Frank C. Powell
Regional Centre of Dermatology
Mater Misericordiae Hospital, Dublin 7, Ireland.
The main contributions of Irish doctors to the speciality of dermatology took place in the 18th and 19th centuries. In this presentation we will describe how Irish doctors first described:
- mercury drug eruptions
- the infectivity of secondary syphilis
- potassium iodide as a treatment for syphilis
- Basal Cell Carcinoma
- Angioneurotic oedema
and other important contributions to dermatology.
In 1798 Whitley Stokes published the first description of the drug eruption « Mercurial Lepra » – describing the fever, and profuse desquamation that accompanied this serious skin eruption due to mercury, then used extensively in medical therapies. This is one of the first clinical descriptions of a cutaneous drug reaction and represented an important step forward to distinguish between the skin reaction due to the disease, and that due to a drug.
Abraham Colles is known for the classical description of the « Fracture of the carpal extremity of the Radius ». In this he accurately described the spectrum of secondary syphilis in 1837… the scaly eruption, the copper-coloured blotché and while « the pustular eruption is aggratated by this treatment the papular eruption… yield most readily to mercury ». The term « Colles’ Law » was used to describe his observation that Syphilitic Infants with oral lesions could not transmit the disease to their infected mothers, but were infective to previously healthy hired wet nurses indicating the immunity of previously infected individuals.
William Wallace set up a ‘Hospital for Skin Diseases’ to « …..afford relief to the poor, supply the means of extending our knowledge of cutaneous diseases, …. and establish a school for instruction of medical students. » Wallace could thus be called the true « Father of Dermatology » in Ireland.
In 1820 he introduces the English speaking world to the findings of Galès at the Hospital Saint Louis (Paris) on the Cure of Scabies by sulphur vapour in a « fumigating cabinet ». In 1835 he was first to introduce the use of potassium iodide for the treatment of syphilis, and in 1836 he established for the first time that secondary syphilis was infective by inoculating patients with lesions taken from sufferers of secondary syphilis.
Arthur Jacob accurately described in 1827 the clinical features of Basal Cell Carcinoma (« an ulcer of peculiar character ») and its differentiation from other skin malignancies. For many years afterwards Basal Cell Carcinoma was known as ‘Jacobs Ulcer’.
Published in 1849 his « Treatise on the pathology diagnosis and treatment of Neuroma », a beautifully illustrated work. In this he described for the first time two patients with generalized Neurofibromatosis, with illustrations of the skin and post-mortem studies. Thirty three years later in 1882 Von Recklinghausen, professor of pathology at Konigsberg, gave a further description of this disease which now bears his name.
William Montgomery in 1837 described « … the development of the little grandular follicles … the objects to which we should principally direct out attention …their presence… very convincing proof of conception ». These cutaneous breast changes, diagnostic of pregnancy are still known as « Montgomery’s Tubercles ».
Robert Graves name is recognised in the medical world for his description of Exopthalmic Goitre which is known as « Graves Disease ». In his book « Lectures in Clinical Medicine » (1843) there are several chapters on skin diseases, and an accurate clinical description of « Angioneurotic Oedema ».
« The tumours rise, run through their course and disappear in the space of a few hours… Sometimes the lips. inside of the mouth and uvula are attacked… On the following day there is no trace of their existance… » This was almost 40 years before the description by the German professor of medicine Quincke in 1882, whose name is now associated with this condition.
Walter G. Smith demonstrated the infectivity of Favus by inoculating himself and a medical colleague with crust from an active lesion. In 1871, while his original description of Monilethrix was published in the British Medical Journal in 1879 under the title » A Rare Nodose Condition of the Hair ». In this he described thinning of the scalp hair with short brittle shafts. Hairs had regular nodose swellings which had an opaque appearance. Fracture of hairs took place through constructions, not through nodes. He accurately distinguished this condition from Trichorexis Nodosa.
Thus Irish doctors made significant contributions to the early knowledge of diseases of the skin. Some, such as Robert Graves, Robert Smith and Arthur Jacob were well recognised in their own time, but their originality in Dermatology has been forgotten. This presentation will help us to remember these Irish Medical Pioneers who assisted in laying the foundations of our speciality.