody present in sera. In the final step, indicator cells (red cell) together with a subagglutinating amount of antibodies (erythrocyte antibodies) are added to the mixture.
Discussion: The test was positive almost exclusively with sera of syphilis patients, but it soon was discovered that some diseases gave positive results in nonsyphilitic individuals. The first such cases were reported in 1909. With the discovery of new, more specific tests for syphilis, the complement fixation tests of Wassermann type gradually were abandoned
Sudden whitening of the hair à Fact or fiction? A historical review
Anne-Marie Skellett, Other, George W Millington, Ph.D., Nick Levell, M.D.. Dermatology Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, United Kingdom
Introduction: For centuries, the phenomenon of hair suddenly turning white has caused intrigue. This change has typically followed a stressful episode. The first recorded occurrence was in 83 BC in the Talmud, when a young Jewish scribe experienced sudden whitening of his hair during an overnight scientific experiment. In 1791 Marie Antoinette may have lost her auburn hair, turning white immediately prior to her execution by guillotine.
Historically, this pigmentary change has been explained by a number of competing theories. One of these was by Von Stieda in 1910, who attributed the sudden appearance of white hair in those stricken with a neurological or psychological event to the fact that they were no longer able to dye their already white locks. The use of hair dye, however, would not explain a case documented by London physicians at the beginning of the 20th century. They described a rebel sepoy of the Bengal army who was taken prisoner - �...stripped completely naked, he was surrounded by soldiers�While actually under observation and within the space of half-an-hour, his hair became grey on every portion on his head, it having been à of jet-black colour�. McCarthy also documented the acute onset of hair depigmentation in young females following cases of rape (1940).
Goldenhersch (1992) describes two stages to explain this phenomenon. First, a patient develops partial hair whitening due to vitiligo or ageing. Second, when the patient has dark coloured hair speckled with white hairs, the sudden whitening occurs due to an episode of alopecia areata selectively affecting pigmented hairs. This creates the illusion of hair turning white. The association of patients �turning white overnight� following a shock can be explained by alopecia areata occurring following a stressful event.
Whether lack of hair dye or stress (such as execution) is the cause, the evidence for sudden whitening of the hair often ends up in the �basket�.
Goldenhersch MA. Rapid whitening of the hair first reported in the Talmud. Possible mechanisms of this intriguing phenomenon. Am J Dermatopathol. 1992; 14: 367-368.
von Stieda L. Ist plotzliches Ergrauen des Haupthaares moglich? Wien Med Wochenschr. 1910; 36: 1484-1487.
The development of immunofluorescence at St John's Institute of Dermatology
Emma L Newell, Other, Balbir Bhogal, Peter Carrington, Martin M Black, Richard Groves. St John's Institute of Dermatology, St Thomas' Hospital, London, United Kingdom
Introduction: In 1941 Albert Coons and N H Kaplan pioneered the immunofluorescence (IMF) technique for labelling specific antibodies with fluorescent dyes, allowing the detection of antibodies and antigenic protein in cells and tissues. Immunodermatology developed from the 1960's onwards as a distinctive investigative area with the discovery of antibody deposits in the skin in a variety of disorders, including cutaneous lupus erythematosus, pemphigus and pemphigoid.
Methods: Immunofluorescence microscopy has now assumed a crucial role in the management of autoimmune blistering skin diseases; although correct diagnosis depends on clinical observation and histological evaluation, immunopathological criteria, in the form of direct (DIF) and indirect immunofluorescence (IIF) assays are of paramount importance. Furthermore, as a result of important IMF studies sophisticated techniques such as immunoelectron microscopy (IEM), immunoblotting, immunoprecipitation, and more recently Enzyme-Linked Immunosorbent Assay (ELISA) have been developed. Although not widely used outside specialist laboratories at present, the deployment of these techniques in the routine investigation of immunobullous disease is envisaged in the future. These technological advances have led to quantum leaps in our understanding of immunobullous disorders.
