Verneuil and Verneuil's Disease: an Historical Overview

Chapter 2 Verneuil and Verneuil’s Disease: an Historical Overview 2 Gérard Tilles Key points 2.1 Biographical Landmarks of a Surgeon-Venereologist QHidradenitis suppurativa is a clinically well described entity Aristide Auguste Stanislas Verneuil (Fig. 2.1) was born in Paris on 29 November, 1823. He was QThe classification has been a continu- appointed Interne des Hôpitaux de Paris in ous source of debate for more than 1843, graduated as a Doctor in Medicine in 1852 100 years (thesis: the movements of the heart) and became Professeur Agrégé at the Paris Faculty of Medi- QThe lack of sweat gland involvement cine in 1853 (thesis: the anatomy and physiology has been described in early studies of the venous system). As Surgeon of the Paris Hospitals from 1856, he was officially in charge of the teaching of venereal diseases from 1863. Non syphilitic venereal diseases and primary syphilis were at this #ONTENTS time managed essentially by surgeons (for ex- ample, Ricord in Le Midi Hospital) whereas 2.1 Biographical Landmarks dermatologists – notably in Saint Louis – were of a Surgeon-Venereologist ................. 4 more involved in the management of secondary 2.2 L’Hidradénite Phlegmoneuse and tertiary forms of syphilis. (Verneuil’s Disease), Primary Observations .. 5 In fact dermatology and syphilology were 2.3 Further Observations and Discussions first regarded only as complementary special- in Europe and Overseas .................... 6 ties. Cazenave – head of Saint Louis Hospital – 2.4 HidrosadenitisandAcneConglobata: was in charge of teaching skin diseases from Controversial Views ....................... 8 1841 until 1843, succeeded by Hardy from 2.5 AcneInversa,theLastMetamorphosis 1862 [1]. The political events that followed of Verneuil’s Disease? ...................... 9 the Franco-Prussian 1870s war encouraged the References ................................ 9 Faculty of Medicine to accept the creation of Chairs of medical specialties. In this trend, the first Chair encompassing cutaneous and syphilitic diseases at the Paris Faculty of Medicine was founded in 1879 and attributed to Alfred As a surgeon Verneuil remains closely connect- Fournier. ed to the history of dermatology. In fact he de- After successive appointments as the head of scribed the cutaneous disease subject of this Lourcine Hospital (for syphilitic women), Le book and was the first official teacher of syphilis Midi Hospital (for syphilitic men) (1865), Hôpi- and venereal diseases at the Paris Faculty of tal Lariboisière (1865), La Pitié (1872) and Hôtel- Medicine at a time when skin diseases were still Dieu (1889), and Professor of Clinical Surgery taught separately. (1872–1889) in La Pitié hospital, Verneuil head- Verneuil and Verneuil’s Disease Chapter 2 5 irritations of the sebaceous follicles, by the absence of cleanliness (…) this kind of inflammation which evolution is usually slow can be sometimes quite painful. Its usual ending is suppuration; healing is exceptional.” Velpeau described a different clinical aspect named phlegmon érysipélateux, similar to the previous one but always quite painful. “Patients are sometimes afflicted with indurations and tumors that may remain the whole life through.” Velpeau regretted “the ignorance of the authors regarding the awful consequences of these inflammations of the axillae which frequency is probably underestimated, while nothing is more common.” Then, from 1854 until 1865 Aristide Verneuil published a series of articles on skin tumors [5]. Observing the absence of any study on this top- ic, Verneuil indicated he would deal with those sudoral tumors that may have a surgical inter- est. Although Velpeau mentioned the origin of the abscesses in the sebaceous follicles, Verneuil taught that Velpeau’s tumors had their origin in Fig. 2.1. Aristide Auguste Stanislas Verneuil (1823– the sweat glands. 1895). Coll Photothèque de l’Académie Nationale de Verneuil admitted he had never observed any Médecine patient with such an acute inflammation of the sudoral glands. In fact, the only occasion he had to observe it was on the cadaver of a young pa- ed the first Chair of Surgery at Hôtel-Dieu Hos- tient who died from cachexia. In this observa- pital (1889–1892). tion entitled “inflammations de la région sacrée President of the Société de Chirurgie in et fessière, abcès multiples circonscrits et sous 1869 and Charter member of the Congress of cutanés siégeant probablement dans les glandes Surgery, he was elected as President in 1888. He sudoripares,” Verneuil indicated in an extreme- was also a member of the Académie de Méde- ly precise way that “the buttocks area was scat- cine (1869), Member of the Académie des Sci- tered with a great number of little escarrs sepa- ences (1887), and Commander of the