JEADVELSEVIER

Journal of the European Academy of Dermatology and Venereology3(1994)551-554

Dermato-venereology: An historical perspective

Michael Waugh *General Infirmary Leeds LSI 3EX, UK

Abstract

Although, at present dertnatology and venereology in the Utiited Kingdom and Eire are practicedseparately, the influence of the European Economic Community may cause certain changes. This articlerefers to events over the course of centuries which have caused the disciplines to develop separate paths.

Keywords: Dermato-venereology; Historical perspective

1. Introduction

In most centres in the United Kingdom, der-matology and venereology are practised sepa-rately, but this has not always been so, and as inmany parts of the world, dermato-venereology isthe traditional specialty.

In most countries the usual specialisation isdermato-venereoiogy. Only in perhaps Scandi-navia and The Netherlands are there dermato-venereologists who mainly practice in sexuallytransmitted diseases (STDs), but they would pri-marily call themselves dermatologists.

The advent of AIDS has meant that infectiousdisease physicians and other specialists have alsodirected their interest into the care of HIV andhave begun to learn about STDs.

' Given as a paper to the Scottish Dermatological Society,Royal College of Physicians, Edinburgh, 2 April 1993.

*Tel. +44-1132 926762: Eax +44-1132 926387.

2. Historical perspective

2.1. The Great Pox syphilis

The Great Pox, later syphilis, is the vehiclewhere dermatology and venereology have tradi-tionally joined.

The Siege of Naples. 1496, is given as the timeof the first well recognised European outbreak ofsyphilis. Whatever its origins, syphilis is a sexuallytransmitted disease with cutaneous and systemicmanifestations. Ung. Saraneciim containing aninth part mercury had been used throughoutmedieval times for skin conditions and this soonbecame used for the treatment of syphilis. Mer-cury was traditionally given by inunction, fumiga-tion, in pill form and later by hypodermic means;but from 1910 was superseded by arsenicals. Atmost, mercury has a very weak treponemicidaleffect. At that time dermatology was still in thehands of surgeons.

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552 M. Waugh/J. Eur. Acad. Dermatol. Venereol. 3 (1994) 551-554

Although the poem of Fracastoro Syphilis siieMorbus Gallicus [1] had been published in 1530,the word syphilis was not used in English litera-ture until 1686 in the translation by the poetlaureate Nahum Tate [2], and in medical litera-ture until Daniel Turner's (1667-1740) OnSyphilis [3].

In fact the first dermatological best seller wasa text book on venereal disease. Jean Astruc's DeMorbis Venereis [4] was first published in Paris in1736 and kept printers busy being published in 24editions in 5 languages over 55 years. IndeedWilliam Allen Pusey [5] (1865-1940) wrote thatJean Astruc, almost a hundred years beforeRobert Willan {1752-1812), should be regardedas the founder of modern dermatology.

2.2. Britain - dermatology

It was not until the end of the eighteenthcentury that dermatology could be said to bestarting as a specialty in its own right in Britain.The dispensary in Carey Street [6], founded in1782 where Robert Willan (1757-1812) andThomas Bateman (1778-1821) worked, both gra-duates of the Scottish Universities, was similar tomany such establishments to be set up over thenext 50 years. Both Willan and Bateman wereinfluenced by the Austrian dermatologist-oph-thalmologist Johann Plenk (1735-1807). Vcnerc-ologically, Bateman [7] is best remembered for abeautiful description of genital herpes in his textbook of 1814.

2.3. France - dermatology

The main stream of development in dermato-venereology occurred tn Continental Europe. Be-fore the Revolution, both skin and venereal dis-eases had mainly been deah with by low gradesurgeons. With the rise of specialism, dermatol-ogy tended to develop with internal medicine,whilst venereology became the domain of medi-cally trained surgeons. However, the internists indermatology looked after a great deal of syphilis,so dermatology and venereology became a spe-cialty united in internal medicine; a situationwhich is broadly seen still reflected in Europe

today. After the Revolution in 1801, L'Hopital StLouis in Paris was turned over entirely to derma-tology [8], providing ample clinical material forthe specialty.

Jean Louis Alibert (1768-1837) celebratedthrough his discoveries and his pupils Is consid-ered the foremost teacher and innovative re-searcher from this early period. He used colouratlases and wax moulagcs to teach.

Philip Ricord (1800-1889), is usually lookedon by venereologists as Alibert's prize pupil, fi-nally demonstrating beyond any doubt the sepa-rate origins of syphilis and gonorrhoea (1838) [9]and dividing syphilis into the primary, secondaryand tertiary stages recognised today. He was saidto be a sceptic to the world in general and wouldhave given blue pills (mercury) to the vestal vir-gins. Through him Paris became the centre forstudents in venereology. His star pupil was Jean-Alfred Fournier (1832-1914) [10] who finally, inthe Annales de Dermatologie et Syphiligraphie in1875, showed that general paralysis of the insaneand tabes dorsalis were the result of syphilis, afact disputed until then. Indeed Charcot, theforemost neurologist of the day, said how could amere dermatologist possibly discover this!