Results: The immunofluorescence department at St. John's Institute of Dermatology was founded by Professor M Black in 1975, initially as an experimental unit refining IMF techniques and examining the pattern of deposition of immunoreactants in a variety of cutaneous autoimmune and inflammatory diseases. Today the department is the main skin IMF laboratory in the UK as well as an international diagnostic centre receiving specimens from Europe, africa and Asia. On average 150 requests a month are recieved for direct (66%) and indirect (34%) IMF analysis. The unit is also at the forefront of research into autoimmune bullous diseases, utilising IEM, immunoblotting and ELISA.
Discussion: This presentation describes the evolution of immunofluorescent techniques at St. John's and charts the development of other powerful molecular tools (IEM, immunoblotting and immunoprecipitation) which are providing new molecular information, enabling precise classification of immunobullous disease and paving the way for new therapeutic strategies.
The medicine of the Templars
Camillo Di Cicco, M.D.. Dermatology, University, Rome, RM, Italy
Introduction: 18 March of 1314, to Paris, on the island of the Seine in front of the Garden real, Jacques de Molay, the last Great Master of the Templars, and Geoffroy de Charny, preceptor of Normandy, were burned like heretics. Therefore the history of the Knights of the Temple finishes. By the Encyclopedia of Martin Mystere we learn that the Templars would have been in possession of the most hidden secrets of alchemy. They were first to use the "iperico", in the burns and hurts from cut, like antiseptic, astringent, healing, and in order to improve humor of the soldiers that remained immobilizes to bed for months. Such experiences landed then to the salernitana medical school, that is remained the crib of the phytotherapy until the six hundred. The Templars created a mixture with pulp of Aloe, pulp of Hemp and wine of palm, called Elisir of Jerusalem, with therapeutic and nourishing property, they used the Arborescens Aloe for its antiseptic, bactericidal and fungicide action and for its capacity to penetration in the deeper layers of the skin. Robert Anton Wilson, in its book on the Templars, asserts that they practiced a shape of Arabic Tantrism and used the hashish. The authors of Holy Blood and Holy Grail Baigent, Leigh and Lincoln comment that the Templars need to treat wounds and illness, made them experts in the use of drugs and the Order in advance of their time regarded epilepsy not as demonic possession but as to controllable disease. Interestingly cannabis is the safest natural or synthetic medication proven successful in the treatment of loads forms of epilepsy. The esoteric inheritance and the alchemical-spagyrics acquaintances were handed from the Templars to the Crocifers. From these Orders, that one of Saint Giacomo or Jacobite managed many Hospitals during the XV� century. To the Jacobite monks, in quality of experts in the cure of the diseases of the skin, the task was entrusted to cure the wounded soldiers during the Crusades, in the Hospitals of Malta and Cyprus. To they, in fact, was attributed the capability to create miraculous ointments.
1th Congress of Spanish dermatologists
Rosa Maria Diaz Diaz, Ph.D., Maria Angeles Martin D�az, M.D., Cristina Rubio Flores, M.D., Jorge Garc�a Macarr�n, M.D., Marta Feito Rodriguez, M.D., Lucia Campo Mu�oz, M.D., Alicia Quesada Cortes, M.D., Mariano Casado Jimenez, Ph.D.. Dermatology, Universitary Hospital "La Paz", Madrid, Spain; Dermatology, Universitary Hospital "La Paz", Madrid, Spain; Dermatology, Universitary Hospital "La Paz", Madrid, Spain; Dermatology, Universitary Hospital "La Paz", Madrid, Spain
Introduction: We want to show some features about the first national congess of dermatology that was celebrated in Spain.
Methods: We had done a revision of the literature about that question.
Results: The first national congress of dermatology in Spain was celebrated at Madrid on 17-18 May, 1934.
There were threescientific topics:
1. Radiotherapy and dermatoses.
2. Paludization on neurosyphilis.
3. Organization, teaching and practising of dermatology in Spain.
Discussion: We are sure that is very important to konw histoy of dermatology of our country and this congess is a great oppportunity to show that to other european dermatologists.
