THE FOUNDATIONS OF BRITISH DERMATOLOGY By H. HALDIN-DAVIS, M.D., OX., F.R.C.S., F.R.C.P. LONDON, ENGLAND T was towards the end of the 1. Maculae eighteenth century that there 2. Pustulae began to be felt among physi- 3. Vesiculae cians the necessity for a closer 4. Bullae Istudy of diseases of the skin, which up 5. Papulae to that time, although sufficiently 6. Crustae obvious to the naked eye, were even 7. Squamae less comprehended than other dis- 8. Callositates orders more deeply seated. The first 9. Excrescentiae cutaneae writer to give expression to this feeling 10. Ulcera cutanea was Plenck, who may be regarded as 11. I nsecta cutanea the man who ended the old order and 12. Vulnera cutanea began the new. He published his 13. Morbi unguium “Doctrina de Morbis Cutaneis” in 14. Morbi pilorum Vienna about 1780 and well describes There are no clinical descriptions of the preexisting state of affairs in his special cases, and a more serious preface. He says: defect, Plenck never attempts to The multitude of diseases which afflict define the terms he uses to describe the human skin, their variety, the obscur- the different conditions to enable those ity of the causes from which they spring, reading his descriptions of diseases to the consequent difficulty of curing them, know exactly what he meant. Plenck and their diversity have rendered this branch of medicine and surgery most was far from being a specialist; in the difficult to learners and almost incapable course of his long life—1732-1807— of explanation. The authors whom one he wrote on almost every branch of can consult are few, of whom some have medicine and surgery, from diseases but touched most cursorily upon a of the teeth to those of the female species of disease common at every age, genital organs, including a textbook while others have discussed their diag- of midwifery. He was first professor nosis in vague and uncertain terminology, of anatomy, surgery and midwifery at and have afforded but a doubtful basis of Bale, subsequently professor of chem- treatment. istry and botany at the Military The “Doctrina de Morbis Cu- Academy at Vienna, and had the taneis” is only a slim volume of 138 reputation of being one of the most pages, but it mentions all the then learned doctors of his time. He can- known skin diseases to the number of not be said to have made any great one hundred and fifteen, which are contribution to the knowledge of divided into fourteen classes. From dermatology, but in the little work, the brevity of the work it will be “Doctrina de Cutaneis Morbis,” he readily understood that the descrip- summarized what was known on the tions are terse in the extreme, and subject at the time. In fact, until the directions for treatment are very appearance of Willan, it obtained for meager. The fourteen classes are: its author the reputation of being the greatest authority on cutaneous medi- orders into which he had projected cine. It is evidently written by a clear- his classification, he only completed headed man, but does not bear much the account of the first four. His indication of patient work on the pupil Bateman, however, saved his subject; and there is no doubt that master’s doctrines from oblivion by Plenck, who was a voluminous writer the publication of “A practical synop- and who only produced this single sis of cutaneous diseases, according to short book on skin diseases, could the arrangement of Dr. Willan,” a have taken scarcely more than a book which had an instantaneous suc- passing interest in dermatology. cess, and ran through eight editions in Contemporary with Plenck but less about twenty years. Any inquiry into well remembered was a French physi- the state of dermatology at the begin- cian, Lorry (1725-1783). He pub- ning of the nineteenth century must lished quite a large volume on derma- therefore center around the figure of tology under the name “Tractus de Willan, although there are other indi- Morbis Cutaneis.” It has been sug- viduals who must not be forgotten. gested that his work was forgotten The main facts of Willan’s life are because it was written in Latin, but well-known, and although it is not so was Plenck’s little book. It is more the purpose of this paper to be an probable that it was too diffuse to be essay on Willan, it is as well to reca- useful and that owing to the confusion pitulate them. He was born in York- in terminology then prevalent those shire, educated at Sedbergh school, who attempted to read it found it very practiced in London, and died of obscure. The present writer who has phthisis at Madeira, on April 7, 1812, dipped into it certainly did. Quite in the fifty-fifth year of his age. He recently Lorry’s memory has been was not one of those who are only revived by Dr. Arne Kissmeyer who recognized after death, for he enjoyed has published a short monograph a great reputation among his contem- about him with quotations from his poraries; his pupil, Bateman, wrote writings, and with a preface by the a memoir of him in the Edinburgh celebrated modern French dermatolo- Medical and Surgical Journal, and he gist, Louis Brocq, written shortly has very properly been honored with before his death. Lorry is said to have an article in the ‘‘Dictionary of been the first physician to attempt to National Biography.” Here our pur- correlate the functions of the skin with pose is chiefly to indicate the more those of the other organs of the body. important effects which his writings Modern dermatology may be said had upon the progress of dermatology. really to have been brought into His first great work was the produc- existence by the work of Robert tion of a rational attempt at the Willan at the Carey Street dispensary. classification of skin diseases based A gestation of some eleven or more on characteristic lesions, a work which years culminated in the publication has influenced his successors prac- of Willan’s famous treatise, which was tically down to the present day. The first published in parts from 1798 original paper which embodied his onward, and appeared as a single classification was awarded the Fother- volume in 1808. Even then it was by gillian prize by the Medical Society no means complete, for of the nine of London in 1789, but no copy can now be found. This essay achieved Scurf, scale, scab, stigma, papula, the introduction of order into chaos. rash (exanthema), macula, tubercle, The defects of his predecessors are well wheal, vesicle, bleb (bulla), and pus- described in his own words in the tule. These terms with slight excep- introduction to the volume of cu- tions are used by all dermatologists, taneous diseases published in 1808: even to the present time. The excep- tions are: first the term stigma, They not only give various interpre- defined by Willan as a bright red tations of the accounts left us by the speck in the skin, without any eleva- ancients, but have perverted the sense of tion of the cuticle. This term has quite many passages, especially in the Greek dropped out of use, but he goes on to authors. They employ the same terms in say “when they coalesce, and assume very different significations. They also make artificial and often inconsistent a dark red or livid colour, they are arrangements, some reducing all the termed petechiae.” The term pete- diseases under two or three genera, while chiae is of course still in common use, others, too studious of amplification, but I am not quite certain that Willan apply new names to different stages or used it as a description of a purpuric appearances of the same complaint. lesion. The term tubercle as used by Willan is now obsolete. It is of course The objects set himself by Willan now exclusively employed as the name were: of the lesion which is the naked eye- 1. To fix the sense of the terms unit of tuberculosis, i.e., miliary tuber- employed by proper definitions. cle. As a general term, its place has 2. To constitute general divisions now been taken by the word nodule, or orders of diseases, from leading which is the exact synonym of the and peculiar circumstances in their Willanian “tubercle.” With these appearance, and to describe at large exceptions, the words used by Willan their specific forms or varieties. as the names of the various types of 3. To class and give names to such skin lesions are still current. He also as have not been hitherto sufficiently divided pustules up into four different distinguished. varieties: phlyzacium, psydracium, 4. To specify the mode of treatment achor, and kerion or favus. But these for each disease. Of these four objects, terms have not persisted with the the first and at that time the primary exception of favus, which is now of and urgent dermatological need of the course used to signify a definite moment, Willan accomplished in full. disease, not a type of lesion. I have He pointed out that all manifold examined the illustrations in Willan’s appearances exhibited by diseases of book, but it is difficult to make out the skin could be reduced to the per- exactly what he meant by these terms. mutations and combinations of twelve The second object of a systematic different types of lesion only. These treatise on skin diseases Willan also types accurately determined and de- carried out.