Famous names crop up at the Hopital St Louis,lupus erythematosus and pemphigus foliaceus as-sociated with Pierre Cazenave (1795-1877), pityr-iasis rosea associated with Camille Gibert (1797-1866) and mycosis fungoides associated with Alib-ert himself.

2.4. Vienna - dermatology

The stage moves eastwards to Vienna. Thereinvigoration of the Vienna Medical Schoolmeant that by the 184O's the triumvirate of Skoda,Rokitansky and Hebra held sway there. Ferdi-nand von Hebra 1816-1880, a pupil of Skoda,demonstrated that scabies was undoubtedlycaused by a mite, built up Ihe Vienna School ofDermatology [11].

It is very difficult in a short paper to state howimportant the Vienna School was, but it hadenormous influence on the work of the develop-ment of dermato-venereology, not only in theGerman speaking world, but also in Scandinavia,

M. Waugh/J. Eur Acad. Dermatol. Venereol. 3 (1994) 551-554 553

Eastern Europe, the United Kingdom and NorthAmerica until the awful period after the An-schluss.

Hebras's immediate successor in the field ofdermatology was Moritz Kaposi (1837-1902). Notonly is his sarcoma (1872) famous, but he was abrilliant teacher, the completer of Hebra's Dis-eases of the Skin and his own Pathologie undTherapie der Hautrankhciten (1881). His contem-porary in the field of syphilis was Karl Sigmundvon Ilanor (1810-1883). It was at this time thatvenereology began to separate from dermatology.

2.5. Germany - dermatology

The discovery of the spirochaete Treponemapallidutn by the dermatologist Erich Hoffmann(1868-1959) working with the protozoologist FritzSchaudinn (1871-1906) demonstrated the newscientific approach. All the brilliant discoveries

Fig. von Hcl>ra

Fig. 2. A nineteenth century syphilitic.

early in this century were German [12], the othersbeing the Wasscrman reaction of 1906 and that ofEhrlich (Salvarsan) in 1909. From the first decadeof the twentieth century there was a very strongmovement in Germany for the state to set up avenereal disease service similar to the one whichwas later instituted in Britain. But for the politi-cal changes which took place just before the endof the First World War such a service wouldprobably have come about.

The parlous state of the health of the nation inEngland and Wales before the First World Warwith one fifth of male deaths in London due tosyphilis, one third of babies born blind due togonorrhoea, and the appalling effects of chronicmorbidity because of syphilis, meant that from1912 onwards a Royal Commission looked at theeffects of venereal diseases [13]. Its recommenda-tions in 1916 meant that, in Great Britain and

554 M. Waugh/J. Eur. Acad. Dermatol. Venereol. 3 (1994) 551-554

Fig. 3. Moritz Kaposi (1837-1902).

parts of the former Empire such as Australia,New Zealand and some of the colonies, venereol-ogy and dermatology became to be practised sep-arately. However, the history of these specialties

may need to be rewritten with the growing influ-ence of the European Economic Community.

References

[1] Fracastoro G. Syphilis sive morbus gailicus. Verona SNicolini da Sabbio 1530.

[2] Tate N. Syphilis or a Poelical History of the FrenchDisease. London J Tonson 1686.

[3] Turner D. Syphilis. A Practical dissertation on the Vene-real Disease. London 1717.

[4] Astruc J. De morbis venereis. Paris G Cavelier 1736.[5] Pusey WA. The History and Epidemiology of Syphilis.

Springfield !L CC Thomas 1933.(6] Rook A. James Startin, Jonathan Hutchinson and the

Blackfriars Skin Hospital. Br J Dermatot 1978; 99:215-219.

[7] Baleman T.A Practical Synopsis of Cutaneous Disease.4th London Longman, Hurst. Rees, Orme and Brown1814.

[8] Ackerknecht EH. Medicine at The Paris Hospital 1794-1848. Baltimore Johns Hopkins 1967.

[9] Ricord P. Traite pratique des maladies veneriennes. Paris.De Just Rouvier et le Bouvier 1838.

[10] Fournier A. De Tataxie locomotrice d'origine syphili-tique. Ann Dermatol Syphiligraph, 1875; 1.7.187-197 and7.401-416.

[11] Lesky E. The Vienna Medical School of the 19th CenturyBaltimore Johns Hopkins 1976.

[12] Waugh MA. History of clinical developments in sexuallytransmitted diseases in: ed Holmes KK. Mardh PA, Spar-ling PF. Wiesner PJ, (eds) Sexually Transmitted Diseases,2nd ed., New York, McGraw-Hill 1990.

[LI] Royal Commission on Venereal Diseases, London HMSO1916.