Acupuncture in dermatology
Eunice Tan, M.D., Nick J Levell, M.D.. Dermatology, Norfolk & Norwich University Hospital NHS Trust, Norwich, United Kingdom
Introduction: Acupuncture is derived from the Latin words meaning needle and puncture. Acupuncture is based on ancient Chinese medical philosophy that health is reflected by the balance and harmony between two forces: Yin and Yang. Disease results from the loss of balance between the Yin and Yang organs, and along the meridians, which are made up of a system of channels that circulate the vital energy Qi. Derangement of the Yin-Yang balance is brought about by the intertwining effect of the external influences (five elements, five seasons, winds) and by internal influences (humors). Health is regained by reestablishing Yin-Yang balance by treating acupuncture points along the meridians. In traditional Chinese medicine, twelve major meridians, relating to specific 'Organ systems,' thus, acupuncture points have defined therapeutic actions. Acupuncture techniques: needling and non-needling techniques of moxibustion, cupping and acupressure, practiced today, have been in existence for centuries. The origins of traditional Chinese medicine and acupuncture are believed to be at least 5000 years old. Some archeological excavations suggest their origins may be much older. Several important manuscripts on Chinese Medicine were uncovered, and are still in use today. The oldest of these is the Huang Ti Nei Jing (Yellow Emperor's Classic of Internal Medicine), as a dialogue between the Qi Po, Toaist teacher and physician and Huang Ti, the Yellow Emperor of China (2698�2598 BC). It indicated acupuncture was already widely practiced in China. There are texts on acupuncture. There are no specific books on dermatology. Dermatology was considered to be a part of Wai Ke (external science) and was practiced by yang yi, who were physicians who cured external illnesses such as wounds, skin problems, broken bones and other traumatic injuries. Acupuncture has traditionally been used in the treatment of chronic pain disorders. In the field of dermatology, acupuncture has been used to treat psoriasis, eczema, and urticaria, but in the West, acupuncture remains an unproven modality of treatment.
Beauty has its price à A historical review of cosmetics and their undesirable
Naomi Webber, Other, Anne-Marie Skellett, Other, Nick Levell, M.D.. Dermatology, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, United Kingdom
Introduction: The first mention of cosmetics dates back to 10,000 BC where face painting was used in Ancient Egyptian burial rituals. The Egyptians lined their eyes with Kohl, a dark coloured powder made of crushed antimony, lead and malachite. It was believed that this eye makeup could restore poor eyesight and reduce eye infection. Surprisingly today products from Asia occasionally still have lead in their composition and there have been reports of lead toxicity. The Ancient Greeks also used white lead to achieve paler skin.
During the Italian Renaissance, facial cosmetics were allegedly used as murder weapons. Aqua Toffana was an arsenic face powder designed for wealthy women who wanted to kill their husbands. The women applied the powder to their cheeks taking care not to ingest it themselves. Following intimate contact and oral ingestion the husbands dropped dead!
Facial foundation was invented and patented by Max Factor in 1936. As well as its cosmetic use it has made a great impact on the lives of people with disfiguring conditions, such as vitiligo and scarring.
Adverse effects, such as irritant and allergic contact dermatitis, have been attributed to cosmetics. Allergic contact dermatitis is usually caused by fragrance or preservatives including rosin (colophony) and dihydroabietyl alcohol (abitol) and these are often found in mascaras. Irritant contact dermatitis, however, is more common due to the length of time the products are in contact with the skin. Foundations have also been implicated in the pathogenesis of acne cosmetica as a result of potentially comedogenic lanolin, petrolatum and lauryl alcohol.
For centuries people have been applying various agents to their skin in order to achieve what they consider to be beauty. Whilst the application of cosmetics can create a beautiful and flawless complexion, they have through history caused a host of unwanted dermatological and systemic problems.