Legion of rated from the others (…) moreover a great Honour. Verneuil died from a bronchopneumo- number of pustules, the size of a pinhead, with- nia on Tuesday 11 June, 1895. His funeral took out any sign of inflammation were disseminat- place on 14 June in a Paris suburb, Maisons- ed; these pustules were filled by a liquid lifting Lafitte [2, 3]. the epidermis without breaking it. After remov- ing the epidermis, the cleaning of the pustule made perceptible a tiny red hole in which one 2.2 L’Hidradénite Phlegmoneuse could introduce a bristle of a boar or a very thin (Verneuil’s Disease), stylet; then one entered a channel of one fifth to Primary Observations one third millimeter crossing the dermis and leading to a subdermal cavity larger than the Two French surgeons fathered the description of subepidermal one and filled with the same hidrosadenitis. In 1833, Velpeau (1795–1867) liquid.” described a phlegmon tubériforme [4] of the Observing these cavities both linked by a axilla, “frequently induced by rubbings and thin channel across the dermis, Verneuil as- 6 Gérard Tilles sumed necrosis of the sudoral glands, the pus [10]. However, the translators of Kaposi’s text- being excreted by the sudoral duct and accumu- book into French, Besnier and Doyon, although lating under the epidermis. admiring the master of Vienna, did not confirm Verneuil localized the abscesses in the sweat the Austrian opinion. Although they admit the 2 gland through clinical and micro anatomical uncertainties on the histopathological aspects observations only. Therefore, he added prudent- of the sweat glands, Besnier and Doyon insisted ly “I make this observation with reservation for on the true existence of the dermal abscesses in it is chiefly the curious distribution of these col- the axillary area, which, according to them, rep- lections that made me adopt the interpretation resent the most perfect type of the hidrosadeni- which I give here. It is therefore a point to be tis described by Verneuil. restudied and to be demonstrated in a more sat- In London, Erasmus Wilson [11], a leading isfactory manner.” However he indicated “to light in British dermatology, summarized Ver- have no more doubt on the existence of a new neuil’s description and indicated that the tu- variety of skin tumors consisting of the hyper- mors, “differ from boils in their deep origin, in trophy of sweat glands.” Nevertheless, he added, the absence of elevation and pointing and also “I have nothing to say on the aetiology of this in the absence of core.” Wilson considered the disease: the causes of these glandular cysts, the affection as caused by external irritation of the symptoms, the evolution cannot be inferred skin from neglect of cleanliness, friction, and from such a small number of observations.” sweating. At the same time, Radcliffe Crocker In 1864 Verneuil named this disease “hidro- described hidradenitis briefly as a type of fu- sadénite phlegmoneuse” [6]. A few decades later runculosis that begins in the sweat coil [12]. when complementary cases were published, Probably the first histopathological study of Dubreuilh (Bordeaux, France) considered the hidrosadenitis was published in 1889 by Giovan- word hidradenitis as improper and hydrosade- nini, who demonstrated the existence of an in- nitis as barbarism [7]. flammatory process borne in the sudoral glands that led to their complete destruction [13]. However, despite this publication which 2.3 Further Observations seemed to demonstrate the origin of hidrosade- and Discussions in Europe nitis, the existence of the disease described by and Overseas Verneuil was highly questioned until the 1890s. In fact most authors denied it as a separate en- The disease described by Verneuil first received tity. very little attention from dermatologists except From the 1890s on the disease seemed to from Bazin (Paris) who coined a syphilid under come into a new era of existence. the name “hydradénite syphilitique” [8]. Bazin In Paris, Barthélémy authored a comprehen- was actually convinced that this type of syphilid sive study on the subject. He regarded hidrade- had its seat in the sweat glands. Therefore, he nitis as a part of the folliculitis that could be regarded the disease described by Verneuil as of generalized or localized in the axillary, labia possible syphilitic origin and pointed out that major or perianal areas. In Barthélémy’s article, there is no need to make any differential diag- hidradenitis described by Verneuil disappears nosis between gommous syphilid and hidra- and is encompassed in a new nosological frame- denitis suppurativa. work that includes acnitis and folliclis, terms In Vienna, Hebra denied the existence of su- coined by the author to designate follicular and doral tumors considering

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